What is cirrhosis?
Cirrhosis is a disease in which your liver deteriorates due to chronic injury. Scar tissue replaces healthy liver tissue, essentially blocking the flow of blood through your liver.

Your liver is responsible for:
  • Fighting off infection
  • Cleansing toxins found in your bloodstream
  • Processing drugs, hormones, and nutrients
  • Producing bile to absorb fats
  • Creating proteins which regulate blood clotting
How common is cirrhosis?
Cirrhosis is the 12th leading cause of death, accounting for roughly 32,000 deaths per year in the United States in 2010. The condition affects men slightly more often than women.

What are the symptoms of cirrhosis?
Many people with cirrhosis have no symptoms in the early stages of the disease. However, as the disease progresses, a person may experience the following symptoms:
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Weight loss
  • Abdominal pain
  • Itching
  • Spider-like blood vessels on the skin
  • Jaundice
  • Easy bruising and bleeding
  • Sensitivity to medication
What causes cirrhosis?
Cirrhosis has many different causes and in some patients there may be more than one factor responsible for the disease:
    Alcohol is one of the major causes of cirrhosis since heavy alcohol usage over several years will slowly damage the liver. The word “heavy” varies for each individual, but typically 2-3 drinks per day for women and 3-4 drinks per day for men is considered “heavy”. In the past, alcohol related cirrhosis led to more deaths than cirrhosis due to any other cause.

    Chronic Hepatitis B and C
    Hepatitis B and C are viruses which can infect the liver, and over a long time the infection can lead to cirrhosis. These viruses can be detected in the bloodstream and can cause the disease to be spread from the blood of the infected person to another. Most children now are vaccinated against hepatitis B.

    Nonalcoholic Fatty Liver Disease (NAFLD)
    As the name implies, alcohol is not involved but fat plays a role in this type of liver damage. Those who are obese, diabetic, and have poor nutrition can have fat build up in the liver and an increased chance of developing NAFLD. These conditions may therefore lead to cirrhosis because fat in the liver can have damaging effects to the liver tissue over time.

    Autoimmune hepatitis
    This is a condition where the body’s immune system attacks the liver cells, causing inflammation and damage. Eventually this chronic inflammation can lead to cirrhosis. This condition is more common in females than males.

    Diseases that damage bile ducts
    Certain diseases such as Primary Biliary Cirrhosis damage the bile ducts and eventually destroy them. Primary Sclerosing Cholangitis is another condition where the bile ducts are injured. These types of liver disease cause a distinct pattern of abnormality which can be detected on routine blood test.

    Inherited disease
    Diseases that affect the liver such as Cystic Fibrosis, Wilson's disease, and Hemochromatosis, may lead to cirrhosis over time.

    Drugs + Toxins
    Repeated exposure to damaging effects of certain drugs and toxins may lead to cirrhosis of the liver.
How is cirrhosis diagnosed?
To diagnose cirrhosis, Dr. Khorrami will review your medical history, your lifestyle habits and medication records. He will also examine you for any of the physical signs of cirrhosis including skin findings and a hardened or enlarged liver. Dr. Khorrami may then order additional tests to evaluate your liver condition such as:
    Blood tests
    These will aid in evaluating liver function and cause of liver disease.

    Imaging tests
    Procedures such as CT scans, ultrasounds, MRIs, or liver-spleen scans, will give additional information regarding the liver problem and provide a more accurate assessment of the degree of cirrhosis.

    Taking a small tissue sample from the liver helps to confirm a diagnosis and shows the extent of disease.
How is the severity of cirrhosis measured?
The model for end-stage liver disease (MELD) score measures the severity of cirrhosis. The MELD score was developed to predict the 90-day survival in people with advanced cirrhosis. The MELD score is based on three blood tests:
  • International normalized ratio (INR)—tests the clotting tendency of blood.
  • Bilirubin – tests the amount of bile pigment in the blood.
  • Creatinine – tests kidney function.
MELD score usually ranges from under 10 to upper thirties, but the lower the score, the better the likelihood of 90-day survival.

How is cirrhosis treated?
Cirrhosis treatment depends on its cause and symptoms. The end goal of treatment is to slow the dying process of the liver. Since alcohol and certain drugs and medications can damage the liver, it is important to abstain from them once cirrhosis has been identified. Other treatment options for patients with cirrhosis include:
    If cirrhosis has resulted in edema and ascites, then the physician may prescribe a diuretic to remove fluids from the body. Eating a healthy and nutritious diet becomes important in order to avoid muscle wasting and weakness. Liquid protein supplements are sometimes recommended to help avoid malnutrition. However, a person with cirrhosis should not eat raw shellfish because they can contain a bacterium that causes serious infection.

    Medication therapy
    Various medications may be prescribed to treat the symptoms of cirrhosis.

    These are prescribed if severe infection is present or sometimes given to prevent future infections from occurring.

    This is a procedure performed during an upper endoscopy to obliterate any esophageal varices that may have developed as a result of cirrhosis.

    This is a laxative that is used to treat hepatic encephalopathy, a complication which may arise from cirrhosis.

    Liver transplant
    When other treatments have failed, then a liver transplantation will be recommended as a last resort treatment. This option requires that one carefully weighs the risks and benefits of this complex surgical procedure. Liver transplantation is not the right choice for every patient, and the number of those who need a liver transplant currently exceeds the number of organs available.
Discuss Your Options with Dr. Khorrami
Dr. Khorrami has been in practice since 1996 as a double-board certified gastroenterologist, has experienced a variety of patient cases, and is well trained to solve your digestive problems. Get in touch to learn more about cirrhosis and how you can successfully treat it.

Source contains material from the National Digestive Diseases Information Clearinghouse (NDDIC).


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About Dr. Khorrami

Dr. Payman Khorrami is a UCLA graduate, has been in practice since 1996, and is double board certified. Undergraduate Education at University of California, Berkeley, Medical School at University of California, San Francisco, Internal Medicine Training at University of California, San Diego Read Full Bio