Cirrhosis is a disease of the liver. In cirrhosis, normal liver cells are replaced by scar tissue, interfering with the normal functions of the liver. Common causes of cirrhosis include viral hepatitis such as hepatitis B, alcoholism, destruction of the bile ducts and an inherited condition of iron overload called hemochromatosis. Without a fully functioning liver, a number of complications can occur.
Fluid Accumulation
According to "Robbins and Cotran Pathologic Basis of Disease," in cirrhosis fluid can build up and distend the abdomen. This condition is called ascites. Two mechanisms may be at work to cause ascites. First, the liver is responsible for making proteins for the blood such as albumin that help to keep the fluid portion of blood inside the blood vessels. When the liver cells are not working well, less proteins is made and fluid leaks out of the vessel walls. In addition, the veins of the intestine, called the portal veins, run through the liver before going to the heart. When the liver is full of scar tissue, the blood cannot pass through as well. As a result, pressure builds up in the veins and fluid leaks into the abdomen.
Bleeding Veins
"Robbins and Cotran Pathologic Basis of Disease" also notes that the obstruction of blood flow through the liver from the scar tissue distends the veins running into the liver. This leads to hemorrhoids, or distended veins in the rectum, and distended veins called esophageal varices in the tube running from the throat to the stomach. These veins are prone to bleed, leading to blood in the stomach and bloody vomit. The bleeding may be profuse and can be a significant source of mortality in cirrhosis.
Abdominal Infections
According to the National Institutes of Health, fluid buildup in the abdomen may be infected by organisms in the condition called spontaneous bacterial peritonitis. It is more common in very advanced liver disease and can also be a source of mortality if not treated early. The condition may be asymptomatic or cause abdominal pain, fever and confusion, according to the National Institutes of Health.
Kidney or Lung Dysfunction
Kidney and lung problems are both associated with cirrhosis. In hepatorenal syndrome, the liver dysfunction leads to kidney failure. Decreased urine output is common. Lung problems may also develop. In hepatopulmonary syndrome, the problems with the blood vessels in the lungs lead to difficulty providing oxygen to the blood. Fluid can also leak from the abdomen into the space between the chest wall and the lung, compressing the lung. In addition, high blood pressure can build up in the lungs, "Robbins and Cotran Pathologic Basis of Disease" notes.
Confusion
The liver helps to clean and filter the blood. Without this action, toxins can build up and cause confusion. Confusion caused by liver dysfunction is called hepatic encephalopathy and is caused in large part by the buildup of ammonia in the circulation, according to "Robbins and Cotran Pathologic Basis of Disease." Disturbance of sleep is often one of the first symptoms, the National Institutes of Health notes.
Cancer
People with cirrhosis are at an increased risk of developing liver cancer, called hepatocellular carcinoma, according to the NIH. The risk is worse for people with cirrhosis caused by hemochromatosis, hepatitis B and hepatitis C infections.
Blood Clotting Problems
In cirrhosis blood may not clot properly, according to the National Institutes of Health. Some of the proteins made by the liver are blood proteins that make clots. Without sufficient levels, there will be excessive bleeding and bruising. Levels of platelets which also help blood to clot will be low. Another complication occurs when the blood moves too slowly through the liver, leading to the formation of a blood clot in the large portal vein leading from the intestine to the liver.
Other Complications
Other complications include osteoporosis, muscle cramps, enlarged spleen, weight loss, itching, spider like blood vessels in the skin, jaundice, shrinking of the testicles, gallstones, sensitivity to medications, fluid around the heart, insulin resistance and diabetes.
References
- "Robbins and Cotran Pathologic Basis of Disease, Professional Edition"; Vinay Kumar; 8th Ed. 2009
- National Institutes of Health: Cirrhosis
- Family Practice Notebook: Cirrhosis
- The Merck Manual: Cirrhosis
