cirrhosis A progressive condition in which fibrous tissue replaces damaged LIVER tissue, usu-

ally over an extended time and as a result of continued injury to the liver. The scarring is permanent and interferes with the liver's ability to function, eventually resulting in LIVER FAILURE. Numerous circumstances and health conditions can result in cirrhosis. The most common causes of cirrhosis are HEPATITIS, LIVER DISEASE OF ALCOHOLISM, chronic dysfunction of the BILE system, STEATOHEPATITIS, and HEPATOTOXINS. Cirrhosis is the leading reason for LIVER TRANSPLANTATION, the only treatment for end-stage cirrhosis and resulting liver failure.

Symptoms and Diagnostic Path

In its mild to moderate stages, cirrhosis often does not show symptoms or generates vague symptoms that suggest a variety of causes. Until cirrhosis becomes fairly advanced, even BLOOD tests that measure liver enzymes (a hallmark of liver function) and diagnostic imaging procedures such as COMPUTED TOMOGRAPHY (CT) SCAN often show normal findings. When symptoms become apparent, the cirrhosis has significantly compromised liver function, and numerous changes occur throughout the body. Indications of these changes often include

•   edema (swelling of the limbs) and ASCITES (fluid accumulation in the abdominal cavity) resulting from PORTAL HYPERTENSION (increased resistance to blood flow through the liver) and RENAL FAILURE (kidney dysfunction)

•   JAUNDICE (yellow discoloration of the SKIN) and PRURITIS (extreme itching of the skin) resulting from the liver's inability to metabolize HEMOGLOBIN and synthesize bile, which allows BILIRU-BIN concentrations in the blood to rise

•   easy bruising and prolonged bleeding due to the liver's inability to synthesize CLOTTING FACTORS and produce enough bile to metabolize the dietary fats necessary for absorbing VITAMIN K

•   lack of APPETITE, resulting from diminished bile production, and corresponding unintended weight loss

•   INSULIN RESISTANCE or type 2 DIABETES resulting from the liver's inability to properly metabolize cholesterol and manage GLUCOSE (sugar) storage and retrieval

• gynecomastia (enlarged breasts) in men and amenorrhea (absence of menstrual periods) in women due to the diminished ability of the liver to metabolize estrogens

The liver may feel enlarged or irregular when the gastroenterologist palpates the abdomen. By this stage, numerous blood chemistry tests show abnormal results. Percutaneous liver biopsy confirms the presence of fibrous tissue and the diagnosis of cirrhosis.

Treatment Options and Outlook

Treatment attempts to manage symptoms, address consequential health problems, and slow the progression of any underlying health conditions. Eliminating alcohol consumption, medications, and environmental exposures that damage liver cells are among the measures essential to preserve remaining liver function. Numerous clinical studies show the ability of the herbal product milk thistle or silymarin, its active ingredient, to help protect the liver from further damage. When cirrhosis progresses despite these interventions, liver transplantation becomes the treatment of final resort. Without liver transplantation, progressive cirrhosis is fatal. Liver transplantation permanently resolves cirrhosis, though at present there are far fewer donor livers available than people who need them. Live donor liver segment donation, in which a living person donates a portion of his or her healthy liver, is an option to full liver transplantation when a donor is available.

Risk Factors and Preventive Measures

Cirrhosis results from chronic, long-term damage to the liver. People who are at risk for developing cirrhosis have longstanding liver disease, such as chronic hepatitis, hepatitis of alcoholism, hemochromatosis, primary biliary cirrhosis, primary sclerosing cholangitis, and Wilson's disease. Preventive measures include vaccination against hepatitis infection (hepatitis A and hepatitis B) and minimizing behaviors that allow exposure to hepatitis. Consistent personal hygiene practices, such as hand washing before handling food and after going to the bathroom, help control the spread of the hepatitis virus.

See also hepatitis prevention; lifestyle and health; organ transplantation.

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