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Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
*Bleeding easily
*Bruising easily
*Itchy skin
*Yellow discoloration in the skin and eyes (jaundice)
*Fluid accumulation in your abdomen (ascites)
*Loss of appetite
*Swelling in your legs
*Weight loss
*Confusion, drowsiness and slurred speech (hepatic encephalopathy)
*Spider-like blood vessels on your skin
When to see a doctor?
Make an appointment with your doctor if you have persistent signs or symptoms of cirrhosis.
Cirrhosis is caused by scar tissue that forms in your liver in response to damage occurring over many years. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As the scar tissue builds up, liver function worsens. In advanced cirrhosis, the liver no longer works very well.
It's important to determine the cause of cirrhosis because treating that underlying cause can help prevent further liver damage. A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
Some of the causes of cirrhosis are inherited or thought to be inherited:
*Iron buildup in the body (hemochromatosis)
*Cystic fibrosis
*Copper accumulated in the liver (Wilson's disease)
*Poorly formed bile ducts (biliary atresia)
*Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
*Genetic digestive disorder (Alagille syndrome)
*Liver disease caused by your body's immune system (autoimmune hepatitis)
Others occur later in life:
*Chronic alcohol abuse
*Hepatitis B
*Fat accumulating in the liver (nonalcoholic fatty liver disease)
*Destruction of the bile ducts (primary biliary cirrhosis)
*Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
*Infection by a parasite common in developing countries (schistosomiasis)
Some people may have more than one cause for cirrhosis, such as alcohol abuse and viral hepatitis. If doctors cannot find a cause for your condition, it's called cryptogenic cirrhosis. Up to 20 percent of people with cirrhosis have cryptogenic cirrhosis.
Complications of cirrhosis can include:
Complications related to blood flow:
*High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
*Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
*Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
*Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may cause enlarged veins (varices) and lead to life-threatening bleeding in the esophagus (esophageal varices) or the stomach (gastric varices). If the liver can't make enough clotting factors, this also can contribute to continued bleeding.
Other complications:
*Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
*Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
*Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
*Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
*Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
*Gallstones and bile duct stones. Blocked flow of bile can lead to irritation, infection and the creation of stones.
*Increased risk of liver cancer.
*Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.
If you have cirrhosis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist) or the liver (hematologists).
Here's some information to help you get ready for your appointment and what to expect from your doctor.
People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more tests or procedures to diagnose cirrhosis.
Laboratory tests:
*Liver function. Your blood is checked for excess bilirubin and certain enzymes that may indicate liver damage.
*Kidney function. Your blood is checked for creatinine.
*Tests for hepatitis B and C. Your blood is checked for the hepatitis viruses.
*Clotting. Your international normalized ratio (INR) is checked for your blood's ability to clot.
Imaging and other tests:
*Magnetic resonance electrography (MRE). This noninvasive advanced imaging testdetects hardening or stiffening of the liver.
*Other imaging tests. MRI, CT and ultrasound can image the liver.
*Biopsy. A tissue sample (biopsy) is not necessarily needed for diagnosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.
If you have cirrhosis, your doctor is likely to recommend regular diagnostic tests to monitor for signs of disease progression or complications, especially esophageal varices and liver cancer. Noninvasive tests are becoming more widely available for monitoring.
Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.
Treatment for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:
*Treatment for alcohol dependency. People with cirrhosis caused by alcohol abuse should try to stop drinking. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.
*Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels.
*Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.
*Medications to control other causes and symptoms of cirrhosis. Medications may slow the progression of certain types of liver cirrhosis. For example, people with primary biliary cirrhosis that is diagnosed and treated early may never experience symptoms.
Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent osteoporosis (weak bones).
Treatment for complications of cirrhosis
Your doctor will work to treat any complications of cirrhosis, including:
*Excess fluid in your body. Edema or ascites may be managed with a low-sodium diet and medication to prevent fluid buildup in the body. More severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure.
*Portal hypertension. Blood pressure medications may control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding. Your doctor will perform an upper endoscopy at regular intervals to look for enlarged veins in the esophagus or stomach (varices) that may bleed.
If you develop varices, you likely will need medication to reduce the risk of bleeding. If you are not able to tolerate medication and have signs that the varices are bleeding or are likely to bleed, you may need a procedure (band ligation) to stop the bleeding. In severe cases, you may need a small tube — a transjugular intrahepatic portosystemic shunt (TIPS) — placed in your vein to reduce blood pressure in your liver.
*Infections. You may receive antibiotics or other treatments for infections. Your doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.
*Increased liver cancer risk. Your doctor will likely recommend periodic blood tests and ultrasound exams to look for signs of liver cancer.
*Hepatic encephalopathy. You may be prescribed medications to help reduce the buildup of toxins in your blood due to poor liver function.
Liver transplant surgery
In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.
Extensive testing is needed before a liver transplant to ensure that a candidate is in good enough health to have the transplant operation. Additionally, transplant centers typically require some period of abstinence from alcohol, often at least six months, before transplantation for people with alcohol-related liver disease.
Reduce your risk of cirrhosis by taking care of your liver:
*Drink alcohol in moderation, if at all. If you choose to drink alcohol and don't have liver disease or cirrhosis, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men over age 65, and up to two drinks a day for men age 65 and younger.
*Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
*Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
*Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.
If you're concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.


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Lusaka, Zambia.

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