Highlights
- Hepatic cirrhosis is an irreversible condition that involves scarring of the liver. It’s usually caused by high alcohol intake, non-alcoholic fatty liver disease, or hepatitis.
- While it isn’t possible to reverse the scar tissue produced by hepatic cirrhosis, treatments are available for underlying causes and complications.
- Many of the medications used to treat hepatic cirrhosis target its complications rather than the condition itself.
Each year, 4.5-million adults receive a liver disease diagnosis. When that disease progresses to hepatic cirrhosis, it results in irreversible scarring. Hepatic cirrhosis usually follows heavy alcohol use, obesity, or hepatitis. In a small number of cases, it arises due to rare metabolic and genetic disorders.
The aim of treatment is usually to control complications. Patients can make positive lifestyle changes too, which may slow down the disease’s progression.
Hepatic Cirrhosis Symptoms
The progression of hepatic cirrhosis has four stages. Symptoms aren’t always present during stages one and two, but patients may notice abdominal discomfort they attribute to other causes.
Stages three and four may produce the following symptoms:
- Fatigue
- Jaundice
- Weight loss
- Poor appetite
- Nausea and vomiting
- Itchy skin
- Dark urine
- Pale stools
When patients reach stage four, they might experience symptoms of end-stage liver failure, including confusion or even coma. Liver failure symptoms arise as liver function dips, making it harder for the body to remove toxins.
Hepatic Cirrhosis Causes
Hepatic cirrhosis causes vary but can typically include hepatitis B or C, long-term alcohol misuse, and fatty liver disease.
Alcohol Use Disorder
According to an analysis of CDC data, in 2019, 10.6 people in 100,000 died of alcoholic cirrhosis. Alcohol misuse is also responsible for one in three liver transplants.
While the liver can break down many toxins, it can’t tackle every toxin that comes from alcohol. Instead, those toxins build up in the liver over time. As toxins continue to build in the liver, they cause inflammation and scarring.
Long-term heavy alcohol use also stops the liver from getting the nutrients it needs to repair itself. This, combined with inflammation and scarring, can eventually lead to cirrhosis.
Hepatitis B
Hepatitis B is a viral infection that’s spread by bodily fluids, usually through unprotected sex or sharing needles. It’s a vaccine-preventable disease, and in 2019 cases ranged between 0.9 to 1.1 per 100,000 of the population.
Between 2.4 and 4.5 million people in the United States have hepatitis C. Much like hepatitis B, the virus transmits through exposure to an infected person’s bodily fluids. Hepatitis C is not a vaccine-preventable disease.
Hepatitis B and C produces scar tissue in a few different ways:
- Inflammation. As inflammation grows worse and the liver struggles to heal, scarring occurs.
- Protein production. Hepatitis B causes the body to overproduce some proteins, making it harder for the liver to heal.
- Autoimmune response. Sometimes hepatitis B triggers an autoimmune response that results in scarring.
Non-Alcoholic Fatty Liver Disease (NAFLD)
Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver. In some cases, NAFLD progresses to non-alcoholic steatohepatitis (NASH). Approximately 24 percent of US adults have NAFLD, and of those 1.5 to 6.5 percent have NASH.
When fat builds up in the liver, it causes an enzyme imbalance that makes it hard for the liver to repair itself. Over time, repeated inflammation and an inability to heal results in liver scarring.
Bile Duct Diseases
The bile ducts are responsible for transferring bile from the liver to the gallbladder. When something causes the bile duct to become swollen or inflamed, cirrhosis may occur.
Metabolic Storage Disorders
Metabolic storage disorders are rare diseases where the body can’t break down or store certain nutrients. As a result, toxins build up in the liver and may cause scar tissue. Metabolic diseases that cause scarring include:
- Wilson’s disease. Wilson’s disease causes abnormal copper metabolism and affects multiple organs, including the liver.
- Alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin deficiency is a genetic condition that makes it harder for the body to process certain proteins.
- Glycogen storage disorder 1. Glycogen storage disorder 1 makes it harder for the body to process glucose and use it for energy. As glucose builds in the liver, it becomes toxic and causes scarring.
Hepatic Cirrhosis Risk Factors
Several risk factors can cause liver cirrhosis and the conditions that cause liver damage. They include:
- Long-term hepatitis B and C exposure. The longer hepatitis B or C remains uncontrolled, the more likely they are to cause liver cirrhosis. Sometimes, they may cause autoimmune cirrhosis.
- Elevated triglycerides and obesity. Even in healthy individuals, having elevated triglycerides can cause NAFLD. Obesity is also a cause of NAFLD.
- Diabetes. Approximately 30 percent of people with diabetes have liver cirrhosis. It arises because of insulin resistance within the liver.
