Definition and Overview
The liver is one of the vital organs in the human body. It is responsible for various activities, such as the manufacture of blood proteins that are essential in powering the immune system and ensuring efficient clotting as well as bringing oxygen to different parts of the body. It also stores nutrients, cleans the bloodstream, stores sugar, and breaks down saturated fat.
However, just like any other part of the body, the liver is also prone to diseases, and one of them is cirrhosis. This disease slowly progresses over time, destroying healthy liver tissue and replacing them with scar tissues. Once the organ is riddled with scar tissues, efficient blood flow is hampered, slowing down the processing of substances, nutrients, and toxins that the liver is responsible for. Other vital processes, such as protein production, will also be affected by the onset of scar tissue.
Millions of people all over the world suffer from cirrhosis of the liver, with a significant percentage needing a liver transplant in order to survive. According to the United Kingdom’s National Institutes of Health, cirrhosis of the liver is among the leading causes of death by disease all over the world. In 2013, 1.2 million people died from the disease, with more men dying from cirrhosis of the liver than women.
Cause of Condition
There are three major causes of cirrhosis of the liver: alcohol abuse, hepatitis C, and hepatitis B.
Alcohol abuse, especially for people who drink heavily over a period of at least ten years, is one of the most dangerous activities for the liver. Over time, heavy drinkers tend to develop alcoholic liver disease, or ALD, which essentially injures the organ. As the injury heals, scar tissue develops and blocks the normal metabolic processes.
Alcohol abuse causes liver injury because of its acetaldehyde contents, which accumulates and reacts with the liver tissues. Two-fifths of deaths caused by cirrhosis in the United States are caused by alcohol abuse.
Progressive cirrhosis of the liver can also be caused by hepatitis B and C. The former is caused by the hepatitis B virus, or HBV, which targets the liver, bringing in its wake acute and chronic infections. HBV can be transmitted through exposure to infected body fluids such as blood. Intravenous drug use and sexual intercourse are also quite common ways of transmitting the hepatitis B virus.
Hepatitis C (or HCV), on the other hand, causes chronic damage to the liver. When symptoms are ignored, the hepatitis C virus can cause enough damage to the liver to cause organ failure and cancer. HCV can be transmitted through blood-to-blood contact, with situations such as intravenous drug use, blood transfusions, and undergoing surgical procedures where medical equipment and surgical instruments were not properly sterilized.
Other possible causes of cirrhosis of the liver include:
Non-alcoholic steatohepatitis (NASH). This type of hepatitis is quite rare, and accounts for only a small number of cirrhosis cases. NASH involves abnormal fat buildup in the organ, which eventually leads to the formation of scar tissues. The symptoms are quite similar to those experienced by heavy alcohol abusers, but NASH patients typically do not have a long history of alcohol abuse.
Primary sclerosing cholangitis. This progressive cholestatic disorder also causes other conditions, such as metabolic bone disease, inflammatory bowel disease, ulcerative colitis, pruritus, and the body’s inability to metabolize fat-soluble vitamins.
Primary biliary cirrhosis. This condition occurs mostly in female patients and involves the damage to the bile ducts, which eventually causes scar tissues to replace healthy liver tissues.
Wilson’s disease. This disorder increases the copper content of the blood and urine, and eventually causes damage to the liver, where the blood is cleansed of toxins.
Autoimmune hepatitis. This type of hepatitis is not caused by a virus like hepatitis B and C. It is an immunological response that causes inflammation and eventual liver damage.
Hereditary hemochromatosis. This disease often occurs in individuals with a family history of cirrhosis and an excessive amount of iron in the bloodstream.
Cardiac cirrhosis. Chronic heart failure on the right side of the organ leads to liver congestion that eventually results in the development of scar tissues.
Indian childhood cirrhosis. This neonatal condition involves an unusually high amount of copper in the patient’s liver.
Presence of hepatotoxic toxins in the liver, or usage of hepatotoxic drugs
Alpha 1 antitrypsin deficiency. This is a hereditary condition involving the absence of a specific enzyme in the organ
Glycogen storage disease type IV
Fat buildup in the liver, caused by diabetes and/or obesity
Parasitic infections targeting the liver
There is a wide variety of symptoms that are associated with cirrhosis of the liver. These include:
- Spider angiomata, a cluster of swollen blood vessels just under the surface of the skin. They resemble a spider’s web, thus the name.
- Red palms, known as palmar erythema, which occur in one out of three patients
- A decrease in the levels of sex hormones, which can lead to loss of sexual drive, impotence, atrophy of the testicles, and infertility
- Abnormal size of the liver (too large or too small)
- An enlarged abdomen, caused by fluid accumulation in the abdomen’s peritoneal cavity
- An enlarged breast gland in male patients, occurring in two out of three cases
- Yellowing of the skin and the whites of the eyes
- Dark urine
- Musty odor in the breath
- Enlarged spleen
- Changes in toe and fingernails
- Sudden weight loss
- Weakness and fatigue
- Injury to the kidney
Who to See and Types of Treatment Available
Any problem with the liver should be referred to a gastroenterologist who specializes in the diagnosis and management of cirrhosis. Currently, there is no treatment for this condition but symptoms and complications can be managed. Patients are typically advised to follow a low-sodium diet, take antibiotics and diuretics, and make lifestyle changes. Other treatments include the removal of fluid from the abdomen, endoscopic treatments for enlarged veins in the throat, and repairing blood flow in the liver, among others.
Carithers RL, Mcclain CJ. Alcoholic liver diseases. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 84.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 156.
Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009;104:1802-1829. PMID: 19455106