Cirrhosis is a chronic, irreversible liver disease. It is caused by repeated damage to the liver, most commonly due to excessive alcohol intake over several years. Ultimately, the liver tissue is destroyed and unable to complete its normal functions, which include synthesis of various molecules and processing of foods, drugs, and toxins.
The majority of cases are due to chronic alcohol use or viral hepatitis, especially hepatitis C. However, any chronic liver disease can lead to cirrhosis.
The initial symptoms include weight loss, anorexia, fatigue, weakness, nausea, dull abdominal pain, and constipation or diarrhea. As the disease progresses, symptoms become more severe and may include jaundice (a yellow discoloration of the skin), gynecomastia (excessive growth of men's breasts), shrinkage of the testicles, bruising, poor blood coagulation, ascites (fluid accumulation in the abdomen), and peripheral edema (fluid accumulation in the legs).
Complications of advanced disease can be fatal. Because the damaged liver is unable to neutralize toxic substances, particularly ammonia, a buildâ€“up of toxins in the bloodstream can cause a condition called hepatic encephalopathy, resulting in delirium, lethargy, confusion, slurred speech, hallucinations, and coma. In addition, the damaged liver loses its ability to produce clotting proteins, which can contribute to uncontrolled bleeding. Further, infection, kidney failure, and liver cancer are far more common in these patients.
- Chronic alcohol abuse: As little as two drinks per day for women or four drinks per day for men, ingested over 10 years or more, can cause cirrhosis. Alcoholic liver disease results in 12,000 deaths per year in the United States. Unfortunately, many patients become symptomatic only after severe liver disease has occurred.
- Unprotected intercourse: Hepatitis B and C infections are easily transmitted through unprotected sexual intercourse.
- Intravenous drug use: Hepatitis B and C transmission is also common through intravenous drug use.
- Inherited or acquired chronic liver disease: Hemochromatosis, Wilson's disease, and autoimmune hepatitis are strong risk factors for cirrhosis.
Cirrhosis: Diagnosis and Treatment
- History and physical examination should include a special focus on alcohol use, exposure to toxins, intravenous drug abuse, blood transfusions, history of viral infections, the presence of tattoos, and the characteristic symptoms of cirrhosis.
- Blood tests can reveal abnormal liver function early in the course of disease. As the disease progresses, blood tests become more abnormal.
- Abdominal CT scan and ultrasound are usually the first tests to evaluate the liver. They can demonstrate the abnormal liver architecture that occurs in cirrhosis and can identify complications of the disease, such as ascites (abnormal abdominal fluid collection) and liver cancer.
- Ultimately, liver biopsy provides a definitive diagnosis. It is not always necessary, especially when cirrhosis is strongly suspected by history and testing.
- Further tests, such as endoscopy, may be required to diagnose the complications of cirrhosis as they arise. During endoscopy, a thin tube with a camera on its end is slowly advanced through the mouth and into the throat and stomach. This procedure is able to identify bleeding and other disorders.
Cirrhosis is irreversible. Treatment is aimed at slowing the progression of the disease, preventing and treating complications, and, if possible, providing a cure through liver transplantation.
- The cause of cirrhosis should be identified and treated. Strict alcohol avoidance is necessary in alcoholics. Avoid medications or drugs that are toxic to the liver, such as acetaminophen (Tylenol). Patients with viral hepatitis should be treated with appropriate antiviral therapies.
- It is also critical to prevent and treat cirrhosis complications. Bleeding in the esophagus is a medical emergency that requires immediate treatment with endoscopy or intravenous medications. Patients with hepatic encephalopathy may benefit from lactulose. Patients with ascites can manage their condition with sodium restriction, diuretics, and antibiotics. In advanced cases of ascites, paracentesis, a procedure to remove abnormal fluid from the abdomen, may be necessary.
- All patients with cirrhosis require regular screening for the development of liver cancer. This can be done by blood tests and ultrasound.
- Ultimately, liver transplantation is the only potential cure. Transplantation is an option for appropriate patients with advanced disease. However, transplantation is contraindicated in patients who continue to use alcohol or drugs. It is also contraindicated in patients who are unsuitable for surgery due to heart or lung disease.
Cirrhosis: Nutritional Considerations
sodium-restricted diet is standard treatment: A sodium-restricted diet (limiting sodium to 2,000 milligrams per day) has been shown to improve survival in patients with cirrhosis. Consultation with a dietician can help patients identify foods that are high in sodium and find appropriate alternatives.
- Limited dietary fat intake: High-fat diets are associated with increased risk for cirrhosis in patients with liver disease, and several studies have concluded that excess dietary fat (including total fat, saturated fat, and polyunsaturated fat) may encourage cirrhosis progression.
- A vegetarian diet may significantly improve symptoms of hepatic encephalopathy. Plant-based diets have more dietary fiber, which may reduce hepatic encephalopathy by removing toxic ammonia from the body. Vegetable protein sources are also higher in arginine, an amino acid that decreases blood ammonia levels, and they are lower in methionine and tryptophan, amino acids that increase the risk of hepatic encephalopathy.
- A diet high in vitamin A, antioxidants, and B-vitamins may reduce the risk for cirrhosis and liver cancer. Cirrhotic patients appear to have significant reductions in antioxidants in their blood. The best way to supplement the body with antioxidants is to eat plenty of fruits, vegetables, and whole grains. However, since many patients have poor appetites, they are likely to benefit from a daily multivitamin that meets 100 percent of the dietary allowance for all vitamins and minerals.
- Probiotic supplementation may improve hepatic encephalopathy. Probiotics are the "healthy bacteria" present in probiotic supplements and some foods, including some soy yogurts. Probiotics may decrease the blood concentrations of toxic ammonia that causes hepatic encephalopathy and may decrease the risk of life-threatening infections.
- Supplementation with branched-chain amino acids may be helpful in patients with hepatic encephalopathy. These supplements can be found at health food stores.