Cirrhosis is the scarring of the liver that happens because of chronic liver disease. Scar tissue blocks blood and bile flow through the liver and keeps it from working as it should.
As the largest internal organ in the body, the liver performs many vital tasks. For example, it gets rid of or neutralizes toxins -- such as poisons, germs, and bacteria -- in the blood and controls infection. The liver also makes proteins that regulate blood clotting and bile that helps your body absorb fats and fat-soluble vitamins it needs to stay healthy.
You can' t undo the damage from cirrhosis, but it progresses slowly, so early treatment can help prevent more damage. As liver function gets worse, you may experience fatigue, weight loss, swelling in your legs and abdomen, and jaundice. If the disease is severe enough, it can be fatal.
The most common causes of cirrhosis in the United States are excessive use of alcohol, chronic infection with the hepatitis C virus, and a condition called nonalcoholic steatohepatitis (NASH).
Symptoms of cirrhosis can range from no symptoms to outright liver failure. The most common symptoms include:
The most common cause of liver disease in the United States is alcohol abuse.
Drinking too much alcohol on a regular basis almost always causes liver damage, although not always cirrhosis. Drinking 32 - 48 oz. of beer, 4 - 8 oz. of liquor, or 16 - 32 oz. of wine every day for 10 - 15 years or longer greatly increases your chances of developing cirrhosis. How much alcohol you drink, how often, and for how many years are more important than what kind of alcohol you drink.
Other causes of cirrhosis include:
Your health care provider will take a detailed history to try to determine the cause of your liver disease and to see if your symptoms might be related to something else. Then, the health care provider will examine you closely for signs of liver disease, including yellowing (jaundice) of your eyes and skin, red spider-like blood vessels just under the surface of your skin, and redness of your palms.
Your health care provider will press on your abdomen to feel the size of your liver. In the early stages of liver disease, the liver may be enlarged and firm, but it shrinks as scar tissue forms.
Your health care provider may order other tests, such as blood tests to look for certain liver enzymes, a bilirubin test, an ultrasound, CT scan, or MRI, or a liver biopsy.
Cirrhosis can't be cured, but you can slow down the progression of the disease. Treatment depends on the underlying cause -- for example, not drinking any alcohol, or taking interferon or other medications to build up your immune system if you have chronic viral hepatitis. Your doctor will also treat complications, such as giving you blood pressure medications to control portal hypertension or drugs to stop bleeding veins. In some cases a liver transplant may be needed.
If you have cirrhosis from any cause, it is vital to not drink any alcohol to prevent further damage to the liver. If your cirrhosis is caused by alcoholism, your doctor may suggest Alcoholics Anonymous as a good place to start your rehabilitation.
You will also need to stop taking medications that may cause liver damage. For example, acetaminophen (Tylenol) can cause liver damage if you take large doses or if you regularly drink alcohol and take acetaminophen. Nonsteroidal anti-inflammatory drugs (such as naproxen or Aleve, and ibuprofen or Motrin or Advil) can also damage the liver, as can some herbs and supplements. If you have liver disease, do not take any over-the-counter medication, herbs, or supplements without first checking with your doctor.
You may need to make changes in your diet, such as lowering salt intake, to treat complications of cirrhosis.
Medications can treat complications such as bleeding from veins, infections in fluid accumulated in the abdomen, and damage to the brain (encephalopathy) caused by toxins circulating in the blood.
You may need a liver biopsy to determine the cause of cirrhosis and to check how much liver damage has occurred. Generally a liver biopsy involves inserting a needle through the abdominal wall to the liver to get tissue samples.
Surgery may be required to stop and prevent certain complications of cirrhosis:
Malnutrition is often a problem for people with cirrhosis. One of the liver' s important functions is to help convert food into stored energy, as well as to rid the body of toxins. For these reasons, eating a healthy diet is an important part of treatment for cirrhosis. You should be eating a well-balanced diet with plenty of fruits, vegetables, and whole grains. Your doctor may also talk with you about proper protein balance, and limiting your fluid and salt intake.
High-quality dietary protein may be particularly important for you if you have buildup of fluid in the abdomen or swelling of the feet, legs, or back. Protein also helps to repair muscle mass. But too much protein can raise ammonia levels and trigger hepatic encephalopathy (see Complications). In general, your doctor needs to determine how much protein is right for you. Your doctor may recommend eating vegetable protein, such as soy, instead of animal protein.
If you have fluid retention, you may need to eat less sodium, since salt encourages the body to retain water. That means more than just passing up the salt shaker. The foods highest in salt are processed and prepared foods, such as canned meats, soups, and vegetables, crackers, and cold cuts. Eat good amounts of fresh foods because they contain very little sodium. Instead of adding salt to your food, try lemon juice or black pepper to add taste.
Avoid raw shellfish, which may carry a bacteria called Vibrio vulnificus that can be dangerous to people with cirrhosis. If you are not sure how well shellfish is cooked, do not eat it.
It is very important that you talk to your doctor before taking any supplement if you have liver disease, including the following:
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications.
People with liver disease must be particularly careful because the liver processes almost everything you take. For these reasons, you should take herbs with extreme care and only under the supervision of your doctor.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for reducing the physical addiction to alcohol and for helping to treat hepatitis. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Remedies that may be recommended for alcoholism include:
Remedies that may be recommended for hepatitis include:
Your doctor will use caution when prescribing medications if you have cirrhosis because many drugs cause complications in someone with liver disease.
