Topic Overview
What is cirrhosis?
Cirrhosis (say "suh-ROH-sus")
is a very serious condition in which scarring damages the
liver. The liver is a large organ that is part of the
digestive system. It does a wide range of complex jobs that are vital for life.
For example, the liver:
- Makes many important substances, including
bile to help digest food and
clotting factors to help stop bleeding.
- Filters poisons from the blood.
- Breaks down
(metabolizes) alcohol and many drugs.
- Controls the amounts of sugar, protein, and fat in the
bloodstream.
- Stores important vitamins and minerals, including
iron.
When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue. This scar tissue prevents the
liver from working as it should. For example, the liver may stop producing
enough clotting factors, which can lead to bleeding and bruising. Bile and
poisons may build up in the blood. Scarring can also cause high blood pressure
in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding
in the digestive tract and other serious problems.
Cirrhosis can
be deadly. But early treatment can help stop damage to the liver.
What causes cirrhosis?
Cirrhosis can have many
causes. Some of the main ones include:
Less common causes of cirrhosis include severe reactions
to medicines or long-term exposure to poisons, such as arsenic. Some people
have cirrhosis without an obvious cause.
What are the symptoms?
You may not have symptoms
in the early stages of cirrhosis. As it gets worse, it can cause a number of
symptoms, including:
- Fatigue.
- Small red spots and tiny lines on the skin called spider
angiomas.
- Bruising easily.
- Heavy nosebleeds.
- Weight loss.
- Yellowing of the skin
(jaundice).
- Itching.
- Swelling from fluid buildup in the legs (edema) and the
abdomen (ascites).
- Bleeding from enlarged veins in the digestive
tract.
- Confusion.
How is cirrhosis diagnosed?
The doctor will start
with a physical examination and questions about your symptoms and past health. If the
doctor suspects cirrhosis, you may have blood tests and imaging tests, such as
an
ultrasound or
CT scan. These tests can help your doctor find out
what is causing the liver damage and how severe it is.
To confirm
that you have cirrhosis, the doctor may do a
liver biopsy. This means that he or she will use a needle
to take a sample of liver tissue for testing.
How is it treated?
Treatment may include
medicines, surgery, or other options, depending on the cause of your cirrhosis
and what problems it is causing. It is important to get treated
for cirrhosis as soon as possible. Treatment cannot cure cirrhosis. But it can
sometimes prevent or delay further liver damage.
There are things you can do to
help limit the damage to your liver and control the symptoms:
- Do not drink any alcohol. If you don't stop
completely, liver damage may quickly get worse.
- Talk to your
doctor before you take any medicines. This includes both
prescription and over-the-counter drugs, vitamins, supplements, and herbs.
Medicines that can hurt your liver include acetaminophen (such as Tylenol) and other pain medicines such as ASA, ibuprofen (such as Advil or Motrin), and naproxen (Aleve).
- Make sure that your
immunizations are up-to-date. You are at higher risk
for infections.
- Follow a
low-sodium diet. This can help prevent fluid buildup,
a common problem in cirrhosis that can become life-threatening.
Symptoms may not appear until a problem is severe. So it's important to see your doctor for regular checkups and lab tests. You may
also need testing to check for possible problems such as enlarged veins in your digestive tract or liver cancer.
If cirrhosis becomes life-threatening, then
a liver transplant may be an option. But a organs are hard to find, and it doesn't always work. And the cost of travel and the medicines needed after a transplant can be
expensive.
If your
cirrhosis is getting worse, you may choose to get care that focuses on your
comfort and dignity.
Hospice palliative care can provide support and symptom relief
so you can make the most of the time you have left. You may also want to make
important end-of-life decisions, such as writing an
advance care plan. It can be comforting to know that you
will get the type of care you want.
It can be hard to face having
cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor. You
may be able to get counselling or other types of help. Think about joining a
support group. Talking with other people who have cirrhosis can be a big
help.
Frequently Asked Questions
Learning about cirrhosis: | |
Being diagnosed: | |
Getting treatment: | |
Living with cirrhosis: | |
End-of-life issues: | |
Symptoms
People who have
cirrhosis sometimes don't have symptoms until
liver damage is extensive. Symptoms of cirrhosis and
its complications may include:
- Fatigue.
