Cirrhosis

Reviewed by Jessica Munoz DPN, RN, CEN

Cirrhosis is an advanced-stage liver disorder in which healthy liver tissue is replaced with scarred tissue and the liver is damaged. Scar tissue prevents the liver from functioning adequately. Several types of liver diseases and conditions damage healthy liver cells, leading to cell death and inflammation. This is followed by cell repair and finally tissue scarring as a consequence of cell repair.

The scar tissue stops the flow of blood through the liver and reduces the liver’s capability to process hormones, drugs, nutrients, and natural toxins. It also decreases the production of proteins and other substances generated by the liver. Cirrhosis actually refrains the liver from working properly, as such advanced-stage cirrhosis is a real threat to human life.

According to scientists cirrhosis of the liver affects about 1 in 400 adults in the United States. It affects about 1 in 200 adults aging between 45 to 54 years old. About 26,000 deaths are attributed to cirrhosis per annum in the United States. It is the 7th leading cause of death in the United States among adults between 25 to 64 years of age.

Symptoms

Cirrhosis doesn’t show any signs and symptoms until extensive liver damage happens. Symptoms of cirrhosis, if they occur, can include:

• Loss of appetite
• Nausea
• Fatigue
• Easily bleeding or bruising
• Weight loss
• Itchy skin
• Swelling in the legs, feet, or ankles (edema)
• Discoloration i.e., yellowness in the eyes and skin (jaundice)
• Fluid accumulation in the abdomen (ascites)
• Spiderlike blood vessels on the skin
• Redness in the hands and palms
• Absence or loss of periods not related to menopause, for ladies
• Confusion, drowsiness, and slurred speech (hepatic encephalopathy)

Causes

Numerous diseases and conditions have the potential to harm the liver, leading to cirrhosis. Some of these causes include:

• Hepatitis B, C, and D i.e., Chronic hepatitis types
• Chronic alcohol abuse
• Cystic fibrosis
• Accumulation of fat in the liver (nonalcoholic fatty liver disease)
• Iron buildup in the body (hemochromatosis)
• Copper accumulated in the liver (Wilson’s disease)
• Poorly formed bile ducts (biliary atresia)
• Alpha 1 antitrypsin deficiency
• Inherited diseases of sugar metabolism (galactosemia or glycogen storage disease)
• Genetic digestive disorder(Alagille syndrome)
• Liver disease is caused by the body’s immune system (autoimmune hepatitis)
• Scarring and hardening of the bile ducts i.e., damage to the bile ducts (primary sclerosing cholangitis)
• Infection, such as syphilis or brucellosis
• Medications, including methotrexate or isoniazid

Risk factors

• Consuming excessive alcohol, is a risk factor for cirrhosis.
• Being obese or overweight increases the risk of conditions that may result in cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
• History of viral hepatitis is a risk factor. Chronic hepatitis is one of the world’s leading causes of cirrhosis.

Complications

Cirrhosis can have the following complications:

• High blood pressure: High blood pressure in the veins that supply blood to the liver i.e., hepatic veins. Cirrhosis decreases the normal flow of blood through the liver and increases the pressure in the vein that brings blood to the liver from the spleen and intestines.
• Swelling in the legs and abdomen: The abnormal pressure in the portal vein can lead to the accumulation of fluid in the legs (edema) and in the abdomen (ascites). Edema and ascites also can result from the inability of the liver to produce sufficient certain proteins, such as albumin.
• Enlargement of the spleen (splenomegaly): Portal hypertension can also lead to changes and swelling of the spleen, and trapping of white blood cells and platelets. Insufficient white blood cells and platelets in the blood can be the warning of cirrhosis.
• Bleeding: Portal hypertension can lead to the blood being redirected to smaller veins. Owing to the extra pressure, the smaller veins can rupture, and cause serious bleeding. Portal hypertension can cause enlarged veins (verices) in the esophagus (esophageal varices) or the stomach (gastric varices) and result in fatal bleeding. In case the liver is unable to make sufficient clotting factors, it also can lead to continued bleeding.
• Infections: Your body may have difficulty fighting infections if you have cirrhosis. Bacterial peritonitis caused by ascites is a serious infection.
• Malnutrition: It will be more difficult for your body to process nutrients in the presence of cirrhosis, which will lead to weight loss and weakness.
• The buildup of toxins in the brain: A cirrhosis-affected liver can’t clear toxins from the blood as effectively as a healthy liver can. These toxins can build up in the brain and result in mental confusion and difficulty concentrating. Over time, hepatic encephalopathy can lead to unresponsiveness or coma.
• Jaundice: Jaundice occurs when the affected liver is unable to remove extra bilirubin, a blood waste product, from the blood. Jaundice is associated with the yellowing of the body’s skin and whites of the eyes and darkening of the urine.
• Bone disease: Some people with cirrhosis can lose bone strength and are at higher risk of fractures.
• Increased risk of liver cancer: The majority of people who develop liver cancer have had cirrhosis in the past.
• Acute-on-chronic cirrhosis: Some people cease to experience multiorgan failure. Researchers believe it to be a distinct complication in certain people with cirrhosis, yet they remain uncertain about its true causes.

Prevention

Taking these steps to reduce your risk of cirrhosis are recommended:

• Avoid consuming alcohol
• Consume a healthy diet.
• Maintain a healthy weight. Being overweight can damage your liver. Make a planliaison with your physician about a weight-loss plan if you’re overweight or obese.
• Reduce your risk of hepatitis. Avoid sharing needles and having unprotected sex, which can increase your risk of hepatitis B and C. Ensure having hepatitis vaccines.
• If you anticipate a risk of liver cirrhosis, collaborate with your health care provider about ways you can avoid the risk.

Treatment

Cirrhosis is not treatable. The damage already done to the liver is everlasting. Nevertheless, depending on the root causes of your cirrhosis, there are certain preventive measures you can take to keep your cirrhosis from getting un-manageable. These can include:

• Stop consuming alcohol
• Treat chronic hepatitis
• Avoid medication that puts extra pressure on the liver.
• Consume a well-balanced, healthy, low-fat diet, such as the Mediterranean diet.

The objectives of treatment for cirrhosis of the liver must be to:

• Reduce further damage to the liver.
• Treat and prevent more symptoms.
• Treat and prevent more complications.

Work cited

• Cirrhosis of the Liver, 2024. Cleveland Clinic. Cirrhosis of the Liver: What is It, Symptoms, Causes & Stages
• Cirrhosis, 2023. Mayoclinic.org. Cirrhosis - Symptoms and causes - Mayo Clinic
• Cirrhosis, Overview. 2020. NHS.uk. Cirrhosis - NHS
• Cirrhosis, 2023. National Institute of Diabetes and Digestive and Kidney Diseases. Cirrhosis NIDDK