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The liver is a large organ that sits in the right upper
abdomen, just under the right lung. It is one of the body's
most "intelligent" organs in that it performs so many
different functions at the same time. The liver makes proteins,
eliminates waste material from the body, produces cholesterol,
stores and releases glucose energy and metabolizes many drugs
used in medicine. It also produces bile that flows through bile
ducts into the intestine where it helps to digest food. This
remarkable organ also has the ability to regenerate itself if it
is injured or partially removed. The liver receives blood from
two different sources - the heart and the intestine. All of this
blood flows through the liver and returns to the heart. It is no
wonder that the ancient Chinese viewed the liver, not the heart,
as the center of the body.
What Is Cirrhosis?
Many types of chronic injury to the liver can result in scar
tissue. This scarring distorts normal structure and re-growth of
liver cells. The flow of blood through the liver from the
intestine is blocked and the work done by the liver, such as
processing drugs or producing proteins, is hindered.
What Causes Cirrhosis?
Cirrhosis can be caused by many things, some known and others
unknown:
•Alcohol-Using alcohol in excess is the most common cause
of cirrhosis in the United States.
•Chronic Viral Hepatitis-Type B and Type C Hepatitis, and
perhaps other viruses, can infect and damage the liver over a
prolonged time and eventually cause cirrhosis.
•Chronic Bile Duct Blockage-This condition can occur at
birth (biliary atresia) or develop later in life (primary biliary
cirrhosis) . The cause of the latter remains unknown. When the
bile ducts outside the liver become narrowed and blocked, the
condition is called primary sclerosing cholangitis. This
condition is often associated with chronic ulceration of the
colon (colitis).
•Abnormal Storage of Copper (Wilson's Disease) or
Iron (Hemochromatosis)-
These metals are present in all body cells. When abnormal
amounts of them accumulate in the liver, scarring and cirrhosis
may develop.
•Drugs and Toxins-Prolonged exposure to certain chemicals
or drugs can scar the liver.
•Autoimmune Hepatitis-This chronic inflammation occurs
when the body's protective antibodies fail to recognize the
liver as its own tissue. The antibodies injure the liver cells as
though they were a foreign protein or bacteria.
• Cystic Fibrosis and Alpha I-antitrypsin
Deficiency-These disorders are inherited.
What Are the Signs and Symptoms?
Cirrhosis takes years to develop. During this time, there are
usually no symptoms, although fatigue, weakness and decreased
appetite may occur and worsen with time. When cirrhosis is fully
developed, a number of signs may be present:
• Fluid Retention in the Legs and Abdomen- The liver produces a
protein, called albumin, that holds fluid in blood vessels. When
the blood level of albumen falls, fluid seeps out of the tissues
into the legs and abdomen, causing edema (fluid accumulation) and
swelling.
• Jaundice-The liver produces bile that normally flows
into the intestine. With advanced cirrhosis, bile can back up
into the blood, causing the skin and eyes to turn yellow and the
urine to darken.
• Intense Itching--Certain types of cirrhosis, such as
chronic bile duct blockage, can produce troublesome itching.
• Gallstones--Cirrhosis causes the abnormal metabolism of
bile pigment. Because of this, gallstones develop twice as often
in cirrhosis patients as in those without the disorder.
• Coagulation Defects-The liver makes certain proteins
that help clot blood. When these proteins are deficient,
excessive or prolonged bleeding happens.
• Mental Function Change-The liver processes toxins from
the intestine. When these substances escape into the bloodstream,
as occurs in severe cases of cirrhosis, a variety of changes in
mental function can develop. Esophageal Vein Bleeding-In advanced
cirrhosis, intestinal blood bypasses the liver and flows up and
around the esophagus (the food tube) to the heart. The veins in
the esophagus dilate (widen) and may rupture, causing slow or
massive intestinal bleeding.
Diagnosis and Liver Biopsy
The physician can always suspect cirrhosis from the
patient's medical history and physical examination. In
addition, certain blood tests and scans or ultrasound
(sonography) can provide helpful information. To make a definite
diagnosis, however, a liver biopsy (tissue sample) is required.
This is performed by anesthetizing the skin of the right-lower
chest and inserting a thin, needle into the liver. A core or
specimen of tissue is removed and examined under a
microscope.
What Is the Course of Cirrhosis?
When cirrhosis is diagnosed, the patient and physician begin a
plan of action designed to preserve the remaining liver cells and
correct the complications mentioned above. By following this
plan, most patients can lead long, productive lives.
Prevention
Perhaps 90 percent of cirrhosis is caused by excessive alcohol
consumption or hepatitis viruses. Of course, alcohol can be
avoided. Alcohol consumption should always be limited to no more
than I or 2 drinks per day. And Type B hepatitis now has an
effective vaccine against it. Vaccination against B hepatitis
virus is safe and inexpensive. It should be taken especially by
certain high-risk groups: all health care professionals, persons
traveling to Third World countries, homosexuals, intravenous drug
users, and prostitutes.
Treatment
Often, the only required treatment for cirrhosis is removing
the offending cause:
• The alcoholic patient must permanently stop consuming
alcohol.
• When iron is being retained in the body, chronic
removal of blood by vein eliminates large amounts of iron.
• Cortisone medicine helps treat autoimmune hepatitis and
cirrhosis.
• Restricting salt and using fluid pills (diuretics)
reduce edema and abdominal swelling.
• Toxins and injurious drugs must be avoided.
• Decreasing dietary protein and using certain laxatives
generally can prevent changes in mental function.
• Bleeding veins in the esophagus can be injected with
sclerosing (clotting) agents or closed with small rubber bands.
Occasionally, surgery is necessary to prevent recurrent massive
bleeding.
• Ursodiol (Actigall) and other drugs have been helpful
in treating primary biliary cirrhosis and primary sclerosing
cholangitis.
Liver Transplant
Liver transplantation has progressed to the stage where it can
now be considered as standard treatment for selected
patients.
Summary
Cirrhosis of the liver is a common disorder that has many
causes. With early diagnosis, much can be done to prevent serious
complications. Various treatments are available, depending on the
cause of the liver injury and its complications. Ongoing medical
research promises major advances in treating cirrhosis in the
future.
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