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(Saturday, 1st Nov, 2014)
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Cirrhosis of the liver

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Cirrhosis

What is cirrhosis?

Cirrhosis is the end result of a number of diseases of the liver, where normal cells are replaced by scar tissue, leading to abnormalities in the liver's ability to handle drugs and toxins. The liver’s main function is in digestion, where it metabolises carbohydrates, fats and proteins from the broken down food and it produces bile which contains a variety of enzymes and aids digestion. Cirrhosis is accompanied by jaundice (yellowing of the skin), itching and fatigue.

What causes cirrhosis?

  • Excessive alcohol intake.
  • Viral liver disease: Hepatitis B and C are associated with cirrhosis.
  • Primary biliary cirrhosis is a liver disease caused by an abnormality of the immune system, which leads to a lack of bile production, resulting in decreased adsorption of calcium and vitamin D.
  • Primary sclerosing cholangitis is a rare disease associated with ulcerative colitis, where bile ducts are obstructed.
  • Errors of metabolism e.g. Haemochromatosis where an inherited disorder of enzyme production results in the accumulation of iron to toxic levels in the liver, which damage tissue and lead to cirrhosis.
  • Autoimmune hepatitis is where the immune system works against the liver.
  • Other causes include; an unusual reaction to drugs, chronic heart failure, exposure to toxins.
  • Surgery to remove gallstones may result sometimes inadvertently cause bile duct blockage, leading to cirrhosis.

What are the symptoms of cirrhosis?

  • Non-specific symptoms such as fatigue, weakness and loss of appetite.
  • Stools which are very light in colour, or bloodstained.
  • Fluid accumulation in the legs.
  • Vomiting blood and black tarry stool.
  • Extreme sensitivity to medications and alcohol.
  • Intense itching.
  • Jaundice (yellowing of the skin and whites of the eye).
  • Fever, nausea and vomiting.
  • Abdominal pain.
  • Bruising easily.
  • Kidney failure.

How is cirrhosis diagnosed?

  • A physical examination may indicate the disease.
  • Evidence of jaundice (yellowing of the skin).
  • X-ray of the liver may be taken.
  • A biopsy may be required, where a piece of the organ tissue is removed for examination.
  • Various blood tests, which can check for the presence of abnormal antibodies and copper, elevated iron levels.

How is cirrhosis treated?

  • Treatment depends on the stage of the disease.
  • Avoid excessive consumption of alcohol.
  • Autoimmune hepatitis requires immunosuppressive drugs.
  • For haemochromatosis, one pint of blood may be removed per week, to keep iron levels under control.
  • Surgery may be required to unblock an obstructed bile duct.
  • If a virus is responsible for liver damage, anti-viral treatment may be prescribed.
  • The effects of fluid accumulation can be reduced by avoiding salt in the diet.
  • Drugs may be prescribed to reduce swelling and itching.
  • Dietary changes may be helpful, such as decreasing protein and increasing fat-soluble vitamins.
  • A liver transplant may be required, in severe cases.

Can I prevent cirrhosis?

  • The easiest way to prevent it is to avoid excessive alcohol. Drink in moderation, not exceeding 21 units of alcohol per week for a man or 14 units per week for a woman. A unit of alcohol is one measure of spirits, one half pint of beer or larger or one glass of wine.
  • Eat a well balanced diet.
  • Consider taking vitamin supplements only if your diet is restricted as the fat soluble vitamins A,D,E&K which are dependent on liver metabolism can be harmful if taken in excess.
  • Take the necessary precautions when using chemicals at home, at work or in the garden, wear protective gloves, goggles, mask & clothes, and open windows to avoid inhalation.

What does the future hold?

This depends on the stage and cause of cirrhosis. If damage is not too severe, the liver can regenerate. Many people live for years with cirrhosis. Liver transplant has a high success rate.

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