Cirrhosis

Cirrhosis is a condition in which scar tissue (fibrosis) replaces normal healthy cells in your liver. The scar tissue makes your liver, normally like a sponge, now hard and lumpy. A scarred liver prevents it from carrying out its many functions such as detoxifying harmful substances in your body, cleaning your blood and making vital nutrients. There are a number of causes of cirrhosis. The most common are hepatitis C, nonalcoholic fatty liver disease and chronic alcoholism. Early cirrhosis may be reversible with prompt and effective treatment.

Virginia Mason's Liver Center of Excellence in the Digestive Disease Institute is dedicated to progressive and innovative management of liver disorders, including cirrhosis.

To schedule an appointment with Virginia Mason's Liver Center specialists, call (206) 223-2319.

Symptoms of Cirrhosis

Individuals with cirrhosis may not show signs of symptoms early on. Symptoms can develop slowly over months or even years. However, as the disease worsens, symptoms occur and may include:

  • Fatigue
  • Loss of appetite
  • Weight gain due to fluid retention
  • Nausea and vomiting
  • Dizziness
  • Itchiness
  • Skin rashes and red and blotchy patches on the skin
  • Vomiting of blood
  • Change in stool color, may be clay colored or black
  • Bruising easily
  • Swelling of the lower legs
  • Abdominal distention or swelling due to fluid build-up
  • Abdominal pain on the right side of the body where the liver is located
  • Jaundice (yellowing of the skin and eyes)
  • Confusion

Diagnosing Cirrhosis

People with early-stage cirrhosis of the liver usually do not have symptoms. Your liver specialist, or hepatologist, will first perform a detailed medical history and physical exam. He or she may suspect cirrhosis based on your signs and symptoms. You may have several tests and procedures to confirm a diagnosis and determine the extent of liver damage, including:

Blood Tests

  • Liver function: Tests for excess bilirubin, which is a product of red blood cells breaking down, as well as clotting factor (INR) and albumin which helps assess severity of cirrhosis. Will also look for elevation in liver enzymes which may indicate liver inflammation or bile duct inflammation.

  • Kidney function: Tests for creatinine as kidney function may decline in later stages of cirrhosis (decompensated cirrhosis).

  • Tests that look for the cause of cirrhosis: Tests for hepatitis B and C, excess iron in the blood, autoimmune factors and other metabolic tests.

Scans/Biopsy

  • Magnetic resonance elastography (MRE): A noninvasive imaging test that detects hardening or stiffening of the liver and may eliminate the need for a liver biopsy.

  • FibroScan: A test similar to an MRE, however it can be done in the office. It is a noninvasive exam that assesses stiffness of liver.

  • Liver biopsy: A liver biopsy is performed by injecting a thin needle through your abdominal skin (percutaneously) and into the liver to remove a small sample of liver tissue. The area of the puncture is numbed first with a local anesthetic. A liver biopsy may be helpful in grading and staging the disease.

  • Other imaging tests: MRI, CT and ultrasounds create images of the liver.

If you have cirrhosis of the liver, scar tissue forms and your liver gets smaller and harder. Most of the time, this damage cannot be undone. The regular monitoring for patients who are at a high-risk for cirrhosis, or the scarring and hardening of the liver, is widely recommended – but often not followed.

Dietary and Lifestyle Changes

Although treatment for cirrhosis depends on the cause and extent of your liver damage, your hepatologist will likely recommend lifestyle changes to help you avoid further damage to your liver. These recommendations may include:

  • Avoiding alcoholic beverages: Alcohol is absorbed and metabolized by the liver and can make cirrhosis worse. Giving up alcohol is important, as heavy drinking can severely hinder all types of therapy. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.

  • Medications: Your hepatologist will talk with you about over the counter medications, such as acetaminophen (Tylenol), and prescription drugs that can damage the liver. There are also medications that may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.
    • Some medications can slow the progression of certain types of liver cirrhosis. For example, people with primary biliary cirrhosis (primary biliary cholangitis) that are diagnosed early, medication may significantly delay progression to cirrhosis.

    • Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent weak bones (osteoporosis).

    • Weight loss: People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels. It is important to maintain adequate protein intake while attempting to lose weight with cirrhosis.

  • Leading a healthy life: If you have cirrhosis you can live a longer, healthier life by bringing positive changes into your daily routine. These include: absence of alcohol, cigarettes and fatty food; possible medication regimen, getting more exercise, eating the right foods and getting plenty of rest.

To schedule an appointment with Virginia Mason's Liver Center specialists, call (206) 223-2319.