Medically reviewed by Daniel Murrell, M. Many things can eventually lead to cirrhosis, including: chronic alcohol consumption autoimmune hepatitis chronic hepatitis C infections nonalcoholic fatty liver disease poorly formed bile ducts cystic fibrosis Cirrhosis is a progressive disease, meaning it gets worse over time.
How is life expectancy determined? What do the scores mean for life expectancy? Score Three-month mortality risk Less than 9 1.
Is there anything that can increase life expectancy? How can I cope with a cirrhosis diagnosis? The bottom line. Read this next. Battling the Stress of Living with Chronic Illness. Medically reviewed by Timothy J. Legg, Ph.
Decompensated Cirrhosis. Binge Drinking Causing Increase in Liver Disease Among Millennials Experts say the excessive drinking among younger adults can also damage their pancreas, heart, and brain.
Child-Pugh Score. Testing Options Until recently, liver biopsy was the only way doctors could determine the stage and degree of liver damage.
Today, there are both blood and imaging tests that can determine liver damage. This is a brief overview of different types of tests your doctor may discuss with you. Understanding Liver Biopsy Results Understanding the results of these different tests can be a challenge.
Healthcare providers use different scales to define the stages of liver damage. Common scales used to grade a liver biopsy are explained here. Most scoring systems examine the impact of fibrosis on the portal vein which brings blood from the intestines and the location and number of septa connecting bands of scars.
If you have cirrhosis or are in the final stage before cirrhosis, please speak with your doctor about liver cancer screenings. This imaging test is not invasive. By measuring the stiffness of the liver your doctor can detect both scarring and fatty change in the liver. Your CAP score is a measurement of fatty change in your liver. Fatty change steatosis is when fat builds up in your liver cells. Your doctor will use your CAP score to grade how much fatty change has happened in the liver.
The table here shows ranges of CAP scores, the matching steatosis grade, and the amount of liver with fatty change. Reliability of Test Scores This table shows liver diseases, ranges of fibrosis results, and the matching fibrosis score. The ranges of fibrosis results in the table are estimates. Your actual fibrosis score may not match the fibrosis score in the table. If you have more than one liver disease you may not be able to use this table.
Your fibrosis result may be overestimated if you have liver inflammation caused by recent illness or drinking alcohol, benign or cancerous tumors in your liver, or liver congestion when liver is too full of blood or other fluids. Cirrhosis is where your liver is severely scarred and permanently damaged.
While the word cirrhosis is most commonly heard when people discuss alcohol-induced liver disease , cirrhosis is caused by many forms of liver disease. While fibrosis is reversible there is a point where the damage becomes too great and the liver cannot repair itself. There is no treatment that can cure cirrhosis.
If possible, treating the underlying cause of cirrhosis may keep your cirrhosis from getting worse and help prevent liver failure. Successful treatment may slowly improve some of your liver scarring. It is important to avoid things that could damage your liver further like alcohol, certain medications and fatty food. Treatment for someone with cirrhosis often means managing the symptoms of cirrhosis and preventing further damage to avoid liver failure.
Doctors treat liver failure with a liver transplant. Someone with cirrhosis is at a very high risk of developing liver cancer.
It is very important to receive routine liver cancer surveillance if you have cirrhosis; most people who develop liver cancer have evidence of cirrhosis. Doctors also treat liver cancer with a transplant. It is important to note, people often live with cirrhosis for a long time before the option of liver transplant is discussed. There is a big difference between liver functioning and disease progression. Our livers are resilient, continuing to function even when they become severely scarred.
Because of this, some people may not experience symptoms or have elevated liver enzyme tests even though their liver is damaged.
It is important to talk to your doctor about your risks for liver disease so you can receive imaging tests that may help diagnosis liver damage. Compensated Cirrhosis v. Decompensated Cirrhosis Cirrhosis is often categorized as either compensated or decompensated. Their symptoms of the disease may be mild or nonexistent even though the liver is severely scarred.
