When you hear the term cirrhosis, the first thing you may think of is alcoholism. While it is true that alcoholism is the leading cause of this liver disease, it is not only heavy drinkers that can come down with this condition. The liver is one of the most active organs in the body, so I believe it is important that we understand how it functions when it is healthy, and what can happen when it is not.
What is Cirrhosis?
Cirrhosis is a chronic degenerative disease that causes irreversible scarring of the liver. Normal liver cells are damaged, and replaced with scar tissue. As more healthy liver cells are affected, the liver progressively loses its ability to carry out its many important functions, such as filtering out harmful substances, purifying the blood, and producing critical nutrients. As swelling from scar tissue increases, the structure of the liver is affected, as well as the blood vessels that supply it with nourishment.
Cirrhosis is a prevalent and life-threatening illness. It is the seventh leading cause of disease-related death in the United States, and the third most common cause of death in individuals from 45-65 years of age. Cirrhosis takes the lives of over 25,000 people annually. The vast majority of cirrhosis cases, perhaps more than 80%, are the result of chronic alcoholism. More men than women suffer from cirrhosis, most likely because there are more males who are heavy drinkers than females.
What Causes Cirrhosis?
Our liver is an incredibly complex and versatile organ that performs hundreds of critical functions. It processes most of the nutrients absorbed from the intestine. Without a healthy liver, we cannot receive sufficient nutrition from the food we consume. The liver also acts as the body’s main filter to weed out drugs, alcohol, toxins, and other harmful and unnecessary substances from our bodies. It also is responsible for the manufacture of bile, a greenish fluid that is stored in the gallbladder, and is needed for the proper digestion of fats. It also produces cholesterol, a substance important in many processes, including healthy cell membranes and nervous system function.
When the liver is exposed to a constant barrage of poisons, such as alcohol and other drugs, tobacco smoke, and environmental toxins, it can become overtaxed, and may begin lose its ability to properly execute its many jobs. The liver is a workhorse, and it can take a lot of abuse, but eventually it begins to break down. Even then, it has the amazing capacity to heal and restore itself by repairing or replacing damaged cells. However, in individuals with cirrhosis, this restoration process malfunctions, and certain cells called stellate cells begin to multiply both in size and number. These abnormal cells are the source of the scar tissue that causes cirrhosis.
There are several main causes for cirrhosis of the liver:
- Alcohol abuse: As mentioned above, alcoholism is responsible for most cases of cirrhosis in the United States. Alcohol is particularly harmful, because when the liver encounters alcohol, it breaks it down into some very toxic chemicals that cause inflammation in the liver. When enough alcohol is consumed, especially on a constant basis for extended periods of time, the liver simply cannot keep up, and liver damage (cirrhosis) occurs. It usually takes about ten years of heavy drinking to cause cirrhosis, but this figure is different for different people. Some individuals have a higher tolerance for alcohol than others before liver damage will occur. Generally, most men can process 2-5 drinks of alcohol per day without damage, whereas in women the threshold may be as low as 1-2 drinks per day.
- Hepatitis: Chronic hepatitis type C is the second leading cause of cirrhosis. Hepatitis related cirrhosis is one of the most deadly kinds. Nearly 25% of folks with hepatitis C will develop cirrhosis, although it may take up to 20 years. Many of these cases will eventually progress to the point of liver failure or liver cancer. Cirrhosis and hepatitis C is a lethal combination. Hepatitis B is also associated with cirrhosis, but it is much less common than type C.
- Toxic exposure: Heavy metals such as mercury, lead, or arsenic can damage the liver over time, and lead to cirrhosis. We may be exposed to these substances through the air we breathe, the water we drink, or from certain contaminated foods. Public water systems use chemicals to treat the water, such as chlorine, which can put a strain on the liver. Watch the amount of fish you eat as well. Too much can expose you to unhealthy levels of mercury and other toxins.
- Autoimmune hepatitis: Autoimmune diseases occur when the immune system mistakenly attacks healthy tissues as if they were antigens to be destroyed. When this occurs in the liver, it is called autoimmune hepatitis, and also becomes a cause for cirrhosis. This is very common in individuals who also have other autoimmune diseases, such as ulcerative colitis, Grave’s disease, or chronic fatigue syndrome. Autoimmune hepatitis can be life threatening, as the severe inflammation often leads to significant cirrhosis and liver failure.
- Nonalcoholic fatty liver disease: Also known as nonalcoholic steatohepatitis, is associated with fat accumulation in the liver which leads to inflammation and possible cirrhosis. This relatively rare form of liver disease is found most often in diabetics and obese people who have abnormally high levels of fats in their blood.
