Cirrhosis—Scarring of the Liver

The liver is an organ that is vital for human survival. Blood travels from the stomach and intestines through the liver before reaching the rest of the body. In the liver, nutrients are removed and processed into usable forms. Toxins in the blood are detoxified in the liver. Medications are processed and vitamins, minerals and sugars are stored. Cholesterol and factors that help the blood to clot are manufactured in the liver.

Cirrhosis is a disease in which normal liver tissue is replaced with scar tissue which cannot function in the same way that normal liver tissue does. This process typically occurs as a consequence of another primary liver disease which may produce inflammation for months or years before leading to scar tissue and cirrhosis. As scar tissue gradually replaces healthy, functioning liver tissue, the liver loses its ability to perform its vital functions and cirrhosis can become life-threatening. Approximately 26,000 people in the United States die from cirrhosis every year.

The most important causes of cirrhosis in the United States are alcohol abuse and infection with hepatitis C. Not every alcoholic develops cirrhosis and alcoholic cirrhosis usually occurs after a decade or more of heavy drinking. Hepatitis C can be contracted from blood transfusions received before the early 1990s, shared needles from using intravenous drugs or tattoos, and, less commonly, by having sex with an infected person. It can take 20 years or more to develop cirrhosis from hepatitis C, but cirrhosis can develop much faster in people who are both infected with hepatitis C and drink heavily.

Nonalcoholic steatohepatitis (NASH) is an increasingly recognized cause of cirrhosis. It is found in people with long-standing obesity, diabetes mellitus and resistance to insulin. Primary sclerosing cholangitis and primary biliary cirrhosis are diseases of the bile ducts that lead to cirrhosis. Several inherited diseases also lead to cirrhosis.

Symptoms of cirrhosis may not appear until significant damage or scarring has taken place. Initial symptoms may include loss of appetite, fatigue, nausea and vomiting, and weight loss. Jaundice develops, in which the skin and whites of the eyes turn yellow. Ascites is the build-up of fluid in the abdominal cavity and is the most common complication of cirrhosis. It is caused by portal hypertension or increased pressure in the liver caused by scar tissue. Sometimes, the fluid in ascites can become infected, leading to spontaneous bacterial peritonitis – a disease which can be fatal if not treated promptly. Variceal hemorrhage can occur when portal hypertension leads to increased pressure in the thin-walled veins of the esophagus. The veins can burst, leading to rapid and life-threatening blood loss. In addition, sometimes people with cirrhosis can develop kidney or lung disease in previously healthy organs. Hepatic encephalopathy develops when toxins which could not be filtered by the diseased liver reach the brain. It can present with disturbing symptoms including confusion and coma. Finally, about five percent of people with cirrhosis develop cancer of the liver.

Cirrhosis is irreversible – the scar tissue already in the liver can never be returned to normal. However, the progress of the disease can be slowed or stopped. Most importantly, the underlying disease that caused cirrhosis should be treated. Drinking alcohol must be stopped completely. Hepatitis C can be treated with drugs. NASH can be treated with gradual weight loss. Many of the other causes of cirrhosis can also be treated with medication.

Certain medications including nonprescription pain relievers should be avoided. Dietary salt intake should be reduced to decrease fluid build-up such as ascites. You may need to be immunized against hepatitis A or B. People with cirrhosis should not eat raw oysters or shellfish because this can lead to severe infection.

Finally, the symptoms and complications of cirrhosis can often be treated with medications. Unfortunately, if too much scar tissue forms, your liver may fail. In this case, only a liver transplant can reverse your condition and save your life.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board-certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny and Pennsylvania Medical Societies. She is in solo practice in the North Hills.