Someone with decompensated cirrhosis will feel and appear sick as their liver is struggling to function. The liver has two sources that supply blood to the liver — the hepatic artery and the hepatic portal vein.
The hepatic artery brings oxygen-rich blood into the liver. Blood coming from our digestive system enters the liver through the hepatic portal vein carrying nutrients, medications, or toxins. When someone has decompensated cirrhosis the scar tissue blocks the blood meant to flow through the portal vein causing an increase of pressure known as portal hypertension.
The blood unable to enter the liver must find new routes; because the blood is not entering the liver, nutrients, toxins and more from the digestive system does not get properly filtered.
Portal hypertension is responsible for symptoms like varices , ascites and encephalopathy. Hepatorenal syndrome can also occur when someone has decompensated cirrhosis. The increased pressure of portal hypertension causes fluid to seep out and pool in the abdominal cavity. This is called ascites. When large amounts of fluid gather in the belly it can lead to swelling and pain and be very uncomfortable.
Ascites can become infected, which can greatly impact the function of your kidneys, and can even be fatal. Ammonia is a waste product made when our body digests protein. The liver processes the ammonia, breaks it down to something called urea, and sends it to our kidneys to be released in urine.
When someone has cirrhosis, ammonia is not eliminated, builds up, travels to the brain, and causes confusion, disorientation, coma, and even death. This is hepatic encephalopathy. Hepatic Encephalopathy or HE can be managed with medications that are taken regularly. One of these medications tries to eliminate extra ammonia through increasing the number of bowel movements.
The other common medication is a powerful antibiotic which eliminates the bacteria in your digestive system responsible for creating the ammonia. Learn more about hepatic encephalopathy in our HE Resource Center. The liver is the largest filter in the body but works closely with our kidneys to eliminate waste from our bodies.
When someone has cirrhosis, they may develop a serious complication where their kidneys begin to progressively fail.
This is called hepatorenal syndrome. Our red blood cells have a substance in them called hemoglobin which is responsible for carrying oxygen.
Bilirubin is a yellow chemical found in hemoglobin. Your body builds new cells to replace broken down red blood cells and the old ones are processed in the liver. The breakdown of the old cells releases bilirubin. A healthy liver processes bilirubin out of the body.
If the liver cannot successfully do this function, bilirubin builds up in the body and your skin or the whites or your eyes may look yellow. This is called jaundice. Jaundice does not only occur in people with cirrhosis. Many healthy babies have jaundice during the first week of life. Jaundice can also be due to blood diseases, genetic conditions, blockages of bile ducts, infections like hepatitis A , and even some medications.
When blood cannot flow through the portal vein into the liver it is forced to find new pathways, such as through the veins in the stomach and esophagus. These enlarged veins are called varices. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck.
Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy. Treatment for cirrhosis depends on the cause of the disease and whether complications are present. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease.
Hospitalization may be necessary for cirrhosis with complications. Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If ascites develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement taken by mouth or through a nasogastric tube-a tiny tube inserted through the nose and throat that reaches into the stomach.
People with cirrhosis are encouraged not to consume any alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medications-prescription and over-the-counter-can affect liver function, a doctor should be consulted before taking them.
For edema and ascites, the doctor will recommend diuretics-medications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites will require intravenous IV antibiotics. The doctor may prescribe a beta-blocker or nitrate for portal hypertension. Beta-blockers can lower the pressure in the varices and reduce the risk of bleeding. Gastrointestinal bleeding requires an immediate upper endoscopy to look for esophageal varices.
The doctor may perform a band-ligation using a special device to compress the varices and stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes. Hepatic encephalopathy is treated by cleansing the bowel with lactulose-a laxative given orally or in enemas. Antibiotics are added to the treatment if necessary.
Patients may be asked to reduce dietary protein intake. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled. Some people with cirrhosis who develop hepatorenal failure must undergo regular hemodialysis treatment, which uses a machine to clean wastes from the blood.
