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Cirrhosis of the Liver
Overview

The liver is actually a very strong organ that handles a lot of tasks for your body. However, liver damage can prevent it from functioning properly. Cirrhosis is long-term liver damage that causes liver failure over time. Cirrhosis is most often associated with heavy alcohol use, but it can happen to anyone that has liver disease. Around 20% of cirrhosis sufferers in the United States have the “non-alcoholic” type. The good news is if the disease is caught early, the damage can be slowed down. Read on to learn more about cirrhosis and how it is diagnosed and treated.

What Is Cirrhosis?

Cirrhosis of the liver happens when the liver tissue becomes scarred. This can be due to any form of liver disease. Your liver filters and cleans out toxins, and provides certain substances and nutrients to the body. The scarring in cirrhosis happens over time from harmful substances, viruses, or the body’s own immune system. Once the liver becomes scarred, it is permanent and causes the liver function to decline. In the late stages, it can be fatal.

Symptoms of Cirrhosis

In the early stages of cirrhosis, there may be no symptoms at all. Or you may have some symptoms that don’t really point to anything being wrong. The classic signs of cirrhosis are:
Itchy skin

Yellow skin

Bruising more than normal or easier than normal

Low appetite

Feeling tired

Feeling weak

In later stages of the disease symptoms advance to:
Swelling in the abdomen

Nausea

Trouble thinking and remembering

Anemia

Weight loss

Swelling in the legs, feet, and ankles

What Causes Cirrhosis?

Contrary to common belief that cirrhosis is a disease of alcoholism, there are many different causes. The causes of cirrhosis include:
Long-Term Alcoholism. Long-term heavy drinking is the number one cause of liver cirrhosis. Large amounts of alcohol over a long period of time causes swelling and scarring of the liver.
Hepatitis. Hepatitis B, hepatitis C, and hepatitis D are all know to cause cirrhosis. Hepatitis is the second most common cause of cirrhosis. Statistics show that one out of four people with this virus develop cirrhosis.
Non-Alcoholic Cirrhosis (Steatohepatitis). Steatohepatitis is “fatty liver disease” and caused by a collection of fat on the liver. It causes liver swelling and scarring that is unrelated to alcohol use. People with non-alcoholic cirrhosis usually have other health issues like; high cholesterol, diabetes, unhealthy diet, and are overweight.
Biliary Disease. Diseases of the bile duct such as; biliary cirrhosis and sclerosing cholangitis are two very common causes of liver cirrhosis. This is because the liver releases bile into the biliary duct and these diseases block the flow of bile. The accumulation of bile causes liver swelling and damage.
Genetic Causes. There are forms of liver disease that are genetic in nature and present from birth. These include; autoimmune hepatitis, Alpha-1 antitrypsin deficiency, Wilson’s disease, and hemochromatosis.

Risk Factors for Cirrhosis

If you have any of the conditions above plus the risk factors below, you may be at higher risk for cirrhosis:
Genetics. If someone in your family has cirrhosis, you have a higher risk.
Gender. Males are at higher risk for alcoholic cirrhosis, but women are at higher risk for biliary cirrhosis.
Age. Cirrhosis is most common in 30 to 60 year olds.
Infection. Certain viral, fungal, and bacterial infections can damage the liver.
History of Smoking. Smoking increases the risk for cirrhosis.
Chemical Exposure. Certain toxins can strain the liver and/or set off an immune reaction in the liver.

Diagnosing Cirrhosis

If you suspect an issue with your liver, see your doctor. Be sure you let them know your medical history and medications you are taking. It is very important to be up front about your social history including; alcohol use, drug use, and sexual history. The doctor may run the following tests:
Liver Function Tests. The doctor can see the health of your liver with a liver function panel. These will show the doctor if your liver is functioning properly.
Antibody Levels. People with cirrhosis may have a high level of anti-mitochondrial antibodies. These are a sign the immune system may be attacking the liver.
Liver Ultrasound. The doctor may order an ultrasound where they place a Doppler on your skin. They can see the outline of the liver and any scarring.
CT/MRI Scans. These can give a much more detailed picture of the organs.
MRE. This scan can see hardening in the liver.
Endoscopy. The doctor can look with a scope at the bile ducts.
Liver Biopsy. As a last resort, the doctor may opt for a liver biopsy to see what stage the cirrhosis is at.

