Dr. Brian M. Kirsh, MD
Very calm and professional staff.
 
-- EL, Strongsville, Ohio - 2010

Cirrhosis

What is cirrhosis?

Cirrhosis describes a pattern of damage to the liver usually the result of long-term injury from alcohol, chronic hepatitis, or chronic bile duct obstruction. Damaged and dead liver cells are replaced by fibrous tissues which lead to scarring. As a result of this scarring, liver cells regenerate into abnormal clumps or nodules. The scar tissue and regenerative nodules alter the blood flow through the liver which causes some of the serious complications of cirrhosis. This pattern of damage is usually irreversible but removing the cause can slow or halt further damage.

Basic function of the liver includes bile formation and secretion, processing healthy nutrients, eliminating toxins and making products necessary for blood clotting. The liver has an amazing ability to maintain function until damage is extensive.

Cirrhosis may be easily diagnosed when a person experiences the typical complications, changes in blood tests and has a known underlying liver disease. At times a liver biopsy is necessary.Many people may have few or no symptoms with the early stages of cirrhosis. Early symptoms may include fatigue, loss of appetite, reddish and blotchy palms, and spider angiomas (pin head sized red spots with radiating blood vessels on the upper body and arms). As liver failure progresses, symptoms include fluid accumulation in the abdomen (ascites) and legs (edema), loss of muscle bulk, fatigue, jaundice, and loss of body hair.

What are the complications of cirrhosis?

  • Ascites is fluid accumulation in the abdomen
  • Portal hypertensionalso causes a backpressure in other blood vessels and structures. Besides causing ascites, portal hypertension causes other complications, such as
  • Esophageal and Gastric Varices are varicose veins in the esophagus and stomach. Esophageal and gastric varices can rupture and lead to significant blood loss, possibly even death.
An endoscopy is performed on patients with cirrhosis to look for varices. If the endoscopy does not detect varices, it is repeated periodically.

Portal hypertension usually causes spleen enlargement (splenomegaly). At times the spleen becomes so large it can be felt below the left rib cage. An enlarged spleen traps certain blood cells - white blood cells (infection fighters) and platelets (aids clotting). Occasionally the platelet count is low enough to notice problems with bruising and bleeding.
 

Liver Cancer

Patients with cirrhosis are at increased risk for liver cancer (hepatocellular carcinoma). This is a cancer that originates in the liver. There are usually no symptoms. To screen for this cancer, a blood test, alphafetoprotein (AFP), and right upper quadrant ultrasound (or other liver imaging tests) are obtained every six months. If cancer is found early, it can be treated and cured.
 

Mental Impairment/ Hepatic Encephalopathy

In more advanced cases of cirrhosis, changes in mental capacity can occur. This mental impairment (encephalopathy) can range from forgetfulness and trouble concentrating to coma and death. This condition is not fully understood but probably involves some blood bypassing the liver going directly to the brain and the liver's decreased capacity to breakdown certain toxins. One of the toxins is ammonia. Measurement of the ammonia blood level is not helpful as almost all people with cirrhosis will have abnormal levels but few have encephalopathy.

Encephalopathy is treated with lactulose, a liquid medication. The correct dose of the medication causes 3-4 soft or loose stools per day. This change in bowel function can be bothersome, but is necessary to clear toxins from your blood. If encephalopathy is present, lactulose should not be discontinued to avoid this problem. Conditions such as dehydration, constipation, infection, surgery and gastrointestinal bleeding can precipitate encephalopathy.
 

General Recommendations:

  • Get vaccinated for hepatitis A and hepatitis B if you are not already immune. Blood tests will be used to determine immunity.
  • Salt (sodium) restriction is very important to control fluid retention. Aim for less than 2000mg of sodium per day.
  • Follow a balanced diet.
  • Even if you are not experiencing symptoms or complications of cirrhosis, office visits every six months are recommended to screen for cancer.
  • Alcohol should be avoided.
  • Acetaminophen (Tylenol) may be used in doses of 2 - 3 grams (four to six 500 mg tablets) per day.
  • Avoid aspirin and non-steroidal anti-inflammatory drugs (ibuprofen and naproxen) because these medications can cause fluid retention or kidney dysfunction.