- Metabolic syndrome. Metabolic syndrome results in an 86 percent increase of liver related events (LREs) including cirrhosis.
- Excessive alcohol consumption. Routinely drinking excessive amounts of alcohol may cause alcoholic liver disease.
- Smoking. Smoking may increase the risk of fibrosis in those who already have underlying conditions, including hepatitis B and C.
Hepatic Cirrhosis Diagnosis
Doctors usually diagnose hepatic cirrhosis using the following tools:
- Physical examination. Medical professionals can look for signs of jaundice in the eyes and skin. During an abdominal examination, they may feel for signs of liver and spleen enlargement. They’ll also look for spider veins, enlarged veins, and swollen legs.
- Blood tests. Blood tests can reveal whether a patient’s liver function is normal.
- Ultrasound. Some doctors may use an ultrasound as their initial imaging tool to look for scarring on the liver. Ultrasounds are also useful for mapping a patient’s progress as they undergo treatment for liver cirrhosis.
- CT scans. CT scans offer a more detailed view of liver damage and can give insights into how the cirrhosis is affecting nearby organs. They’re useful for seeing precisely where scarring has occurred.
Hepatic Cirrhosis Complications
As liver damage progresses, the complications associated with it can become severe and life threatening. Complications can include:
- Ascites. Ascites is a condition where fluid builds in the abdomen. It is associated with multiple complications, including malnutrition, bacterial infections, and kidney failure.
- Wernicke’s encephalopathy. Wernicke’s encephalopathy is a condition that occurs when the brain doesn’t get enough B1, often as a result of a long-standing history of alcohol abuse. People who develop this condition may suffer from severe confusion and, eventually, irreversible brain damage.
- Weakened immune system. Eventually, liver scarring may make it harder for patients to produce the proteins their immune system relies upon.
- Portal hypertension. The portal vein takes blood from various abdominal organs and drains them into the liver. Advanced liver cirrhosis may cause a buildup of pressure in the portal vein, resulting in blood overloading in other vessels. The greatest risk of ongoing portal hypertension is rupture, which causes internal bleeding.
- Liver cancer. There is a strong link between hepatic cirrhosis and liver cancer. The risk is higher among those who have liver disease caused by hepatitis C.
- Variceal bleeding. Varices are enlarged veins in the digestive tract that occur in more advanced cases of hepatic cirrhosis. They’re most often found in the esophagus. When the varices bleed, they may cause severe hypotension (low blood pressure) or cause veins to collapse.
Hepatic Cirrhosis Treatment
Although the scarring that comes with hepatic cirrhosis is irreversible, there are ways to slow the disease’s progression.
Lifestyle Changes
Regular exercise, maintaining a healthy diet, cutting out alcohol, and quitting smoking can all slow hepatic cirrhosis down. People who struggle with alcohol dependence may need additional support when withdrawing from alcohol. Doctors sometimes prescribe benzodiazepines, including diazepam, to make alcohol withdrawal easier.
Medications
The types of medications used to treat hepatic cirrhosis depend on the disease’s progression. They include:
- Diuretics. Diuretics such as furosemide and spironolactone can offload fluid and treat ascites.
- Beta-blockers. Beta-blockers can reduce variceal bleeding by reducing the heart rate. Propranolol and nadolol are commonly used for this purpose.
- Lactulose. When hepatic encephalopathy occurs, lactulose is useful for reducing toxins. It ferments in the intestines and lowers the pH there as well as reducing the amount of ammonia in the blood. Lactulose also acts as a laxative, allowing toxins to be removed by digestion.
Treating Underlying Conditions
When an underlying condition causes hepatic cirrhosis, treatment slows the progression. Using antivirals to treat hepatitis B or C, for example, is essential.
Liver Transplant
In severe cases of hepatic cirrhosis, liver transplants are necessary. According to the United Network for Organ Sharing (UNOS) more than 15,000 liver transplants took place between 2020 and 2022. Allocation of livers depends on medical need and how close the patient is to the donor.
Hepatic Cirrhosis Prevention
Preventing hepatic cirrhosis isn’t always possible. However, making certain choices can reduce the likelihood of it occurring:
- Drinking less alcohol. The CDC recommends that women drink no more than the equivalent of one alcoholic drink per day and men should drink no more than two. One alcoholic drink means a five-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of hard liquor.
- Vaccines. Hepatitis A and B vaccines are available to most people.
- Needle use. Avoiding reusing and sharing needles can make hepatitis less likely.
- Safe sex. Using barrier contraceptives, including condoms, dental dams, and diaphragms, can prevent the spread of some types of hepatitis and reduce a person’s risk of developing hepatic cirrhosis.
- Healthy weight maintenance. Maintaining a healthy BMI can reduce the risk of NAFLD.
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