The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.

What is the impact of Cirrhosis?
Cirrhosis is the seventh leading cause of death by disease. About 25,000 people die from cirrhosis each year. There also is a great toll in terms of human suffering, hospital costs, and the loss of work by people with cirrhosis.

CAUSES

• Chronic alcoholism is the most common cause
• Chronic viral hepatitis (types B, C, and D)
• Chronic biliary obstruction (biliary atresia , primary biliary cirrhosis, bile duct injuries)
• Cystic fibrosis
• Alpha-1 antitrypsin deficiency
• Hemochromatosis (abnormal storage of iron)
• Wilson's disease (abnormal storage of copper)
• Galactosemia
• Glycogen storage disease

SYMPTOMS
EARLY STAGES: People with cirrhosis often have few symptoms at first. The two major problems that eventually cause symptoms are loss of functioning liver cells and distortion of the liver caused by scarring. The person may experience fatigue, weakness and exhaustion. Loss of appetite is usual, often with nausea and weight loss.

ADVANCED STAGE: As liver function declines, less protein is made and results in water accumulating in the legs (edema) or abdomen (ascites). A decrease in proteins needed for blood clotting makes it easy for the person to bruise or to bleed. In the later stages of cirrhosis, jaundice (yellow skin) may occur, caused by the buildup of bile pigment that is passed by the liver into the intestines. Some people with cirrhosis experience intense itching due to bile products that are deposited in the skin. Gallstones often form in persons with cirrhosis because not enough bile reaches the gallbladder.

The liver of a person with cirrhosis also has trouble removing toxins, which may build up in the blood. These toxins can dull mental function and lead to personality changes and even coma (encephalopathy). Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleeping habits.

Drugs taken usually are filtered out by the liver, and this cleansing process also is slowed down by cirrhosis. The liver does not remove the drugs from the blood at the usual rate, so the drugs act longer than expected, building up in the body. People with cirrhosis often are very sensitive to medications and their side effects.

A serious problem for people with cirrhosis is pressure on blood vessels that flow through the liver. Normally, blood from the intestines and spleen is pumped to the liver through the portal vein. But in cirrhosis, this normal flow of blood is slowed, building pressure in the portal vein (portal hypertension). This blocks the normal flow of blood, causing the spleen to enlarge. So blood from the intestines tries to find a way around the liver through new vessels.

Some of these new blood vessels become quite large and are called 'varies'. These vessels may form in the stomach and esophagus (the tube that connects the mouth with the stomach). They have thin walls and carry high pressure. There is great danger that they may break, causing a serious bleeding problem in the upper stomach or esophagus. If this happens, the patient's life is in danger, and the doctor must act quickly to stop the bleeding.

DIAGNOSIS
The doctor often can diagnose cirrhosis from the patient's symptoms and from laboratory tests. During a physical exam, for instance, the doctor could notice a change in how your liver feels or how large it is. If the doctor suspects cirrhosis, you will be given blood tests. The purpose of these tests is to find out if liver disease is present. In some cases, other tests that take pictures of the liver are performed such as the computerized axial tomography (CAT) scan, ultrasound, and the radioisotope liver/spleen scan.

The doctor may decide to confirm the diagnosis by putting a needle through the skin (biopsy) to take a sample of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.

MANAGEMENT
Treatment of cirrhosis is aimed at stopping or delaying its progress, minimizing the damage to liver cells, and reducing complications. In alcoholic cirrhosis, for instance, the person must stop drinking alcohol to halt progression of the disease. If a person has hepatitis, the doctor may administer steroids or antiviral drugs to reduce liver cell injury.

Medications may be given to control the symptoms of cirrhosis, such as itching. Edema and ascites (fluid retention) are treated by reducing salt in the diet. Drugs called 'diuretics' are used to remove excess fluid and to prevent edema from recurring. Diet and drug therapies can help to improve the altered mental function that cirrhosis can cause. For instance, decreasing dietary protein results in less toxin formation in the digestive tract. Laxatives such as lacunose may be given to help absorb toxins and speed their removal from the intestines.

The two main problems in cirrhosis are liver failure, when liver cells just stop working, and the bleeding caused by portal hypertension. The doctor may prescribe blood pressure medication, such as the beta blocker, to treat the portal hypertension. If the patient bleeds from the varices of the stomach or esophagus, the doctor can inject these veins with a sclerosing agent administered through a flexible tube (endoscope) that is inserted through the mouth and esophagus. In critical cases, the patient may be given a liver transplant or another surgery (such as a portacaval shunt) that is sometimes used to relieve the pressure in the portal vein and varices.

Patients with cirrhosis often live healthy lives for many years. Even when complications develop, they usually can be treated. Many patients with cirrhosis have undergone successful liver transplantation.