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Cirrhosis

Definition:

Cirrhosis is a condition in which there is scarring of the liver that can result in abnormal liver function and long term damage to the liver.

Causes

  • Alcohol- Alcoholic liver disease is a very common cause of liver damage that has 3 stages: a) fatty alcoholic liver, b) alcoholic hepatitis, 3) cirrhosis.  The damage to the liver from alcoholic fatty liver or hepatitis may be reversible if alcohol use is stopped. However, alcoholic hepatitis can be very serious, resulting in liver failure and death. Once cirrhosis is present, the damage is permanent.
  • Chronic viral hepatitis- Viral hepatitis can be caused by several viruses including hepatitis A, B, and C that infect the liver and create inflammation and potentially liver damage. Chronic hepatitis is an infection that lasts longer than 6 months.
  • Chronic bile duct blockage: Primary Biliary Cirrhosis (PBC) and Primary Sclerosing Cholangitis (PSC) are two (2) forms of cholestatic (stasis of bile flow) liver diseases which involve the bile ducts. The cause of these disorders is uncertain, but is thought to be related to a problem with the immune system attacking the bile ducts. PBC is most often detected in middle-aged women. Itching may be a presenting symptom. Medication can help impair the progression of liver damage. PSC is more commonly found in young adults to middle-aged men. Patients often have underlying inflammatory bowel disease. The diagnosis is made by a cholangiogram that involves taking an x-ray picture of the large bile ducts after dye is injected.
  • Abnormal storage of copper (Wilson’s disease) - Wilson's disease is a disorder of copper metabolism that most often presents in individuals less than 45 years of age. Excessive copper is deposited in the liver and other organs, resulting in damage. With early detection and medication to bind the copper, liver damage is preventable.
  • Drugs and Toxins-Medications, sometimes, may cause liver disease. The extent of liver injury may vary widely from mild hepatitis to severe injury. Drug reactions will rarely cause acute liver failure. Acetaminophen, present in many pain medications, may cause liver damage if taken in large doses or mixed with alcohol. When a drug-induced liver injury is recognized, the medication should be stopped immediately. In most cases, if the problem is detected promptly, the liver is able to recover.
  • Autoimmune Hepatitis-Autoimmune Liver Disease is a disorder in which a person's immune system attacks the liver and causes liver damage, which can progress from hepatitis to cirrhosis. Females are more often affected than males. The diagnosis can usually be made by blood tests and liver biopsy.
  • Cystic Fibrosis and Alpha 1-antitrypsin Deficiency
  • Non-alcoholic steatohepatitis (NASH) - Although the exact cause of NASH is not known it is often occurs in patients that have fatty liver conditions. Fatty Liver is a very common cause of abnormal liver blood tests. If fat accumulates inside liver cells (hepatocytes), the cells may become irritated or inflamed. This may produce elevated or abnormal liver enzymes. Although fatty liver is often a benign process, in some individuals, it can cause hepatitis and even advance to cirrhosis. Certain conditions such as being overweight, having diabetes mellitus, high cholesterol or fat content in the blood may be risk factors for fatty liver. There are no specific blood tests to make the diagnosis. Often, it is necessary to perform blood tests to exclude other conditions that may cause hepatitis.

Signs and Symptoms:

Diagnosis and liver biopsy:

Evaluation of the liver can be done by history and physical examinations, blood tests and radiographic tests (x-rays, ultrasound and CT scans). Another important method to assess the liver is to perform a liver biopsy. This involves removing one or more very small pieces of the liver by needle biopsy. A physician at the patient's bedside or radiologist using ultrasound to guide the direction of the biopsy may perform the biopsy.

Prevention-Much attention is given to liver disease -

as it should be. Your liver is a vital organ. But liver wellness and disease prevention are very important! What can a person do to keep his or her liver working well? There are several things that are simple, but helpful. Proper nutrition with a good, balanced diet, low in fat and cholesterol is important. Maintaining ideal body weight and exercise are helpful also. Avoiding damaging the liver by too much alcohol and abstaining from drug abuse and unsafe sexual practices, which may expose a person to viruses and other illnesses, is essential. There are now vaccines for hepatitis A and B that can control the spread of these viruses. Patients with cirrhosis should be vaccinated against hepatitis A and B.

Treatment:

Treatment for liver disease is based on the under lying cause of the problem.

Liver Transplant:

Patients are examined by a team of specialist to determine if a liver transplant is appropriate and likely to succeed. If so they are placed on a national transplant waiting list. This waiting list is prioritized by the sickest people and those who meet transplant criteria

Summary:

Cirrhosis is an advanced stage of liver disease with liver damage present. Cirrhosis requires ongoing physician evaluation and treatment.

Organizations

American Gastroenterological Association
www.gastro.com

American College of Gastroenterology
www.acg.gi.org

American Liver Foundation
www.liverfoundation.org

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