Cirrhosis

The liver’s job is to detoxify all the food we eat & drugs we take (& anything else that gets into our stomachs).ย  It also make (“synthesizes”) many of our body’s proteins. Some diseases cause the liver to suddenly stop working, but they’re rare (see Liver Failure — Acute).ย  More commonly, Cirrhosis is when the liver gets so scarred from injury that it can’t function normally.ย  This causes some major problems:

  • Ammonia build up from toxins, so the brain doesn’t work well
  • Scars prevent normal blood flow through the liver, so 1) veins get weak in the belly & esophagus (varices), can rupture & cause massive bleeding; 2) fluid leaks out of the bloodstream into the abdomen (ascites), causing swelling, which can get infected
  • Immune system weakens, so it’s easy to get pneumonia & other serious infections

The earliest abnormal blood test in cirrhosis is when a complete blood count finds low platelets.ย  Then the blood level of albumin drops & the prothrombin time rises (INR) — these are proteins made by the liver, so abnormalities indicate the liver is failing.ย  Finally, the bilirubin level rises as patients turn yellow with jaundice.ย  Common liver function tests are usually elevated on blood tests, but they don’t tell us how bad the liver is, like the albumin & prothrombin time do (they’re called “synthetic function,” meaning that if they’re normal, the liver can synthesize proteins, and thus is also doing everything it needs to do).

An ultrasound can identify early liver scars (described as “nodular contour,” meaning loss of normal smoothness).ย  With more advanced cirrhosis, the ultrasound can find congested blood flow and fluid build up (called “ascites”).

Physical signs of cirrhosis include little spider-like spots on the chest, and red palms.ย  Men get shrunken testicles and puffy breasts.ย  Fluid build-up can make the feet swell, & the belly can swell so much as to look pregnant.ย  Eventually eyes and skin turn yellow (jaundice).

The main causes of cirrhosis in the US are alcohol, Hepatitis B, and Hepatitis C.ย  A condition called “Fatty Liver” is becoming more common with our obesity epidemic; nobody knows why it happens, most people with it don’t get cirrhosis, but some do.ย  There ย are lots of other diseases which can cause cirrhosis, like copper overload, iron overload, autoimmune hepatitis, and rare genetic conditions.ย  See Liver Disease — Chronic (non-viral).

Then thereโ€™s also Acute Liver Failure, which occurs abruptly and can be rapidly fatal.ย  See the link for a discussion. There’s no treatment for cirrhosis except liver transplant.ย  But there is some prevention: stop drinking, control hepatitis B, cure hepatitis C.ย  For fatty liver, weight loss is the only treatment that sometimes helps.

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