Liver Health Liver Health Basics

Cirrhosis: An Introduction

A 47-year-old business executive came to me with fatigue and swelling in her legs. She said that for the past six months she had felt more tired than usual, but attributed it to putting in longer hours at work. She became more concerned when she developed swelling in her legs and her doctor told her she had an enlarged spleen. Her doctor thought she might have a liver problem and referred her to me.

She did in fact have cirrhosis. Her blood work pointed to autoimmune hepatitis, a disease in which the body attacks the liver and causes scarring. I performed a liver biopsy to confirm the diagnosis so she could start treatment.

She was very surprised to learn that she had cirrhosis, considering that she rarely drank and that, besides her fatigue, she felt well. I explained that alcohol abuse is not the only culprit in the disease, and that it causes a wide spectrum of symptoms.

Cirrhosis is irreversible end-stage liver disease, and is the eleventh leading cause of death in the United States. In a cirrhotic liver, the normal liver cells transform into nonfunctioning cells, and the overall shape and structure of the liver is changed, leaving it bumpy and scarred.

Imagine that the normal liver is a brand-new sponge that is soft and flexible when wet. Now imagine an old used sponge that is hard and crumbles when squeezed. Water easily flows through the new sponge, but has a harder time passing through the old sponge. A cirrhotic liver is like an old sponge.

Many patients are often surprised to learn that excessive alcohol consumption is not the only cause of cirrhosis. In fact, an increasing number of cirrhosis cases in the U.S. are being linked to non-alcoholic steatohepatitis, or NASH, in which fatty deposits build up in the liver, causing inflammation. This condition is related to obesity and diabetes, both of which are on the rise in the U.S. Other potential causes of cirrhosis include viral hepatitis, some metabolic disorders (such as hemochromatosis, a genetic disorder in which excess iron damages the liver and other organs) and autoimmune diseases. Sometimes a cause of cirrhosis is not even found.

Diagnosing Cirrhosis

There are a number of ways to diagnosis cirrhosis, including liver biopsy, patient history and symptoms, blood tests and x-rays. There are also different degrees of cirrhosis, ranging from mild to severe, and they can be graded using the Child-Turcotte-Pugh scoring system. Doctors can determine the degree of cirrhosis with blood tests that measure substances released by the liver, including certain proteins and bilirubin, a pigment that is produced when the liver breaks down old red blood cells.

Liver Biopsy

The most certain method of diagnosing cirrhosis is with liver biopsy. This involves extracting cells from the liver itself for testing. However, in some patients liver biopsy may not be possible.

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