- Inherited diseases: Certain diseases that are genetically passed on can cause significant liver damage and associated cirrhosis. Some of the more common ones are cystic fibrosis, Wilson’s disease (causes abnormal accumulations of copper in the liver), andhereditary hemochromatosis (abnormally high iron levels in the liver).
- Bile duct dysfunction: One of the functions of the liver is to produce bile, a substance involved in the digestion of fats. Normally, the bile is manufactured by the liver and transported through thin tubes called “bile ducts” into the gallbladder and small intestine where it is stored until needed. Certain conditions can cause the bile ducts to become inflamed or obstructed, causing bile to back up into the liver. This causes inflammation, and results in cirrhosis in the liver. This can also happen as a complication from surgery on the liver, gallbladder, or bile ducts. Even newborns can develop cirrhosis if their bile ducts are blocked or missing at birth, a condition known as biliary atresia.
What Are the Symptoms of Cirrhosis?
Cirrhosis is a chronic disease that can progress over many years. Often, in the early stages, there are no apparent symptoms. However, as more healthy liver tissue is replaced by scar tissue, the liver cannot continue to function efficiently, and signs begin to appear. Some of the typical ones include:
- Red palms (often one of the first signs of cirrhosis)
- Poor appetite
- Weight loss
- Abdominal pain (a dull ache)
- Intense itching (especially on the hands and feet, and eventually spreading to the whole body, due to bile salts in the skin.)
- Easy bruising
- Small, red “spider” veins (under the skin)
- Lowered libido
- Edema (swelling in the legs and feet from fluid accumulation)
- Cognitive problems (confusion, memory loss, inability to concentrate)
What Are the Possible Complications of Cirrhosis?
There are many possible complications from cirrhosis. The liver is involved in multiple bodily functions, so when it isn’t operating properly, many other organs can suffer. Some of the more serious complications are as follows:
- Hepatic encephalopathy: This occurs when the liver is no longer able to filter out toxins efficiently, and they begin build up. Ammonia is one of the biggest offenders. Ammonia is a byproduct of protein digestion, and can be very toxic when it is allowed to accumulate. Excess ammonia can cause brain damage and cognitive changes in behavior and personality. Hepatic encephalopathy can exhibit symptoms such as confusion, mood swings, forgetfulness, and slurred speech. It can also advance to the point where it may cause delirium, coma, and eventually death.
- Jaundice: If the liver becomes unable to remove the debris left by old red blood cells—a substance called bilirubin—it begins to build up in the blood. It eventually leaches into the skin and the whites of your eyes, turning them yellow. Jaundice also causes the urine to sturn “cola-colored,” and stools to resemble pale clay. Jaundice is a red flag for advanced cirrhosis and serious liver disease.
- Bruising and internal bleeding: Another liver function that cirrhosis interferes with is the production of vitamin K and certain proteins that are involved in blood clotting. When this process breaks down, bleeding (and bruising) can become a real problem. This can be especially dangerous when bleeding occurs in the esophagus or intestinal tract. Sometimes hemorrhaging can be life threatening.
- Liver cancer: Cirrhosis increases the risk of liver cancer, which involves the growth of malignant cells in the tissues of the liver. The prognosis is not very positive for the treatment of liver cancer.
- Liver failure: This occurs when the liver is so damaged, that it ceases to function. A transplant is the only hope for a patient with liver failure.
What Treatments Are Available for Cirrhosis?
The damage from cirrhosis is irreversible, but there is hope for some patients to prevent further damage, and avoid complications.
- Alcoholic cirrhosis can often be arrested simply by the patient making the decision to totally abstain from alcohol. I say simply, but it is actually not that simple. Years of addiction to alcohol can be an extremely difficult pattern to break. However, that is the first hurdle in treatment. The next consideration would be nutritional. Most alcoholics suffer from chronic malnutrition. A major part of the recovery process is teaching the patient how to eat properly and maintain a diet that will aid in the short term recovery process, and develop good long term nutritional habits as well.
- Patients with other forms of cirrhosis, such as hepatitis related, must also deal with the underlying condition if they want to regain as much of their health as possible.
- Patients recovering from cirrhosis must take extra care to avoid infections if at all possible. When the liver is compromised, especially in the case of autoimmune hepatitis, patients are much more susceptible to serious infections. One tip: Avoid consuming raw shellfish. It may contain a bacterium called vibrio vulnificus, which can cause dangerous infections in cirrhosis patients.