Ann R. Punnoose, MD, Writer;
    Cassio Lynm, MA, Illustrator;
    Robert M. Golub, MD, Editor


Cirrhosis is the end stage of any condition in which the liver progressively becomes scarred. It is diagnosed based on physical findings as well as a microscopic examination of liver tissue from a biopsy (tissue sample) or evidence from other diagnostic tests such as ultrasound. Under the microscope, cirrhosis appears as widespread bands of fibrous (made up of fibers) tissue that divide the liver into nodules (small knots or collections of tissue). Eventually, cirrhosis interferes with the function of the liver and can lead to liver failure or liver cancer. The February 22/29, 2012, issue of JAMA includes an article on diagnosing cirrhosis.

COMMON RISK FACTORS

•     Hepatitis B or C infection

•     Autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis

•     Nonalcoholic fatty liver disease, often found in obese individuals who do not drink alcohol. Although it can have a benign course, it can sometimes progress to cirrhosis.

•     Hereditary metabolic liver diseases, such as hemochromatosis (iron overload), Wilson disease (copper overload), and α1-antitrypsin deficiency (inability to make a type of protein)

•     Long-term exposure to excess amounts of alcohol can lead to inflammation in the liver, which eventually causes cirrhosis.

PHYSICAL FINDINGS

•     Because the liver does not appropriately process bile (a fluid that helps absorb digested fats) and bilirubin (a waste product), jaundice or yellowing of the skin may occur.

•     Palmar erythema (redness of the palms), spider angiomas (blood vessels that spread out in a spider shape), gynecomastia (breast enlargement in men), decreased body hair, and shrinking of the testicles may occur.

•     Patients can experience spontaneous bleeding because the liver is unable to make factors in the blood that form normal clots.

•     As cirrhosis progresses, it becomes increasingly difficult for blood to travel through the vessels in the liver. This causes increased pressure (portal hypertension) in the portal vein (the major vein in the liver). This results in the formation of esophageal varices (enlarged veins in the esophagus) that can bleed easily.

•     The liver is responsible for making several proteins, like albumin. Portal hypertension and low albumin levels cause ascites (accumulation of fluid in the abdominal space) and edema (water retention leading to swelling in dependent areas).

•     As the liver fails, it becomes unable to remove toxins from the body. This buildup can affect a person's level of awareness, called hepatic encephalopathy.

TREATMENT

•     If possible, treat the illness that led to cirrhosis to prevent progression or worsening of cirrhosis before liver failure or cancer develops.

•    Control complications that cirrhosis causes by supplementing nutrition, transfusing clotting factors to prevent bleeding, and using medications to reduce ascites, edema, and the buildup of toxins.

•     Avoid alcohol and any medications that could affect the liver.

•     When cirrhosis progresses and the complications can no longer be controlled, physicians and their patients may discuss liver transplantation.