Cirrhosis; many causes.

Basic facts about the liver

Your liver, the largest organ in your body, weighs about three pounds and is roughly the size of a football. It lies in the upper right side of your abdomen protected by the lower ribs. The normal liver is soft and smooth and is connected to the small intestine by the bile duct which carries bile formed in the liver to the intestines.

Nearly all of the blood that leaves the stomach and intestines must pass through the liver. Acting as the body's largest chemical factory it has thousands of functions including:

* the production of clotting factors, blood proteins, bile and more than a thousand different enzymes

* the breakdown of old red blood cells 

* the metabolism of cholesterol

* the storage of energy (glycogen) to fuel muscles

* maintenance of normal blood sugar concentration

* the regulation of several hormones

* and the detoxification of drugs and poisons, including alcohol. It is no wonder that liver disease can cause widespread disruption of body function. While many liver diseases can occur, one of the most important ones is cirrhosis.

What is Cirrhosis?

Cirrhosis is a term that refers to a group of chronic diseases of the liver in which normal liver cells are damaged and replaced by scar tissue, decreasing the amount of normal liver tissue. The distortion of the normal liver structure by the scar tissue interferes with the flow of blood through the liver. It also handicaps the function of the liver which, with the loss of normal liver tissue, leads to failure of the liver to perform some of its critically important functions. Cirrhosis takes the lives of over 27,000 Americans each year and ranks third as a cause of death among adults aged 25-59 in this country

What causes Cirrhosis?

There are a number of conditions that can lead to cirrhosis:

* excessive intake of alcohol (most common)

* several types of viral hepatitis

* inborn abnormalities hemochromatosis -- abnormal handling by the body of iron Wilson's Disease -- abnormal handling by the body of copper

* congenital or inherited conditions glycogen storage diseases -- inability to properly utilize sugars alpha 1 antitrypsin deficiency -- inherited absence of a specific enzyme in the liver

* severe reaction to drugs

* prolonged exposure to environmental toxins

* some forms of heart disease (cardiac cirrhosis)

* prolonged obstruction or other diseases of the bile ducts (biliary cirrhosis)

* Schistosomiasis (parasitic conditions)

Can the condition responsible for the Cirrhosis be identified?

Causes of the cirrhosis can be identified by certain factors:

In alcoholic cirrhosis

* history of regular and excessive alcoholic intake

* physical and behavioral changes

* examination of liver tissue obtained by needle biopsy under local anesthesia

In active viral hepatitis infection

* blood tests

* liver biopsy

* direct look at the liver at operation or through a laparoscope (lighted tube inserted into the abdomen)

Does heavy drinking always lead to Cirrhosis?

While almost everyone who drinks excessive amounts of alcohol sustains some liver damage, it does not necessarily develop into cirrhosis. In those individuals who drink one-half to one point (8 to 16 ounces) of hard liquor per day (or the equivalent in other alcoholic drinks), for 15 years or more, about one third develop cirrhosis. Another third develop fatty livers, while the remainder have only minor liver problems.

In general, the more you drink, the greater the frequency and regularity of excessive intake, the more likely cirrhosis is to result. A poor diet, long considered to be the main factor in the development of cirrhosis in the alcoholic, is probably only a contributing factor.

Alcohol by itself, in large amounts, is a poison which can cause cirrhosis.

Can social drinkers get Cirrhosis?

Some individuals who are "social drinkers", not alcoholics, may develop cirrhosis. Factors affecting the development of cirrhosis include:

* the amount of alcohol consumed

* the regularity of intake

* natural tendency

* perhaps the state of nutrition

It is not known why some individuals are more prone to adverse reactions to alcohol than others.

Does Hepatitis always result in Cirrhosis?

Only a very small number of persons with viral hepatitis develop cirrhosis. There are four known types of viral hepatitis, each caused by a different virus.

* Hepatitis A does not lead to chronic hepatitis.

* Hepatitis B and non-A, non-B Hepatitis lead to chronic hepatitis in 5 to 10% of patients. In a few of these patients, the chronic hepatitis progresses to cirrhosis.

* Hepatitis D infects individuals already infected by hepatitis B.

What are the signs and symptoms of Cirrhosis?

The onset of cirrhosis is often "silent" with few specific symptoms to identify what is happening in the liver. As continued scarring and destruction occur, the following signs and symptoms may appear:

* Loss of appetite 

* Nausea and vomiting 

* Weight loss

* Enlargement of the liver

* Jaundice -- yellow discoloration of the whites of the eyes and skin occurs because bile pigment can no longer be removed by the liver

* Itching -- due to retention of bile products in the skin

* Ascites -- abdominal swelling due to accumulation of fluid caused by the obstruction of blood flow through the liver

* Vomiting of blood -- frequently occurs from swollen, ruptured varices (veins that burst) in the lower end of the esophagus due to the increased pressure in these vessels caused by scar tissue formation

* Increased sensitivity to drugs -- due to inability of the liver to inactivate them

* Encephalopathy (impending coma) -- subtle mental changes advancing to profound confusion and coma

Many patients may have no symptoms and are found to have cirrhosis by physical examination and laboratory tests, which may have been performed in the course of treatment for unrelated illnesses.

