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(originally published to Helium writing site, now gone)

Cirrhosis is a long-term disease of the liver, the body’s largest organ. A healthy liver removes poisons, bacteria and germs from the blood, controls infection, regulates blood clotting and produces bile to help fat absorption. With cirrhosis, scar tissue replaces the normal tissue. This reduces the flow of blood through the liver and prevents it functioning as it should. A number of factors can cause cirrhosis, including alcohol, hepatitis, blocked bile ducts, infections, certain inherited diseases, and medications.

Symptoms don’t always appear in the early stages. But as scar tissue takes over from healthy tissue in the liver, a person may experience symptoms such as weakness, loss of appetite, weight loss, fatigue, exhaustion, nausea and abdominal pain. However, these can also relate to a range of other conditions.

As the disease progresses, other symptoms may occur. Many are present in other illnesses and do not necessarily mean a person has cirrhosis. A common symptom is spider-shaped groups of blood vessels on the skin. Palms may become red and blotchy, or have more speckled mottling than usual. Fingers may thicken and curl towards the palm. Nail changes may include white horizontal lines, large white areas extending towards the tips, and a flattening of the slight dip between the near end of the nail and the skin of the finger.

Painful inflammation of the arm, leg and thigh bones may occur. A wrist tremor may cause the hand to flap, akin to a bird’s wing. Males may suffer enlarged breasts with a thickening around the nipples. Impotence or loss of sex drive may be a symptom, as can the wasting away of the testicles. Infertility may occur in women. The spleen may increase in size. Breath might have a musty odor. Another symptom is jaundice, where the skin and eyes are yellowish and urine may be darker.

Some patients will only be diagnosed in the more advanced stages of cirrhosis when various complications might set in. Symptoms at this stage may include bruising and bleeding. The skin may become itchy due to a build up of bile. Ammonia and other toxins normally eliminated from the blood by the liver may go to the brain, affecting its functioning. A person may be unresponsive, be forgetful, have poor concentration and sleep badly.

Blood flow through the portal vein to the intestines and spleen is slowed with cirrhosis, increasing the pressure in the vein. This is called portal hypertension. Slow blood flow associated with cirrhosis may result in fluid leaking into the abdominal cavity, a condition known as ascites. This may result in penile swelling in males. It may also cause larger blood vessels in the esophagus and stomach, and these vessels may burst. A lack of blood flowing to the kidneys can be due to cirrhosis and may result in renal failure.

There may be many other symptoms. A person can be more prone to infection as cirrhosis may cause immune system problems. Liver cancer is a symptom or complication of cirrhosis. A person can become more sensitive to medication as the liver is slower at removing the drugs from the blood. Fluid may accumulate in the legs. A lack of bile in the gallbladder may result in gallstones. Resistance to insulin in a diabetic may be due to cirrhosis as damaged liver cells don’t use insulin properly.

Cirrhosis can’t be reversed but it’s possible to delay or prevent progression of the disease. Treatment will vary depending on the cause of the cirrhosis. For example, if it was caused by alcohol, abstinence is the best treatment. Medications such as interferon and corticosteroids are used in treating cirrhosis from hepatitis. If cirrhosis was due to copper build-up, chelating drugs will remove the metal. Portal hypertension can be treated with the drug propranolol, which should lower the pressure.

For best results, these treatments should be combined with a healthy lifestyle. Good eating will give the body the extra nutrients it needs to help reduce the effects of cirrhosis. Cutting back on salt is necessary as cirrhosis causes salt retention. Exercise will be of benefit, although in the advanced stages of cirrhosis, it can result in bleeding.

In cases where cirrhosis is stable, factors such as infection, bleeding, constipation, alcohol or medication may result in a relapse known as decompensated cirrhosis. Treatment often requires hospital admission to monitor fluid balance and to administer various medications.

A liver transplant may be an option, except where cirrhosis is very advanced. Eighty per cent of transplant patients survive at least five years. Risks include rejection and the side effects of drugs used to lessen the chances of rejection of the new organ.

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