Cirrhosis is an irreversible, life-threatening disease of the liver in which normal liver tissue is replaced by non-functioning fibrotic scar tissue and nodules which impede normal blood flow to the liver, and normal liver function. About 5.5 million Americans have cirrhosis of the liver. It is the third most common cause of death in people ages 45-65, after heart disease and cancer.
The body's largest organ (except for the skin), the liver performs numerous vital functions. It metabolizes food and drugs, removes toxins from the blood, stores vitamins, minerals and sugars, converts food into energy or waste, produces proteins which help the blood clot, breaks down the body's waste products, and produces bile which helps digest and absorb food and vitamins. Almost all the blood leaving the stomach and intestines flows into the liver before it reaches the rest of the body.
About 40% of all cirrhosis cases in the US are caused by chronic alcohol abuse. However, cirrhosis can result from a number of chronic liver diseases as well. These include chronic viral hepatitis (hepatitis C, B and D), autoimmune hepatitis, alcohol-induced liver disease, and bile duct diseases (blocked bile ducts, primary sclerosing cholangitis and primary biliary cirrhosis), cystic fibrosis, alpha-1 anti-trypsin deficiency, Wilson disease, hemochromatosis, and glycogen storage diseases.
Other causes of cirrhosis include nonalcoholic steatohepatitis (NASH), a fatty buildup in the liver which is associated with diabetes, protein malnutrition, obesity, coronary artery disease, corticosteroid use, and severe reactions to certain prescription drugs, chronic environmental toxin exposure, the parasitic infection schistosomiasis, and chronic heart failure. Co-infection of hepatitis B or hepatitis C with cirrhosis steeply increases the risk of liver failure and death, and requires close monitoring. If the liver becomes so damaged that it stops functioning, a liver transplant is necessary, and can be life-saving.
Early-stage cirrhosis usually produces no symptoms; about one-third of people with cirrhosis never have symptoms, even in late-stage disease. Others may feel sick, weak, and tired, and as the disease progresses, some patients experience a loss of appetite, weight-loss, fatigue, nausea and vomiting, abdominal pain, and develop spider-like blood vessels on the skin. Patients may develop jaundice, itching, or fluid buildup in the legs (edema) and abdomen (ascites), and greasy stools. Individuals with cirrhosis may also experience abnormal bruising and bleeding.
A serious complication of cirrhosis is portal hypertension, an elevation in pressure in the liver's portal vein, which carries blood from the intestine and spleen to the liver. As a result of this, some patients with cirrhosis experience varices: enlarged blood vessels in the esophagus, stomach, or rectum, as blood flow through the portal vein slows down and backs up. Varices can sometimes rupture, causing a serious, life-threatening condition.
Other complications of cirrhosis include insulin resistance and diabetes, frequent infections, blood clotting problems, impotence, osteoporosis, and kidney dysfunction and failure. Confusion, personality changes, depression, and other mental and cognitive changes and even coma may occur with advanced cirrhosis; this complication is called hepatic encephalopathy. A small percentage of patients with cirrhosis will develop liver cancer, or hepatocellular carcinoma.
NewYork-Presbyterian's liver specialists are among the nation's best, and have extensive expertise diagnosing and treating cirrhosis. We have a number of experts in the areas of hepatitis and primary biliary cirrhosis as well.
To assess whether a patient has cirrhosis, our doctors will take a full medical history, perform a physical examination, and perform a number of tests, including liver function tests (blood tests). Your physician may also perform imaging tests such as a cholangiography, ultrasound, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI) to gain detailed images of the liver and surrounding area. Physicians may also perform a laparoscopy to view the liver and remove a small tissue sample – a biopsy. A pathologist will examine the sample for signs of cirrhosis.
While cirrhosis is a permanent, irreversible condition, treatment is vital to prevent further damage and reduce the chance of complications. Treatment will depend on the cause, whether and which complications exist, the patient's age and overall health.
In all cases of cirrhosis it is vital that individuals with cirrhosis tell their doctors about all drugs they are taking, including over-the-counter pain relievers, dietary supplements, and any alcohol they consume. Stopping all alcohol consumption prevents further liver damage, and conversely, continued alcohol use, even in small amounts, causes cirrhosis to worsen and may lead to life-threatening complications.
If cirrhosis is caused by hepatitis, anti-viral medication will be prescribed for viral hepatitis, and corticosteroids for autoimmune hepatitis. In all cases of cirrhosis, doctors stress the importance of avoiding all alcohol, which further damages a cirrhotic liver, and many pain medications, eating a healthy diet including low-salt food and less protein to reduce toxin buildup, and taking supplemental vitamins.
Our liver disease team has extensive experience applying the latest medications and techniques to proactively manage cirrhosis, and we are conducting basic and clinical research to address complications and reduce the need for liver transplant.
NewYork-Presbyterian's recent research includes testing of a drug, terlipressin, to reduce portal hypertension in patients with hepatorenal syndrome, a condition for which no treatment other than liver transplant is available. Other work includes exploring the use of rifaximin to treat hepatic encephalopathy, reducing the rate of blood clotting problems in patients with hepatitis C, and a number of clinical trials to slow the progression of primary biliary cirrhosis.
NewYork-Presbyterian's Department of Digestive Diseases, in collaboration with the NewYork-Presbyterian Transplant Institute, is currently conducting research and clinical trials on using artificial livers and living donor transplants to treat patients with cirrhosis.