How is Cirrhosis treated?

Treatment depends on the type and stage of the cirrhosis. It aims at stopping the progress of the cirrhosis, reversing (to whatever extent possible) the damage which has already occurred, and treating complications that are disabling or life-threatening. Stopping or reversing the process requires removal of the cause:

In alcoholic cirrhosis

* abstinence from alcohol

* an adequate, wholesome diet

In cirrhosis caused by viral hepatitis

* experimental approaches that include the use of drugs to improve immune responses to viral infection (interferon) or to help destroy the virus (anti-viral compounds). Such treatment has resulted in limited success to date.

In certain types of cirrhosis caused by chronic hepatitis

* corticosteroids are indicated

In cirrhotic patients with jaundice

* supplemental fat soluble vitamins may be helpful

Wilson's Disease

* removal of excessive copper

Hemochromatosis

* removal of excess iron

What are the complications of Cirrhosis?

Complications of cirrhosis include ascites, coma and hemorrhage from esophageal varices.

* Ascites is treated by restriction of intake of salt, administration of drugs to improve excretion of salt and water (diuretics) and in some instances, the construction of shunts (redirection of fluid from the abdomen to a vein in the neck) to promote excretion of excessive liquid.

* Treatment of coma, or impending coma (encephalopathy) includes specific medications, reduction of intake of protein foods, and control of intestinal hemorrhage.

* Treatment of hemorrhage from varices (internal varicose veins) includes compression of the bleeding point with a specially constructed balloon and several surgical procedures.

How can I avoid Cirrhosis?

1. Do Not Drink to Excess.

Avoid the use of alcoholic beverages.

Alcohol destroys liver cells. How well damaged cells regenerate varies with each individual. Prior injury to the liver by unknown and unrecognized viruses or chemicals can also affect the regeneration process.

2. Take Precautions When Using Man-Made Chemicals. The liver must process many chemicals which were not present in the past. More research is needed to determine the effects on the liver of many of these compounds. When using chemicals at work, in cleaning your home or working in your garden:

* be sure there is good ventilation

* follow directions for use of all products

* never mix chemical products

* avoid getting chemicals on the skin as they can be absorbed through the skin. Wash promptly if you do

* avoid inhaling chemicals

* wear protective clothing

3. Seek Medical Advice. Remain under supervision of physician when you develop viral hepatitis until your recovery is assured.

How might Cirrhosis affect other diseases I might have or treatment of them?

The responsibility of the liver for the proper functioning of the whole body is so great that the chronic disease of the liver may modify the body's responses to a variety of illnesses. Abnormal function of the liver in cirrhosis may:

* affect the dose of medicine required in the treatment of other conditions

* affect the treatment of diabetes

* alter response of the body to infection

* alter tolerance for surgical procedures

Patients with cirrhosis are particularly prone to develop fatal bacterial infections, kidney malfunctions, stomach ulcers, gallstones, a type of diabetes and cancer of the liver.

What are my prospects for reasonable health and survival with treatment?

This varies with the individual patient and the type and state of the cirrhosis.

Early diagnosis and identification of the cause of the cirrhosis improve the outlook for stopping or reversing the course of the cirrhosis.

Treatment at this stage, with proper adherence to the physician's recommendations, leads to improvement in the majority of cases and the patient is able to pursue a normal life and activities.

When cirrhosis is not discovered until extensive damage has resulted, the outlook may be less favorable for improvement, and complications such as ascites and hemorrhage are more likely to be encountered.

The liver is a large organ and is able to perform its vital functions despite some damage. It also has the ability to repair itself to a limited degree. Cells that die are replaced by new cells. If the cause of cirrhosis can be removed, these factors provide hope for both improvement and carrying on a normal life.

An increasing number of scientific investigators conducting liver research give hope for new breakthroughs in treatment, management and cures for liver diseases in the foreseeable future.

MORE RESEARCH IS NEEDED to help millions of Americans suffering with liver diseases . . . many of them incurable at this time.

The AMERICAN LIVER FOUNDATION is the only national voluntary health agency dedicated to attacking liver diseases, the third leading disease-related cause of death in the 25-59 age group.

HOPE FOR THE FUTURE DEPENDS ON YOUR HELP!