- Yellowing of the skin
(jaundice).
- Itching.
- Swelling from fluid buildup in the legs (edema).
- Bruising easily and having heavy nosebleeds.
- Redness of
the palms.
- Small red spots and tiny lines on the skin called spider
angiomas.
- Weight loss and muscle
wasting.
- Belly pain or discomfort.
- Frequent
infections.
- Confusion.
Complications of cirrhosis
Scar
tissue from cirrhosis may block the proper flow of blood from the intestines through the
liver. The scarring can lead to increased pressure in the veins that supply this area. This is called
portal hypertension. It can lead to
other complications, which may include:
- Fluid buildup in the belly (ascites).
- Bleeding from enlarged
veins (varices) in the digestive tract. This is called
variceal bleeding.
- Increased spleen size. This can lead to a low blood
platelet count.
- Infection of the fluid in the belly (spontaneous bacterial peritonitis, or SBP).
- Altered brain function
(encephalopathy). This usually only occurs in
people who have advanced portal hypertension.
- Hepatorenal
syndrome. Kidney (renal) failure can occur in cases of advanced liver disease.
- Hepatopulmonary syndrome. Portal
hypertension can cause lung problems, such as
widening of the blood vessels in the lungs. This causes the blood to
move too swiftly through the lungs to pick up enough oxygen.
- Hepatic hydrothorax. Fluid can
build up between the lungs and the chest (pleural effusion) and press on the
lungs.
People who have cirrhosis also are at increased risk
of getting liver cancer, mainly
hepatocellular carcinoma.
Examinations and Tests
Your doctor will do a physical examination and ask about your medical history to see if you have symptoms of liver disease and to help find out possible
causes of liver damage.
If your doctor thinks you may have cirrhosis, you may have blood and imaging tests. You also may have a liver biopsy. This test can show for sure if you have cirrhosis.
Blood tests to check liver function
Measuring
the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:
Blood tests to check for inflammation of the liver
You may have blood tests to check your liver enzymes. These can help show whether you have had liver inflammation for a long time. These blood tests include:
Some people with
cirrhosis have normal liver enzymes.
Blood tests to diagnose a cause of cirrhosis
Tests to check for conditions that may cause cirrhosis
include:
Tests that show an image of the liver
Imaging
tests can check for tumours and blocked bile ducts. They also can be used to look at
liver size and blood flow through the liver. These tests include:
Other tests
Other tests also may be done to
confirm cirrhosis or to look for possible complications. These
include:
Treatment Overview
No treatment will cure cirrhosis or repair
scarring in the liver that has already occurred. But treatment can sometimes
prevent or delay further liver damage. Treatment involves lifestyle changes, medicines, and regular doctor visits. In some cases, you may need surgery for treatment of complications from cirrhosis.
Lifestyle changes
Your doctor will recommend some lifestyle changes to help prevent further liver damage.
- Stop drinking alcohol. You need to quit
completely.
- Talk to your doctor about all of the medicines you take,
including non-prescription drugs such as acetaminophen (for example, Tylenol), ASA, ibuprofen (for example, Advil or
Motrin), and naproxen (Aleve). These could increase the risk of liver damage and bleeding.
- Get immunized (if you have not already)
against
hepatitis A and
hepatitis B,
influenza, and
pneumococcus.
- Begin following a low-sodium diet if
you have fluid buildup (ascites). Reducing your sodium intake can help prevent
fluid buildup in your belly and chest.
Treatment for complications of cirrhosis
Cirrhosis can cause other problems (complications) that need treatment with medicines or procedures. Complications include:
- Fluid buildup in the
belly (ascites). It can be deadly if it is not controlled.
Treatment can include:
- Bleeding from enlarged veins. Variceal bleeding in the digestive tract can be treated with:
- Changes in mental function. Encephalopathy may
occur when the liver cannot filter poisons from the bloodstream. As these toxins build
up in your blood, they can affect your brain function. You may need to:
- Eat a limited amount of protein. Too much protein can cause toxins to build up.
- Take
lactulose or antibiotics. These medicines help prevent the buildup
of ammonia and other toxins in the large intestine.
- Avoid sedative medicines, such as sleeping pills,
antianxiety medicines, and narcotics. These can make symptoms of encephalopathy
worse.
