Liver cirrhosis is the end stage of chronic liver disease when normal liver cells have been injured and non-functioning scar tissue has formed. The U.S. Department of Veterans Affairs states that Hepatitis C infection and chronic alcohol consumption are the main causes of cirrhosis in the United States. Obesity is also a major risk factor for liver cirrhosis. The U.S. Centers for Disease Control and Prevention report that cirrhosis is the twelfth leading cause of death by disease, and 27,000 deaths each year are attributable to liver cirrhosis. The stages of liver cell cirrhosis are broken down into compensated and decompensated.
Compensated
People with compensated liver cirrhosis are often asymptomatic, but may display symptoms of weakness, fatigue, loss of appetite, vomiting, weight loss and easy bruising. Liver function tests may reveal increased levels of certain liver enzymes. Liver damage is not reversible, but further damage can be prevented by treating the underlying cause, like alcoholism and viral infection. Additionally, constant monitoring is required for the early detection of loss of liver function that leads to life-threatening complications.
Decompensated
The V.A. states that a person is diagnosed with decompensated cirrhosis if they develop either jaundice, bleeding in the esophagus or stomach, edema in the legs and/or abdomen, also known as ascites, or encephalopathy. The liver performs many bodily functions, including the removal of bilirubin, which is a product of red blood cell catabolism. Accumulation of bilirubin causes jaundice, or yellowing of the skin and eyes. The liver also converts ammonia to urea. If this liver function is compromised, ammonia builds up in the blood and may cause encephalopathy, leading to symptoms of confusion and potentially coma and death. Progressive liver scarring decreases blood flow, resulting in portal hypertension. During this process, blood is forced back into vessels in the esophagus and abdomen, which can lead to blood vessel hemorrhage and bleeding. The V.A. reports that approximately 50 percent of patients with liver cirrhosis develop serious blood vessel damage. The build-up of fibrous tissue in the liver can also cause the liver to swell and increase fluid accumulation in the abdomen.
Hepatocellular Carcinoma
A study in the "Annals of the New York Academy of Sciences" estimated that between 2.5 and 7 percent of cases of liver cirrhosis progress to hepatocellular carcinoma. Most cases of hepatocellular carcinoma are related to viral exposure. Hepatocellular carcinoma is not easily treated and often results in death. Advancements in increased surveillance of patients with liver cirrhosis have reduced the mortality from hepatocellular carcinoma. Additionally, administration of the drug, sorafenib and the surgical procedure of blocking blood vessels that deliver nutrients to liver tumors, increase survival rates in patients with hepatocellular carcinoma.
References
- U.S. Department of Veterans Affairs: Management and Treatment of Patients with Cirrhosis and Portal Hypertension
- National Digestive Diseases Information Clearinghouse: Cirrhosis
- National Digestive Diseases Information Clearinghouse: What I Need to Know About Liver Cirrhosis
- PubMed: Epidemiology, Risk Factors, and Natural History of Hepatocellular Carcinoma
