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Immunology => Cirrhosis


Cirrhosis, a chronic disease of the liver. Cirrhosis of the liver has several causes, but they all lead to irreversible destruction of the liver cells. It is characterized by areas of fibrosis (scarring) and death of the hepatocytes (liver cells). The two major results of cirrhosis are the failure of liver cell function and high blood pressure in the portal vein, which leads from the stomach to the liver.

In western Europe, alcohol and hepatitis B cause the majority of cases of cirrhosis. In the United Kingdom, two-thirds of all cases are caused by alcohol; the incidence of cirrhosis is much lower in countries where alcohol consumption is reduced (for example, in Islamic states). Many people who are not alcoholics still suffer from alcohol-damaged livers; 30 per cent of cases in Britain have an unknown cause.

Primary liver cancer is a complication which can occur in liver cirrhosis. About 1 in 5 people with alcoholic cirrhosis develop liver cancer in Britain and the United States.

It is possible for a person to have a cirrhotic liver but not suffer from any symptoms. This is known as latent cirrhosis. The symptoms caused by active cirrhosis include abdominal pain, liver tenderness, diarrhoea, lack of appetite, ascites (accumulation of fluid in the peritoneal cavity), jaundice, weakness, muscle wasting, and weight loss. Ascites is caused because of the increased pressure in the portal vein and the lack of albumin in the plasma (albumin is normally made by the liver). An individual with cirrhosis often has a characteristic appearance: they have thin arms and legs but a large stomach due to the combination of weight loss and ascites. Jaundice is caused by abnormally high levels of bilirubin in the blood because the liver is not removing it as it normally does. There may be mental changes caused by toxins in the blood passing to the brain without being metabolized by the liver. These symptoms range from confusion, irritability, and childishness, to coma. There is often a fluctuation in these symptoms. The portal hypertension can lead to gastrooesophageal bleeding (bleeding in the gut), which is one of the most severe symptoms and carries a high risk of mortality.

Complete recovery is impossible. However, since the healthy cells may regenerate, it is sometimes possible for some degree of normal liver function to return. Alcohol should be avoided, unless there is firm evidence that the cirrhosis was not caused by alcohol. Because there is no treatment for the irreversible liver damage, only the symptoms can be treated; this normally requires treatment in hospital.