Follow-up visits
It's important to work with your doctor to watch your condition, especially because symptoms may not start until a problem has
become severe. In addition to regular checkups and lab tests,
you will also need periodic screening for enlarged veins (varices) and liver cancer
(hepatocellular carcinoma).
- The American College of Gastroenterology
recommends testing for varices with endoscopy for all people who have
been diagnosed with cirrhosis. This recommendation is also followed in Canada. If your initial test does not find any varices, you can be
tested again in 2 to 3 years. If you already have large varices, you may need
more frequent testing and treatment with beta-blocker medicines to try to
prevent future bleeding episodes.1
- Testing to check for liver cancer usually takes place every 6
months. You will likely have a test for alpha-fetoprotein
and a liver ultrasound or a magnetic resonance imaging test (MRI).
Liver transplant
Receiving a liver from an organ donor (liver transplant) is the only
treatment that will restore normal liver function and cure
portal hypertension. A liver transplant is usually
considered only when liver damage is severe and threatening your life.
Before your
condition becomes severe, you may want to talk to your doctor about whether you will be a good candidate for a
liver transplant if your disease becomes advanced.
Liver transplant surgery is
very expensive. You may have to wait a long time for a transplant, because so
few organs are available. Even if a transplant occurs, it may not work. With these things in mind, doctors must decide who will benefit
most from receiving a liver. Good candidates include those who have not abused alcohol or illegal drugs
for the previous 6 months and those who have a good support system of family and friends.
Talk to your doctor about what steps you
can take now to improve your overall health so that you can increase your
chances of being considered a good candidate.
Hospice palliative care
If your cirrhosis gets worse, you
may want to think about
hospice palliative care. This is a kind of care for
people who have illnesses that do not go away and often get worse over time. Hospice palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit.
For more information, see
the topic
Hospice Palliative Care.
End-of-life issues
If you have not already made
decisions about the issues that may arise at the end of life, consider doing so
now. Many people find it helpful and comforting to state their health care
choices in writing (with an advance directive such as a living will) while they
are still able to make and communicate these decisions. You may also think
about who you would choose as your health care agent to make and carry out
decisions about your care if you were unable to speak for yourself.
A time may come when
your goals change from treating or curing an illness to maintaining comfort and
dignity. Hospice palliative care health
professionals can provide hospice palliative care and comforting surroundings for
someone who is preparing to die.
For more information, see the
topic
Hospice Palliative Care.
Home Treatment
Lifestyle changes may reduce symptoms
caused by complications of the disease and may slow new
liver damage.
Giving up alcohol
If you are
diagnosed with cirrhosis, it is extremely important that you stop drinking
alcohol completely, even if alcohol was not the cause of your cirrhosis. If you
don't stop, liver damage may quickly become worse. For information about how
to quit drinking, see
Alcohol: Drinking and Your Health.
Changing your diet
You may need to limit the amount of salt or protein you
eat.
If your body is retaining fluid, the most important
dietary change you need to make is to reduce your sodium intake. You do this by reducing the
amount of salt in your diet. People with liver damage tend to retain sodium.
This can make fluid build up in your belly (ascites).
Healthy Eating: Eating Less Sodium- Low-Salt Diets: Eating Out
If you are at risk for altered mental function (encephalopathy) because of advanced liver disease,
your doctor may want you to limit the amount of protein you eat for a while.
You will still need protein in your diet to be well nourished. But you may need
to get most of your protein from vegetable sources (rather than animal sources).
And you may need to avoid eating large amounts of protein at one time.
Avoiding harmful medicines
Some medicines should
be used carefully or not taken by people who have cirrhosis. For example,
acetaminophen (such as Tylenol) can speed up liver damage.
ASA and other non-steroidal anti-inflammatory drugs (NSAIDs)—for example, ibuprofen (such as Motrin or Advil) and naproxen (Aleve)—increase the risk of
variceal bleeding if you have enlarged veins (varices)
in the digestive tract. NSAIDs can also raise your risk for ascites. Talk to your doctor or pharmacist about what medicines
are safe for you.
Certain prescription medicines used to treat
other conditions may be harmful if you have cirrhosis. Make sure your doctor
knows all the medicines (including all non-prescription medicines, vitamins, herbs, and supplements) that you are taking.
