What are the symptoms of cirrhosis?

Many people with cirrhosis show no symptoms during the early stages of the disease. Symptoms may not appear until complications of cirrhosis set in. This results in quite a number of people being unaware they have cirrhosis until a complication arises.

The most common symptoms an individual may notice include:

• loss of appetite
• nausea
• weight loss
• fatigue
• weakness
• exhaustion

What happens as liver function decreases?

As liver function decreases, fewer proteins such as albumin are produced resulting in fluid accumulation in the legs (edema) or abdomen (ascites). Individuals with cirrhosis may bleed and bruise easily due to a decrease in proteins required for blood clotting. Some people may even experience intense itching due to deposit of certain products in the skin.

What problems are associated with the later stages of cirrhosis?

Towards the later stages of cirrhosis, jaundice occurs and gallstones are more common because insufficient levels of bile reach the gallbladder. Cirrhosis slows the liver’s ability. A cirrhotic liver no longer removes toxins effectively leading to toxin accumulation in the blood, which in turn can impair mental function and lead to personality changes and possibly coma. Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, concentration problems or changes in sleeping habits. Because the normal cleansing process is impaired by cirrhosis, drugs are not properly filtered resulting in medications acting longer than expected and building up in the body. This causes a person to be more sensitive to medications and their side effects.

Normally, blood from the intestines and spleen is pumped to the liver through the portal vein. However, cirrhosis blocks the normal flow of blood through the liver. This can lead to swelling of the liver and potentially the spleen. Blood from the intestines, is then forced to find a new way around the liver through new vessels. Some of these new blood vessels called "varices" which form primarily in the stomach and esophagus become quite large. These varices may rupture due to high blood pressure (portal hypertension) and thin vessel walls, causing bleeding in the upper stomach or esophagus.

What are the major causes of cirrhosis?

Cirrhosis can be caused by a number of conditions, such as

• chronic alcoholism
• viral infections caused by chronic viral hepatitis (types B, C and D)
• metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia and glycogen storage disorders
• inherited diseases such as Wilson's disease and hemochromatosis
• biliary cirrhosis resulting from diseases such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)
• toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins
• repeated bouts of heart failure with liver congestion

How do babies develop cirrhosis? Can they be treated?

Children may be born with Biliary atresia, a condition caused by absent, blocked or injured bile ducts. It is the most common cause of cirrhosis in babies. These babies are jaundiced after their first month of life due to a build-up of bile that damages the liver. The liver becomes inflamed, starting the long process of cell damage that leads to cirrhosis. New ducts can be surgically formed in some cases restoring normal bile secretion. Transplantation is required in other cases.

What treatments are used to fight liver cirrhosis?

Treatment for cirrhosis cannot reverse liver damage, but it can stop or slow progression of the disease, minimize liver cell damage and reduce complications. Treatment depends on the precise cause of cirrhosis and which particular complications, if any, have appeared. When cirrhosis is caused by alcohol, the patient must immediately stop drinking to halt the progression of the disease. Cirrhosis caused by viral hepatitis may be treated with antiviral drugs to reduce liver cell injury. Medications can be given to control the symptoms of cirrhosis. For example, the doctor may recommend drugs called "diuretics" – medications that are used to remove excess fluid from the body and to prevent edema and ascites from recurring. Combined diet and drug therapy may serve to improve altered mental function. For instance, decreasing dietary protein results in less toxin formation in the digestive tract. Laxatives, such as lactulose, may be given to help absorb toxins and speed their removal from the intestines. A serious consequence of cirrhosis may be bleeding as a result of portal hypertension. Medications, such as beta blockers, may be prescribed to reduce portal hypertension.

Even when complications develop, they can usually be treated. If the patient bleeds from the varices of the stomach or esophagus, the doctor can inject these veins with a sclerosing (hardening) agent administered through a flexible tube (endoscope) that is inserted through the mouth and esophagus. Rubber bands can also be placed around the veins through the endoscope. In critical cases, a liver transplant or a portacaval shunt, which relieves the pressure in the portal vein and varices, may be necessary.

When is a liver transplant indicated for cirrhosis?

A liver transplant is considered when complications cannot be controlled by treatment. In this operation the diseased liver is removed and replaced with a healthy one from an organ donor. A team of doctors determine the risks and benefits of the procedure with reference to each patient. Survival rates have improved over the past several years because of effective drugs that suppress the immune system and keep it from attacking and damaging the new liver.

How is Cirrhosis Diagnosed?

Your medical history, current symptoms, or physical exam findings may serve as indications to your doctor that you have cirrhosis. The steps in making the diagnosis of cirrhosis will include medical analysis of the following:

• Identifiable symptoms
• Physical examination
• CAT scan (computerized axial tomography)
• Ultrasound
• Radioisotope liver/spleen scan
• Liver Biopsy

Once it is determined that liver disease is present, immediate treatment is recommended.

How can I prevent liver cirrhosis?

The best way to avoid cirrhosis is to avoid the underlying conditions that cause it.

• Be aware of the risk factors for hepatitis B and hepatitis C and safeguard yourself as much as possible.
• Stay away from risky behaviour, such as alcohol abuse, IV drug use, and unprotected sexual intercourse.
• Ensure alcohol only in moderation, if at all.
• Adopt a healthy lifestyle. Refrain from smoking. Eat a wholesome diet, get plenty of physical activity and adequate rest, and maintain your weight in a healthy range.

• Consult your doctor before taking vitamin supplements. Large doses of vitamins and minerals, especially vitamin A, iron, or copper, can do more harm than help.