Medications are also given to improve blood flow through the kidneys. Other treatments address the specific causes of cirrhosis. Treatment for cirrhosis caused by hepatitis depends on the specific type of hepatitis.
For example, interferon and other antiviral drugs are prescribed for viral hepatitis, and autoimmune hepatitis requires corticosteroids and other drugs that suppress the immune system.
Medications are given to treat various symptoms of cirrhosis, such as itching and abdominal pain. When is a liver transplant indicated for cirrhosis? A liver transplant is considered necessary when complications cannot be controlled by treatment. Liver transplantation is a major operation in which the diseased liver is removed and replaced with a healthy one from an organ donor. A team of health professionals determines the risks and benefits of the procedure for each patient.
Survival rates have improved over the past several years because of drugs that suppress the immune system and keep it from attacking and damaging the new liver. The number of people who need a liver transplant far exceeds the number of available organs. A person needing a transplant must go through a complicated evaluation process before being added to a long transplant waiting list.
Generally, organs are given to people with the best chance of living the longest after a transplant. Survival after a transplant requires intensive follow-up and cooperation on the part of the patient and caregiver. What causes cirrhosis? Most people who consume alcohol do not suffer damage to the liver. But heavy alcohol use over several years can cause chronic injury to the liver. The amount of alcohol it takes to damage the liver varies greatly from person to person.
For women, consuming two to three drinks-including beer and wine-per day and for men, three to four drinks per day, can lead to liver damage and cirrhosis. In the past, alcohol-related cirrhosis led to more deaths than cirrhosis due to any other cause. Deaths caused by obesity-related cirrhosis are increasing. Chronic hepatitis C The hepatitis C virus is a liver infection that is spread by contact with an infected person's blood.
Chronic hepatitis C causes inflammation and damage to the liver over time that can lead to cirrhosis. Chronic hepatitis B and D The hepatitis B virus is a liver infection that is spread by contact with an infected person's blood, semen, or other body fluid.
Hepatitis B, like hepatitis C, causes liver inflammation and injury that can lead to cirrhosis. The hepatitis B vaccine is given to all infants and many adults to prevent the virus. Hepatitis D is another virus that infects the liver and can lead to cirrhosis, but it occurs only in people who already have hepatitis B.
This increasingly common liver disease is associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications. Autoimmune hepatitis This form of hepatitis is caused by the body's immune system attacking liver cells and causing inflammation, damage, and eventually cirrhosis. Researchers believe genetic factors may make some people more prone to autoimmune diseases.
About 70 percent of those with autoimmune hepatitis are female. Diseases that damage or destroy bile ducts Several diseases can damage or destroy the ducts that carry bile from the liver, causing bile to back up in the liver and leading to cirrhosis.
In adults, the most common condition in this category is primary biliary cirrhosis, a disease in which the bile ducts become inflamed and damaged and, ultimately, disappear. Secondary biliary cirrhosis can happen if the ducts are mistakenly tied off or injured during gallbladder surgery. Primary sclerosing cholangitis is another condition that causes damage and scarring of bile ducts.
In infants, damaged bile ducts are commonly caused by Alagille syndrome or biliary atresia, conditions in which the ducts are absent or injured. Inherited diseases Cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are inherited diseases that interfere with how the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.
Cirrhosis can result from these conditions. Drugs, toxins, and infections Other causes of cirrhosis include drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion.
Complications of Cirrhosis Because the liver becomes lumpy and stiff in cirrhosis, blood cannot flow through it easily, so pressure builds up in the vein that brings blood to the liver. Edema and ascites When liver damage progresses to an advanced stage, fluid collects in the legs, called edema, and in the abdomen, called ascites. Ascites can lead to bacterial peritonitis, a serious infection. Bruising and bleeding When the liver slows or stops producing the proteins needed for blood clotting, a person will bruise or bleed easily.
Portal hypertension Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension.
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