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Cirrhosis

DEFINITION

Cirrhosis is the medical term for scarring of the liver. The liver is located in the right upper part of the abdomen. The liver has several jobs including getting rid of toxic material from the blood making clotting components to help stop bleeding, producing hormones, and storing energy in the form of glycogen for later use. Scarring of the liver or cirrhosis happens when the liver is having long-term damage. The long-term damage can be caused by chronic alcohol abuse, hepatitis B, hepatitis C, cystic fibrosis, primary sclerosing cholangitis (scarring of the bile ducts), primary biliary cirrhosis (a disease that causes destruction of the bile ducts), hemochromotosis (buildup of iron in the body), nonalcoholic fatty liver disease (accumulation of fat in the liver), autoimmune hepatitis (where the body fights its own liver), galactosemia (a disease where the body cannot process milk sugars), schistosomiasis (a parasite in developing countries), glycogen storage diseases (a set of diseases which cause problems releasing energy when needed), Wilson’s Disease (which causes accumulation of copper in the liver), and biliary atresia in babies (poor formation of bile ducts). When the liver tries to repair itself from the damage, it generates a small amount of scar tissue. Over time, that scar tissue comes to replace much of the functioning cells of the liver. The degree of damage to the liver determines how much function the liver has which has very little capacity to function in advanced stages. In advanced stages, cirrhosis can cause frequent infections, malnutrition, hepatic encephalopathy (toxins circulating in the blood that lead to cloudy thinking and even coma), high pressure in the portal vein in the liver (which can lead to increased risk of bleeding from backup to other veins and flow of fluid into the abdomen), and increased risk of liver cancers.

SYMPTOMS
Fatigue, easy bruising or bleeding, large abdomen filled with fluid, nausea, swelling in the legs, weight loss, loss of appetite

DIAGNOSIS
Your doctor will begin by talking to you about symptoms and doing a physical exam with special attention paid to the liver. Your doctor will likely want to check blood tests that show the liver function and can help determine the cause of the cirrhosis. Liver tests will often be normal until end stages of cirrhosis. Your doctor may recommend taking pictures of the liver with either computed tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may recommend seeing a specialist called a gastroenterologist. Your doctor or gastroenterologist may recommend taking a small sample of the liver called a biopsy which can make a definitive diagnosis of cirrhosis, especially in questionable cases.

TREATMENT
No treatment can cure cirrhosis short of liver transplant. Treatment of cirrhosis begins with treating the underlying cause of cirrhosis to prevent further damage to the liver. Your doctor may recommend treatment for alcohol dependence. If you have hepatitis, your gastroenterologist may recommend treatment for that condition. Other treatments for cirrhosis are more focused on control of symptoms including removing fluid from the body both by draining it and using medications in addition to a low salt diet, surgery to place a stent in the portal vein and relieve increased pressure in the portal vein, treatment of infections, regular screening for liver cancer, taking medications to help treat the mental fuzziness caused by hepatic encephalopathy. Ultimately, the only true cure for cirrhosis is liver transplant. However, the transplant list is long and cirrhosis can occur in the new liver if the cause of the cirrhosis is still present. You should discuss all of your treatment options with your doctor and gastroenterologist.

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