Cirrhosis of the Liver: Symptoms, Causes, Diagnosis and Treatment
Cirrhosis is a condition of the liver in which it has become severely scarred and damaged. Healthy liver is replaced by scar tissue, preventing the liver from normal function. Blood flow is also restricted by the growth of scar tissue. As cirrhosis worsens, liver failure can begin and death can occur.
Some individuals are particularly at risk of developing cirrhosis. These include people with a history of alcohol abuse, overweight individuals and those with hepatitis.
Symptoms
Symptoms of cirrhosis often are nonexistent or go unnoticed until the damage has significantly progressed. Make sure to contact your doctor at the first sign of symptoms if you are at risk of cirrhosis.
Commonly, the first symptoms noted are:
- Fatigue
- Decreased appetite
- Nausea and vomiting
- Unexplained weight loss
As the disease worsens, other symptoms become noticeable, including:
- Easy bruising or bleeding
- Darker urine color
- Itchy skin
- Skin and whites of the eyes yellowing known as jaundice
- Significant swelling in legs, ankles and feet known as edema
- Fluid buildup in the abdomen causing bloating known as ascites
- Redness in hands, particularly the palms
- Vessels on your skin appearing spiderlike
- Confusion, slurred speech, difficulties with memory
- Women may experience cessation of menstruation unrelated to menopause
- Men may experience breast enlargement, known as gynecomastia, atrophy of the testicles and diminishment of sex drive
Causes
There are many different causes of cirrhosis and multiple causes can contribute to the same case.
More common causes
- Alcoholic liver disease which impairs the liver and its ability to function through alcohol abuse
- Chronic hepatitis B
- Chronic hepatitis C
- Fatty liver disease not due to alcohol abuse
More unlikely causes
- Cystic fibrosis
- Autoimmune hepatitis
- Buildup of iron in the body known as hemochromatosis
- Accumulation of copper in the liver known as Wilson’s disease
- Poor formation of bile ducts known as biliary atresia
- Sugar metabolism disorders such as galactosemia or glycogen storage disease
- Sustained use of certain medications
- Chronic heart failure
- Genetic digestive disorder known as Alagille syndrome
Diagnosis
Doctors use a combination of your medical history, a physical exam and laboratory and imaging tests to diagnose cirrhosis and assess the severity.
At Your Initial Doctor Appointment
You will be asked about your symptoms: what they are, how long they have been occurring and what effect they have on your day-to-day life. Your doctor will want to discuss your full medical history as well as any conditions which can potentially cause cirrhosis such as hepatitis, cystic fibrosis and inherited liver diseases such as Wilson’s disease.
Your doctor will also ask about your relationship with alcohol and drugs. It is important to be honest in these situations so the correct diagnosis can be given and appropriate treatment can begin as soon as possible.
The physical exam consists of your doctor using a stethoscope to listen to your abdomen where your liver resides. They will also likely touch or apply pressure to certain parts of your abdomen. If you experience pain or tenderness when they are touching or applying pressure to your body, let them know. They will need to see if your liver is enlarged which doctors are trained to recognize through a physical exam, though you may not be able to feel it yourself.
Tests and Specialists
If your medical history and physical exam point to you potentially having cirrhosis, your doctor will order tests to be done to confirm or possibly refer you to a specialist to have them run tests.
Possible tests include laboratory tests, imaging tests and liver biopsy.
Lab Tests
Laboratory tests include blood tests checking for signs of liver damage. Indications in the blood that something is wrong with the liver include high levels of certain liver enzymes, increased bilirubin levels and decreased levels of blood proteins.
Your will also be checked for anemia which can be caused by internal bleeding, and you will be screened for viral infections to determine whether you have hepatitis B or hepatitis C.
Depending on the results, your doctor may be able to see what the cause of your cirrhosis is should it be present. The lab tests also can show the seriousness of your cirrhosis.
Imaging Tests
Imaging tests can refer to x-rays such as computerized tomography (CT) scans, ultrasounds or magnetic resonance imaging (MRI). Because these provide a full picture of the liver, doctors can use them to assess stiffness which shows scarring. They can also see the amount of fat that is in the liver. This information is used to inform treatment, and after treatment, repeat tests can be used to assess whether treatment is or isn’t helping by the stiffness of the liver.
Liver Biopsy
A biopsy is a tissue sample. For a liver biopsy, your doctor will insert a long needle into your liver through your abdomen and recover a sample of tissue. From it, your doctor can determine the degree of your cirrhosis’s advancement, as well as the cause. They can also check for liver cancer using the biopsy. This is important because the presence of cirrhosis increases the chance that a person will develop liver cancer.
Treatment
Once it is determined that cirrhosis is present, your doctor will discuss possible treatment options with you.
Unfortunately, there is currently no cure for cirrhosis, but it can be managed in many cases. Some underlying diseases that cause cirrhosis can be cured, which can help to stop the worsening of your cirrhosis and stave off liver failure. Over time, some treatment may help heal your liver scarring to a degree.
Depending on the cause of your cirrhosis, your doctor may take different approaches to help mitigate symptoms and prevent the further hardening of your liver.
Alcoholic Liver Disease
If alcohol abuse is the cause of your cirrhosis, your doctor will likely recommend you quit drinking entirely cold-turkey to prevent further harm. Any alcohol use at that point is damaging to your liver. To achieve this, you may want to attend an alcohol abuse treatment program to which your doctor may be able to refer you.
Nonalcoholic Fatty Liver Disease
If your cirrhosis is a result of your body weight and fat percentage, your doctor will recommend weight loss. When achieved through healthy activity and eating, weight loss can reduce the fat in the liver, decreasing inflammation and scarring. Your doctor may be able to recommend a specific diet program to follow or a weight loss program to attend.
Hepatitis
If a type of hepatitis is the root of your cirrhosis, your doctor will probably prescribe medication specifically for the strain you have. By treating the hepatitis, your cirrhosis may be helped. Chronic hepatitis B might require antiviral medication. Chronic hepatitis C can be cured in many cases, so doctors will likely try to use medication to eliminate the hepatitis to help with cirrhosis. Autoimmune hepatitis is typically treated with medicine that suppresses or minimizes your immune system’s activity.
Regardless of the cause, certain practices are usually recommended to help heal the damage of cirrhosis. These include stopping or limiting drinking alcohol, losing weight if you are obese, eating a diet rich in protein and minimizing salt intake.
Treatment of Complications of Cirrhosis
Portal Hypertension
If your cirrhosis has caused portal hypertension, your doctor will probably prescribe medication to lower your blood pressure. They may also prescribe medicine to decrease the amount of fluid in your body.
Infections
Antibiotics can be used to treat bacterial infections caused by cirrhosis.
Liver Cancer
Treatment for liver cancer will depend on the advancement of the cancer, but typical treatments are surgery to remove tumors, radiation therapy and chemotherapy. These may be used individually or in combination with each other. Live transplants can also be used in some cases.
Liver Failure
If your cirrhosis has progressed so much that you are experiencing liver failure or end-stage liver disease, the only option is a transplant.
With an early diagnosis and the right treatment, liver disease can be effectively treated. If you believe you or someone you love may have cirrhosis, please schedule an appointment with your doctor to discuss symptoms and a possible treatment plan.
