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Cirrhosis

  • Definition
    • Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.

  • Alternative Names
    • Liver cirrhosis; Chronic liver disease; End-stage liver disease; Liver failure - cirrhosis; Ascites - cirrhosis

  • Causes
  • Symptoms
    • There may be no symptoms, or symptoms may come on slowly, depending on how well the liver is working. Often, it is discovered by chance when an x-ray is done for another reason.

      Early symptoms include:

      • Fatigue and loss of energy
      • Poor appetite and weight loss
      • Nausea or belly pain
      • Small, red spider-like blood vessels on the skin

      As liver function worsens, symptoms may include:

      • Fluid buildup of the legs (edema) and in the abdomen (ascites)
      • Yellow color in the skin, mucous membranes, or eyes (jaundice)
      • Redness on the palms of the hands
      • In men, impotence, shrinking of the testicles, and breast swelling
      • Easy bruising and abnormal bleeding, most often from swollen veins in the digestive tract
      • Confusion or problems thinking
      • Pale or clay-colored stools
  • Exams and Tests
  • Treatment
    • LIFESTYLE CHANGES

      Some things you can do to help take care of your liver disease are:

      • Drink no alcohol.
      • Eat a healthy diet that is low in salt.
      • Get vaccinated for diseases such as influenza, hepatitis A and B, and pneumococcal pneumonia.
      • Talk to your provider about all medicines you take, including herbs and supplements and over-the-counter medicines.

      MEDICINES FROM YOUR DOCTOR

      • Water pills (diuretics) to get rid of fluid build-up
      • Vitamin K or blood products to prevent excess bleeding
      • Medicines for mental confusion
      • Antibiotics for infections

      OTHER TREATMENTS

      When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

  • Support Groups
    • You can often ease the stress of illness by joining a liver disease support group whose members share common experiences and problems.

  • Outlook (Prognosis)
    • Cirrhosis is caused by scarring of the liver. In most cases, the liver cannot heal or return to normal function once damage is severe. Cirrhosis can lead to serious complications.

  • Possible Complications
    • Complications may include:

      • Bleeding disorders
      • Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
      • Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
      • Increased pressure in the blood vessels of the liver (portal hypertension)
      • Kidney failure (hepatorenal syndrome)
      • Liver cancer (hepatocellular carcinoma)
      • Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)
  • When to Contact a Medical Professional
    • Call your provider if you develop symptoms of cirrhosis.

      Get emergency medical help right away if you have:

      • Abdominal or chest pain
      • Abdominal swelling or ascites that is new or suddenly becomes worse
      • A fever (temperature greater than 101°F or 38.3°C)
      • Diarrhea
      • Confusion or a change in alertness, or it gets worse
      • Rectal bleeding, vomiting blood, or blood in the urine
      • Shortness of breath
      • Vomiting more than once a day
      • Yellowing skin or eyes (jaundice) that is new or gets worse quickly
  • Prevention
  • References
    • Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the AmericanGastroenterological Association. Hepatology. 2012;55(6):2005-2023. PMID: 22488764 www.ncbi.nlm.nih.gov/pubmed/22488764.

      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(7):1802-1829. PMID: 19455106 www.ncbi.nlm.nih.gov/pubmed/19455106.

      Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

      Kamath PS, Shah VH. Overview of cirrhosis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 74.

      Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93(4):901-915. PMID: 19577121 www.ncbi.nlm.nih.gov/pubmed/19577121.

      O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;105(1):14-32. PMID: 19904248 www.ncbi.nlm.nih.gov/pubmed/19904248.