What is cirrhosis?

Causes and Symptoms

The
liver is a large, spongy organ that lies in the upper-right abdomen. Regarded as primarily part of the digestive system because it manufactures bile, the liver has many other functions, including the synthesis of blood-clotting factors and the detoxification of such harmful substances as alcohol.

Cirrhosis describes the fibrous scar tissue (or nodules) that replaces the normally soft liver after repeated long-term injury by toxins such as alcohol or viruses. The liver may form small nodules (micronodular cirrhosis), large nodules (macronodular cirrhosis), or a combination of the two types (mixed nodular cirrhosis). Cirrhosis is a frequent cause of death among middle-aged men, and increasingly among women. While
alcoholism is the most common cause, chronic hepatitis and other rarer diseases can also produce the irreversible liver damage that characterizes cirrhosis. The resulting organ is shrunken and hard, unable to perform its varied duties. Because of its altered structure, the cirrhotic liver causes serious problems for surrounding organs, as blood flow becomes difficult. The barrier to normal circulation leads to two serious complications: portal hypertension (the buildup of pressure in the internal veins) and
ascites (fluid leakage from blood vessels into the abdominal cavity).

Treatment and Therapy

Diagnosis is usually made from a history of alcoholism. A physical examination may reveal jaundice; a large nodular liver or a small shrunken one, depending upon the stage; or a fluid-filled abdomen (ascites). Laboratory studies may show elevated liver enzymes released from damaged cells and low levels of products that the liver normally produces (protein, clotting factors). A definitive diagnosis can be made only by biopsy, although radiographic methods such as computed tomography (CT) scanning and magnetic resonance imaging (MRI) can be quite conclusive.

The mortality rate is very high, as the damage is irreversible. Deaths from internal vein rupture and hemorrhage (the results of portal hypertension) and from kidney failure are most common. Repeated hospitalizations attempt to control the variety of complications that arise with agents that stop bleeding, bypass tubes that relieve pressure, the removal of the ascitic fluid, and nutritional support for malnutrition. Eventually, kidney failure ensues or one of these control measures fails, and death rapidly follows. Liver transplantation is considered in some cases. Cases of mild cirrhosis, where sufficient normal tissue remains, have a clearly better course.

In 2013, a study led by Dr. W. Kim Ray, of the Mayo Clinic in Rochester, Minnesota, found a link between advanced fibrosis and higher death rates in patients with nonalcoholic fatty liver disease. The incidence of nonalcoholic fatty liver disease has risen over the last twenty-five years and it is now the most frequently occurring liver disease in the United States.

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