Center for Digestive Diseases

UNM Hospitals Center
for Digestive Diseases

Address:
1001 Martin Luther King Ave. NE
Albuquerque, New Mexico 87106

Appointments:
(505)272-2530 or
(505)925-6000

Facsimile:
UNMH: (505)272-6839
CDD: (505)925-7849

Cirrhosis


What is Cirrhosis?

Cirrhosis occurs when there is scar and dysfunction of the liver.  After years of inflammation in the liver due to viral infection, alcohol use or inflammatory conditions of the liver scar can eventually form and the liver’s vital functions can be diminished.  The liver is responsible for making the factors involved in blood clotting, for filtering blood from the intestines, removing bilirubin (the breakdown products of blood cells) from the blood and clearing toxins from the blood.  Once scar forms in the liver, these functions may be compromised. 


What are the symptoms of Cirrhosis?

Once cirrhosis develops the functions of the liver are compromised and bleeding, confusion or jaundice may occur.  Due to the presence of scar in the liver, the blood from the intestine that normally is filtered by the liver backs up and large varicose veins (varices) can form in and around the esophagus, stomach and rectum.  These varices can cause life-threatening bleeding.  Upper gastrointestinal bleeding from the esophagus or stomach may cause black tarry stools. The increased pressure that develops in the the veins draining into the liver due to scar may cause fluid to leak out into the abdomen.  Large amounts of fluid called ascites may develop in the abdomen and this may cause distension.  Due to the diminished ability to filter the blood, toxins that cause confusion may build up.  This may cause patients to feel irritated, have trouble sleeping at night, sleep more during the daytime, become disoriented or somnolent.  Due to the decreased function of the liver, bilirubin (a normal breakdown product of red blood cells) may not be properly removed and patients may develop jaundice (yellowing of the skin).  Cirrhosis can also cause liver cancer to develop and your doctor may recommend periodic screening for liver cancer with ultrasound or CT scan and a blood test.


What causes Cirrhosis?

After years of inflammation in the liver due to viral infection, alcohol use or inflammatory conditions of the liver, scar can eventually form and the liver’s vital functions can be diminished.  Chronic viral infections of the liver that can cause inflammation and eventual cirrhosis include hepatitis B virus infection and hepatitis C virus infection. Chronic alcohol use can cause inflammation of the liver over time and that inflammation can lead to cirrhosis. Many other conditions can cause chronic inflammation that leads to cirrhosis. A common cause of inflammation in the United States is the development of fatty liver disease associated with obesity, diabetes, high blood pressure, high cholesterol and a family history of liver disease.  In this process, fatty infiltration of the liver causes inflammation that can damage the liver over time. Autoimmune conditions of the liver can also cause inflammation that over time may lead to scar.  Examples of autoimmune conditions include primary biliary cirrhosis, autoimmune hepatitis and autoimmune cholangiopathy.  A genetic disorder call hereditary hemochromatosis causes deposition of high amounts of  iron in the liver and that can cause chronic inflammation and eventually causes cirrhosis.  Chronic obstruction of the bile ducts can also cause cirrhosis. Examples of such processes include a rare disorder called primary sclerosing cholangitis and bile duct stones and/or strictures.


How is Cirrhosis diagnosed?

Cirrhosis is diagnosed after a careful detailed clinical history is obtained and physical examination is performed by your doctor.  Certain blood and x-ray tests (ultrasound, CT scan or liver/spleen scan) often help in the diagnosis of cirrhosis. Often the cause of cirrhosis can be determined based on careful history and examination and specific blood tests. Occasionally a liver biopsy is recommended.  Liver biopsy may help your doctor to determine the extent of liver disease and cause of cirrhosis.


What is the treatment for Cirrhosis?

The treatment for cirrhosis is aimed at correcting the underlying cause of the liver damage and treating and preventing the complications of cirrhosis.  In cases where cirrhosis is severe and/or progressive, liver transplantation may be recommended.  Depending on the underlying cause of cirrhosis, treatment may focus on viral infection, avoiding alcohol, losing weight, or taking medications to decrease inflammation.  Prevention of complications focuses on screening and treating esophageal varices (enlarged veins in the esophagus), screening and treating liver cancer, and administering vaccines to prevent infection.  Development of ascites (fluid accumulation in the abdomen) or edema (swelling in the legs) can be treated with diuretics and avoidance of sodium.  Your doctor may recommend a strict low-sodium diet.  Occasionally paracentesis (removal of fluid from the abdomen) is performed.  Confusion (called hepatic encephalopathy) is treated with medications aimed at eliminating toxins that the liver may not be able to filter. Your doctor may prescribe lactulose or rifaximin for this indication. 


Dedicated Specialists in this area:

Dr. Joseph Alcorn (Director)
Dr. Trent Taylor
Dr. Sanjeev Arora


For more information about cirrhosis please visit: http://patients.gi.org/topics/liver-cirrhosis/