Certain herbs and supplements are known to harm the liver or cause complications that affect people with liver disease. A short list is below. Talk to your doctor before taking any herb or supplement if you have liver disease.
Pregnant or breastfeeding women should not use milk thistle or licorice.
Complications from cirrhosis include:
Cirrhosis can be serious and life-threatening, especially if you continue to drink alcohol. The good news is that with proper diet, medical management, and avoidance of alcohol, you can drastically slow down the rate of progression of liver damage.
Addolorato G, Russell M, Albano E, Haber PS, Wands JR, Leggio L. Understanding and treating patients with alcoholic cirrhosis: an update. Alcohol Clin Exp Res. 2009 Jul;33(7):1136-44.
Agency for Healthcare Research and Quality. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects. Summary, evidence report/technology assessment: number 21, September 2000.
Angulo P, Lindor KD. Treatment of nonalcoholic fatty liver: present and emerging therapies. Semin Liver Dis. 2001;21(1):81-88.
Arun J. Sanyal, M.D., Naga Chalasani, M.B., B.S., Kris V. Kowdley, M.D., et al, and for the NASH CRN. Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. N Engl J Med. 2010 May 6; 362(18): 1675â€“1685.
Cave M, Deaciuc I, Mendez C, Song Z, Joshi-Barve S, Barve S, McClain C. Nonalcoholic fatty liver disease: predisposing factors and the role of nutrition. J Nutr Biochem. 2007 Mar;18(3):184-95. Review.
Chitturi S, Farrell GC. Herbal hepatotoxicity: an expanding but poorly defined problem. J Gastroenterol Hepatol. 2000;15(10):1093-1099.
Day CP. Who gets alcoholic liver disease: nature or nurture? J R Coll Physicians Lond. 2000;34(6):557-562.
Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, Bielenberg J. Antiviral effects of Glycyrrhiza species. Phytother Res. 2007 Sep 20; [Epub ahead of print]
Fukushima H, Miwa Y, Shiraki M, Gomi I, Toda K, Kuriyama S, et al. Oral branched-chain amino acid supplementation improves the oxidized/reduced albumin ratio in patients with liver cirrhosis. Hepatol Res. 2007 Sep;37(9):765-70.
Kalaitzakis E, Bjornsson E. Renal function and cognitive impairment in patients with liver cirrhosis. Scand J Gastroenterol. 2007 Apr 30:1-7.
Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease -- benefits and dangers. [Review]. Aliment Pharmacol Ther. 2001;15(9):1239-1252.
Lieber CS. Liver disease by alcohol and hepatitis C: early detection and new insights in pathogenesis lead to improved treatment. Am J Addict. 2001;10 Suppl:29-50.
Lirussi F, Azzalini L, Orando S, Orlando R, Angelico F. Antioxidant supplements for non-alcoholic fatty liver disease and/or steatohepatitis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004996. Review.
Liu CT, Chuang PT, Wu CY, Weng YM, Chen W, Tseng CY. Antioxidative and in vitro hepatoprotective activity of Bupleurum kaoi leaf infusion. Phytother Res. 2006 Nov;20(11):1003-8.
Liu C, Hu Y, Xu L, Liu C, Liu P. Effect of Fuzheng Huayu formula and its actions against liver fibrosis. Chin Med. 2009 Jun 29;4:12.
Liu YK, Shen W. Inhibitive effect of cordyceps sinensis on experimental hepatic fibrosis and its possible mechanism. World J Gastroenterol. 2003 Mar;9(3):529-33.
Lucey MR. Management of alcoholic liver disease. Clin Liver Dis. 2009 May;13(2):267-75.
Moriarty KJ, Platt H, Crompton S, Darling W, Blakemore M, Hutchinson S, et al. Collaborative care for alcohol-related liver disease. Clin Med. 2007 Apr;7(2):125-8.
Nakaya Y, Okita K, Suzuki K, Moriwaki H, Kato A, Miwa Y, et al; Hepatic Nutritional Therapy (HNT) Study Group. BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition. 2007 Feb;23(2):113-20.
Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD002235. Review.
Seeff LB, Lindsay KL, Bacon BR, Kresina TF, Hoofnagle JH. Complementary and alternative medicine in chronic liver disease. Hepatology. 2001 Sep;34(3):595-603.
Urata Y, Okita K, Korenaga K, Uchida K, Yamasaki T, Sakaida I. The effect of supplementation with branched-chain amino acids in patients with liver cirrhosis. Hepatol Res. 2007 Jul;37(7):510-6.
Verma S, Thuluvath PJ. Complementary and alternative medicine in hepatology: review of the evidence of efficacy. Clin Gastroenterol Hepatol. 2007 Apr;5(4):408-16. Review.
Vintro AQ, Krasnoff JB, Painter P. roles of nutrition and physical activity in musculoskeletal complications before and after liver transplantation. AACN Clin Issues. 2002;13(2):333-347.
Wang R, Kong J, Wang D, Lien LL, Lien EJ. A survey of Chinese herbal ingredients with liver protection activities. Chin Med. 2007 May 10;2:5.
Yen MH, Weng TC, Liu SY, Chai CY, Lin CC. The hepatoprotective effect of Bupleurum kaoi, an endemic plant to Taiwan, against dimethylnitrosamine-induced hepatic fibrosis in rats. Biol Pharm Bull. 2005 Mar;28(3):442-8.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885