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Chronic Liver Disease and Cirrhosis

What is Cirrhosis?

Cirrhosis is a progressive and irreversible liver disease in which healthy liver tissue is replaced with scar tissue, fibrosis, and nodules.

Cirrhosis is a serious and irreversible condition that prevents the liver from producing important proteins and processing nutrients, hormones, and drugs. While it is impossible to undo existing damage, it remains possible to delay or stop further harm.

To formulate a successful treatment plan, experienced physicians at Memorial Hermann consider each patient’s age, overall health, specific associated symptoms, family medical history, tolerance for certain treatments, and lifestyle.

All patients with cirrhosis can benefit from avoiding alcohol completely, eating nutritiously and receiving vaccinations for hepatitis A and B. If a patient’s cirrhosis has progressed to end-stage liver disease, physicians may recommend liver transplantation.

Causes of Cirrhosis

The causes of chronic liver disease and cirrhosis include:

  • Long-term infection of hepatitis B or C
  • Fatty liver disease (a condition associated with diabetes and obesity)
  • Long-term alcohol abuse
  • Bile duct disorders
  • Metabolic disorders
  • Autoimmune inflammation

Incidence

An estimated 400,000 Americans are affected by chronic liver disease, and 15-20% of these patients present symptoms of cirrhosis by the time they are diagnosed. Cirrhosis is the 12th leading cause of death in the United States.

Symptoms and Diagnosis

Mild cirrhosis occasionally causes no symptoms at all, and individual patients experience the symptoms of cirrhosis differently. These symptoms may include:

  • Abnormal nerve functioning
  • Ascites (fluid buildup in the abdominal cavity)
  • Hair loss
  • Gallstones
  • Poor appetite
  • Redness or curling of the palms
  • Salivary gland enlargement
  • Jaundice
  • Muscle loss
  • Poor appetite
  • Kidney failure
  • Weakness
  • Vomiting blood

Because the symptoms of chronic liver disease and cirrhosis are variable and can resemble the effects of other medical problems, it is very important that patients consult a physician for a proper and accurate diagnosis.

Complications

Patients with any of the below complications of cirrhosis require extensive follow-up and monitoring to control their symptoms and prevent further complications.

The experienced team of liver physicians at the Memorial Hermann Transplant Center individualize transplant and non-transplant treatment plans for patients with advanced liver disease to minimize complications, maximize survival, and improve quality of life.

Ascites

Ascites is fluid build-up inside the abdomen. The fluid accumulation may cause discomfort, pain, and breathing difficulties. Ascites can become infected, a condition called "spontaneous bacterial peritonitis", which requires antibiotic treatment. Ascites may require periodic drainage of the fluid, called paracentesis, or special procedures to help control the fluid.

Gastrointestinal Bleeding

Cirrhosis changes the normal blood drainage from the stomach and intestines, and can result in the development of abnormally-large blood vessels called "varices" in the esophagus and other locations. Sometimes these varices rupture internally; causing gastrointestinal bleeding (vomiting red blood or black/bloody stools). Treatment procedures are sometimes needed to treat the varices and prevent rupturing.

Jaundice

When blood cells are broken-down by the body as part of a normal process, the hemoglobin (red pigment) is transformed into bilirubin (yellow pigment). Bilirubin is normally cleared through the bile. In cirrhosis the liver may not clear bile correctly, causing the buildup of bilirubin. Bilirubin build-up results in a yellow color that is best seen in the white part of the eyes. This is called jaundice.

Hepatic Encephalopathy

When the liver does not clear toxins well, these toxins can build up in the body and cause lethargy, sleepiness, confusion, or even coma. These mental changes in liver disease are called "hepatic encephalopathy". Medications such as lactulose may be required to help control the symptoms of hepatic encephalopathy.

Primary Liver Cancer

This cancer can develop in livers with cirrhosis. Surveillance for primary liver cancer with either ultrasound or CT scan plus monitoring of a tumor marker called alfa-feto protein (AFP) is required at regular intervals.

Kidney Problems

When liver disease becomes advanced the kidneys may become affected and kidney function worsens. This may require admission to the hospital for proper treatment and even initiation of dialysis.

Lung Problems

When liver disease advances, the lungs may be affected with fluid accumulation (hepatic hydrothorax) causing shortness of breath. Impairment of the normal oxygenation called hepatopulmonary syndrome may occur.

Diagnosing Cirrhosis

To confirm cirrhosis, affiliated physicians employ a variety of diagnostic techniques based on the patient’s individual medical history and physical status.

Generally, cirrhosis of the liver is diagnosed through liver biopsy, a procedure in which tissue samples are removed from the liver (either through a needle or during surgery) for laboratory examination. Liver specialists may also call for:

  • Laboratory tests (special blood tests that measure liver functioning)
  • Cholangiograph (an X-ray examination of the bile ducts using dye contrast)
  • CT scan (a precise imaging procedure used to produce detailed images of specific parts of the body)
  • Ultrasound or sonography (an imaging technique that uses sound waves to create images and assess blood flow of a patient’s internal organs)

Treatment for Cirrhosis

At Memorial Hermann, we understand that psychological support is often necessary to help our patients with cirrhosis adjust to the lifestyle changes that are necessary to halt the progression of the disease.

We carefully monitor complications associated with chronic liver disease and cirrhosis (most often, bleeding disorders, hypertension, kidney failure, fluid buildup and infection) and provide patients with a full array of treatment options to help manage these conditions.

What is the Liver?

The liver, a vital organ located on the right side of the upper abdomen, is the largest and most complex solid organ in the body. When the liver does not function well many body systems are affected.

The normal functions of the liver include:

  • Metabolic Functions: The liver metabolizes nutrients, breaks down toxins and drugs, and generates glucose for energy.
  • Carbohydrates: The liver stores energy in the form of glycogen and generates glucose for energy.
  • Fat: The liver has a key role in the metabolism of fat and cholesterol.
  • Manufacturing of Proteins: The liver makes essential proteins including albumin, blood clotting factors, hormones, enzymes, and immune factors.
  • Bile Production: The liver produces bile that aids in digestion of dietary fat and provides clearance of waste products such as bilirubin.