Cirrhosis

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CIRRHOSIS When chronic diseases cause the liver to become permanently injured andscarred, the condition is called cirrhosis. The scar tissue that formsin cirrhosis harms the structure of the liver, blocking the flow ofblood through the organ. The loss of normal liver tissue slows theprocessing of nutrients, hormones, drugs, and toxins by the liver. Alsoslowed is production of proteins and other substances made by the liver.People with liver cirrhosis may develop many problems beyond the liver.When the liver is scarred, the blood cannot easily get through theliver, and backs up under higher than normal pressure (portalhypertension). This often causes ascites, which is yellow fluid

thatleaks out of the bloodstream into the abdominal cavity.If the ascites becomes tense, it can cause an umbilical hernia (aprotruding belly button). The backed-up blood also often createsvarices, in which the pressure causes the blood vessels around theesophagus to burst causing significant blood loss. Varices can betreated with beta blockers, or can be obliterated usingendoscopically-placed rubber bands or injections of liquid that causethe varices to scar. If endoscopy fails to stop bleeding, a TIPS(transjugular intrahepatic portosystemic shunt) can be created byinserting a short metal mesh tube through a neck vein into the liver andconnecting the portal vein in the liver to a regular vein in the liver.Another alternative is to surgically redirect some of the blood flowaround the liver. People with cirrhosis sometimes may develop jaundice (a yellowing of thewhites of the eyes or the skin)

due to an accumulation of bilirubin inthe blood. If the bilirubin is excreted in the urine, the urine may turndark. People with cirrhosis are also at risk for hepatic encephalopathy, whichis fatigue or confusion caused by ammonia and other products of proteindigestion which are inadequately cleared from the bloodstream by theliver. People with cirrhosis often bruise easily because the liver manufacturesreduced amounts of clotting factors. Additionally, platelets may belower than normal in the circulation if the spleen is enlarged.A spleen enlarged from portal hypertension may hold onto too manyplatelets.Chronic HCV infection leads to cirrhosis in at least 20 percent ofpatients within 2 decades of the onset of infection. Cirrhosis andend-stage liver disease may occasionally develop rapidly, especiallyamong patients with concomitant alcohol use. - National Institutes ofHealth Consensus

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