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Cirrhosis is the severe scarring of the liver and poor liver function seen at the terminal stages of chronic liver disease. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections. The liver is located in the upper right side of the abdomen below the ribs. It has many essential body functions. These include:
According to the National Institutes of Health (NIH), cirrhosis is the 12th leading cause of death due to disease in the United States. It’s more likely to affect men than women.
The liver is a very hardy organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and scarred. A scarred liver can’t function properly, and ultimately this may result in cirrhosis.
Cirrhosis causes the liver to shrink and harden. This makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. The portal vein carries blood from the digestive organs to the liver. The pressure in the portal vein rises when blood can’t pass into the liver. The end result is a serious condition called portal hypertension, in which the vein develops high blood pressure. The unfortunate consequence of portal hypertension is that this high-pressure system causes a backup, which leads to esophageal varices (like varicose veins), which can then burst and bleed.
The most common causes of cirrhosis in the United States are long-term viral hepatitis C infection and chronic alcohol abuse. Obesity is also a cause of cirrhosis, although it is not as prevalent as alcoholism or hepatitis C. Obesity can be a risk factor by itself, or in combination with alcoholism and hepatitis C.
According to the NIH, cirrhosis can develop in women who drink more than two alcoholic drinks per day (including beer and wine) for many years. For men, drinking more than three drinks a day for years can put them at risk for cirrhosis. However, the amount is different for every person, and this doesn’t mean that everyone who has ever drunk more than a few drinks will develop cirrhosis. Cirrhosis caused by alcohol is usually the result of regularly drinking more than these amounts over the course of 10 or 12 years.
Hepatitis C can be contracted through sexual intercourse or exposure to infected blood or blood products. It’s possible to be exposed to infected blood through contaminated needles of any source, including tattooing, piercing, intravenous drug abuse, and needle sharing. Hepatitis C is rarely transmitted by blood transfusion in the United States due to rigorous standards of blood bank screening.
Other causes of cirrhosis include:
The symptoms of cirrhosis occur because the liver is unable to purify the blood, break down toxins, produce clotting proteins, and help with absorption of fats and fat-soluble vitamins. Often there are no symptoms until the disorder has progressed. Some of the symptoms include:
More serious symptoms include:
A diagnosis of cirrhosis begins with a detailed history and physical exam. Your doctor will take a complete medical history. The history may reveal long-term alcohol abuse, exposure to hepatitis C, family history of autoimmune diseases, or other risk factors. The physical exam can show signs such as:
Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:
Additional tests that can evaluate the liver include:
If your blood is unable to pass through the liver, it creates a backup through other veins such as those in the esophagus. This backup is called esophageal varices. These veins are not built to handle high pressures, and begin to bulge from the extra blood flow.
Other complications from cirrhosis include:
Treatment for cirrhosis varies based on what caused it and how far the disorder has progressed. Some treatments your doctor might prescribe include:
Liver transplantation is an option of last resort, when other treatments fail.
All patients must stop drinking alcohol. Medications, even over-the-counter ones, should not be taken without consulting your doctor.
Practicing safe sex with condoms can reduce the risk of getting hepatitis B or C. The U.S. Centers for Disease Control and Prevention recommend that all infants and at-risk adults (such as healthcare providers and rescue personnel) be vaccinated against hepatitis B.
Becoming a nondrinker, eating a balanced diet, and getting adequate exercise can prevent or slow cirrhosis. The World Health Organization reports that only 20 to 30 percent of people infected with hepatitis B will develop cirrhosis or liver cancer. The National Institute of Health reports that 5 to 20 percent of people infected with hepatitis C will develop cirrhosis over a period of 20 to 30 years.
Written by: The Healthline Editorial Team
Medically reviewed on: Oct 19, 2015: Steven Kim, MD
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