Treatment for Cirrhosis

There is no cure for cirrhosis and the damage cannot be repaired. There are treatments that may slow the progression of the disease. If the disease becomes advanced, a liver transplant may be needed. Treatments for cirrhosis include:
Treat alcoholism

Lose extra weight

Medications

Low protein diet

If left untreated, cirrhosis can have health complications. These complications include:
Portal Hypertension
When the liver hardens due to cirrhosis, the flow of blood through the veins in the liver slows down. This increases blood pressure in other veins around the liver. Treatments for this complication are:
Blood Pressure Medications
Transjugular intrahepatic portosystemic shunt (TIPS). A shunt is place in the vein to open it up and increase blood flow.
Hepatic Encephalopathy
When liver damage becomes severe, it cannot to its job to clean toxins out of your blood. This means your brain is nourished by blood full of toxic substances. This can lead to confusion, trouble thinking, personality changes, and can lead to a coma if left untreated. Treatment for hepatic encephalopathy Includes giving medications that can help remove the toxins from the blood.
Edema and Ascites
When the portal vein cannot carry blood properly through the abdominal cavity, fluid begins to build up in the lower legs, ankles, and the abdomen (ascites). One reason this happens is low albumin levels from the liver. Treatments for edema and ascites include; low-salt diet, diuretic medications, and if necessary draining the fluid from the abdomen with a needle (Paracentesis).
Bleeding
The liver makes certain proteins that help your blood to clot. Cirrhosis reduces the production of these proteins and can leading to bleeding and anemia. Another bleeding condition with cirrhosis is, varices. Portal hypertension causes smaller veins to become engorged and burst, leading to bleeding. This is most common in the esophagus and abdomen. Treatments for this complication include:
Medications. Beta blockers may help to control bleeding. Over time, medications to help build up the blood may be needed.

Banding. The doctor will “tie-off” the varices to prevent them from getting blood flow.

Distal Splenorenal Shunt (DSRS). A shunt is placed to divert blood flow away from the varices.

Devascularization. This is complete removal of the varices.

Esophageal Transection. The doctor will cut into the esophagus and tie-off the varices. The esophagus is then closed with staples.

Peritonitis
Fluid build-up in the abdomen can lead to an infection in the lining of the abdominal cavity. This is treated with antibiotics and then draining the fluid.
Liver Failure
In the later stages of the disease, complete liver failure usually occurs. Once this happens, the only treatment is a liver transplant.

Lifestyle Changes for Cirrhosis

If you have been diagnosed with cirrhosis, certain lifestyle changes can help reduce liver damage and symptoms. These include:
Quit drinking alcohol completely

Eat a healthy diet low in salt and protein

Make sure you get vaccinated for Hepatitis A, Hepatitis B, Influenza, and pneumonia

Check with your doctor before taking any new medications or herbal supplements.

Alternative Medicine for Cirrhosis

There are some alternative remedies that natural medicine practitioners may offer. These include:
Licorice root

Astralgus

Milk Thistle

Most doctors tend to be wary of herbal supplements for liver disease, because of the risk of more liver damage from some herbs. If you want to try an herbal supplement, talk to your doctor first.

Cirrhosis Prevention

Cirrhosis is very preventable if you take the following precautions to prevent liver damage:
Limit Alcohol Use. If you don’t have liver disease and you have risk factors for cirrhosis, limit your alcohol use. Remember that some people can develop cirrhosis with very little alcohol use. Avoid daily drinking and only allow yourself one or two drinks per week.
Use Caution with Medications. Some medications can be toxic to the liver such as; acetaminophen. If you take this medication, do not drink with it as this can double the effects on the liver.
Protect Yourself from Chemical Exposure. Some chemicals can be absorbed by breathing them in or touching them. When they enter your bloodstream, the liver must filter them out. Over time, this can damage the liver.
Protect Yourself from Hepatitis. If you use intravenous street drugs, do not share needles. Use a condom during sex with multiple partners, and get your hepatitis B vaccinations.

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