I’ve heard a lot about liver cirrhosis. Can you tell me what it means, what causes it and what types of treatment are available?

— Stan, Hollister

Answered by Dr. Brian Berk, St. Luke’s Clinic, Gastroenterology:

Cirrhosis is a term used to describe advanced scarring of the liver. There are four stages of scarring. In stage 1, you are replacing single cells in the liver with scar. With stage 2, you are replacing several cells in a row with scar. In stage 3, you are creating bands of scarring that replace entire sheets of cells. Finally in stage 4, the bands of scarring interconnect and form nodules of scarring, which trap cells. The condition of cirrhosis interferes with the flow of blood through the liver, which leads to a decrease in normal liver functions and an increase in blood detouring around the liver.

Any chronic liver disease that inflames liver cells can progress into cirrhosis. The most common causes of cirrhosis are excessive long-term use of alcohol viral hepatitis (B and C), and NASH (a type of fatty liver disease). There are also a variety of inherited liver diseases, autoimmune liver diseases, medication-induced liver conditions and other causes.

Many times, you are not aware that you have liver disease until the organ is failing. You can maintain liver function with as little as 10 percent of the total number of functioning liver cells. Subtle symptoms that may indicate liver failure including pain in the upper right side of your abdomen, fatigue, muscle wasting, pain in muscles or joints, headaches, and nausea. The more visible symptoms include jaundice, confusion (dementia-like symptoms), ascites/edema (fluid accumulation in the abdomen and legs), and intestinal bleeding from engorged veins that line the esophagus or stomach. Cirrhosis can also lead to liver cancer that arises in the nodules of scar from chronic liver cell inflammation.

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To determine if there is liver disease, blood tests and imaging (ultrasound or CAT scan) are done to determine the scope of the problem. If there is further concern, a liver biopsy can be performed to clarify the type of disease and stage of scarring. This procedure is performed with sedation to minimize discomfort. Once the underlying disease is confirmed, treatment options are available for most chronic liver diseases.

In terms of treatment for cirrhosis, management of the underlying disease can help slow down or reverse the damage. This is most notable with Hepatitis C and NASH. Routine blood testing and imaging are performed to monitor liver functions and watch for liver cancer. Routine endoscopic monitoring of the engorged veins that line the stomach and esophagus allows for the prevention of bleeding with medication and variceal ligation. There are also a variety of treatment options for the other complications of cirrhosis including liver cancer. In some cases, a liver transplantat may be a treatment option.

If you think you may have liver disease, the best course of action is to see your primary care physician and get blood tests that can detect liver disease. Your liver health will be determined by these tests. If liver disease is suspected, you will be referred to a specialist who will determine the cause of liver disease, stage of the condition and treatment options.

Disclaimer: The content of this article is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Do not stop or delay seeking treatment because of something you read in this article. Further, the views or opinions expressed in this article are for informational purposes only and do not necessarily represent those of St. Luke’s. Reliance on any information provided by St. Luke’s, St. Luke’s employees or others supplying information for the column at the invitation of St. Luke’s is solely at your own risk.

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