Improving your general health
Taking other steps
to improve your overall health may help you cope with the symptoms of
cirrhosis.
- Stop smoking. Quitting tobacco use will
improve your overall health, which may help make you a better candidate for a
liver transplant if you need one.
- Your doctor may encourage you to
take a multivitamin. Don't take one containing extra iron unless your doctor
tells you to. And don't take an iron supplement unless your doctor recommends it.
- Brush and floss
your teeth daily to avoid dental problems that could lead to infection (abscess). Be gentle when you floss so you don't make
your gums bleed.
- Make sure you have been vaccinated against:
Using complementary and alternative medicines wisely
In general, you should avoid most herbal and other supplements, which may
make liver disease worse.
Kava is particularly bad for people who have liver
problems.
Limited research has shown that the herbal supplement
milk thistle may help protect the liver, but other research has not shown a
benefit.2 Milk thistle will not reverse existing liver
damage, and it will not cure infection with the hepatitis B or hepatitis C
virus. Milk thistle should not be used by people who have complications from cirrhosis (such as variceal bleeding or ascites). Talk to your doctor about whether you should try milk thistle (or any
other alternative treatment).
Other Places To Get Help
Organizations
| Canadian Centre on Substance Abuse |
| 75 Albert Street |
| Suite 500 |
| Ottawa, ON K1P 5E7 |
| Phone: | (613) 235-4048 |
| Fax: | (613) 235-8101 |
| Email: | info@ccsa.ca |
| Web Address: | www.ccsa.ca |
| |
The Canadian Centre on Substance Abuse (CCSA) is an independent
national organization working to reduce health, social, and economic harm
associated with substance abuse and addictions. The centre promotes informed
debate on substance abuse issues and supports organizations seeking to prevent
or treat substance abuse. |
|
| Canadian Digestive Health Foundation |
| Web Address: | www.cdhf.ca |
| |
The Canadian Digestive Health Foundation provides
educational information about digestive diseases and supports research into
their causes and treatment. |
|
| Canadian Liver Foundation |
| 2235 Sheppard Avenue East |
| Suite 1500 |
| Toronto, ON M2J 5B5 |
| Phone: | (416) 491-3353
1-800-563-5483 |
| Fax: | (416) 491-4952 |
| Email: | clf@liver.ca |
| Web Address: | www.liver.ca |
| |
The Canadian Liver Foundation funds medical research and offers
education and support programs for liver disease patients, their families and
friends, health professionals, and the general public. |
|
| Health Canada |
| Web Address: | www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php |
| |
Canada's Food Guide provides resources to help guide food selection and promote the nutritional health of Canadians. Resources include outlines of the food groups, the recommended range of daily servings, background information about the food guide, and other information about healthy eating. |
|
| U.S. National Digestive Diseases Information Clearinghouse |
| 2 Information Way |
| Bethesda, MD 20892-3570 |
| Phone: | 1-800-891-5389 |
| Fax: | (703) 738-4929 |
| TDD: | 1-866-569-1162
toll-free |
| Email: | nddic@info.niddk.nih.gov |
| Web Address: | www.digestive.niddk.nih.gov |
| |
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
|
|
References
Citations
- Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086–2102.
- Milk thistle (2005). Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted
- Angulo P, Lindor KD (2010). Primary biliary
cirrhosis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1477–1488.
Philadelphia: Saunders.
- Talwalkar JA, Lindor KD (2006). Primary biliary
cirrhosis. In M Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 579–587. Philadelphia: Saunders Elsevier.
- Bacon BR (2012). Cirrhosis and its
complications. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2592–2602. New York:
McGraw-Hill.
- Bataller R (2008). Cirrhosis of the liver. In EG Nabel, ed., ACP Medicine, section 4, chap. 9. Hamilton, ON: BC Decker.
- Carithers RL, McClain CJ (2010). Alcoholic liver
disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1383–1400.
Philadelphia: Saunders.
- Swain MG (2011). Chronic liver disease. In C Repchinsky,
ed., Therapeutic Choices, 6th ed., pp. 764–781.
Ottawa: Canadian Pharmacists Association.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Brian D. O'Brien, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | W. Thomas London, MD - Hepatology |
|---|
| Last Revised | March 14, 2012 |
|---|
