Liver

Introduction | Disease Progression/Prognosis | Treatment Options | Liver Issue: Cirrhosis | Alcohol: Can it hurt my Liver? | Videos

Liver Issue: Cirrhosis

What is cirrhosis?

When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis. The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs and toxins by the liver. When this blood backs up, it can also cause baggy veins, known as varicies, in the esophagus and the stomach. These veins are at a significant risk of rupturing and bleeding—any variciael bleed carries a 50 percent risk of death.

What are the symptoms?*

• You may have no symptoms at all in the early stages. As cirrhosis progresses you may:
• feel tired or weak
• lose your appetite
• feel sick to your stomach
• lose weight

Cirrhosis can also lead to other problems, such as:

• You may bruise or bleed easily, or have nosebleeds.
• Bloating or swelling may occur as fluid builds up in the abdomen or legs. Fluid build up in the abdomen is called ascites and in the legs is called edema.
• Medications may have a stronger effect on you because your liver does not break them down as quickly.
• Waste materials from food may build up in the blood or brain and may cause confusion or difficulty thinking. For example, protein that you eat breaks down into chemicals like ammonia. When red blood cells get old, they break down and leave a substance called bilirubin—a healthy liver removes these byproducts, but a diseased liver leaves them in the body.
• Blood pressure may increase in the vein entering the liver, a condition called portal hypertension.
• Enlarged veins, called varices, may develop in the esophagus and stomach. Varices can bleed suddenly, causing vomiting of blood or passing of blood in a bowel movement.
• The kidneys may not work properly or may fail.

*Source: National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

What causes cirrhosis?

There are many causes of cirrhosis. Long-term alcohol abuse is one. Chronic hepatitis is another major cause. In children, the most frequent causes are biliary atresia, a disease that damages the bile ducts, and neonatal hepatitis. Cirrhosis can also be caused by hereditary defects in iron or copper metabolism or prolonged exposure to toxins.

Treatment Options

Portal Caval Shunt: This is a procedure where the portal vein is connected with the vena cava. This allows back pressure from the liver to empty in to the vena cava circulation.

Meso Caval Shunt: This is when the superior mesenteric vein is attached to the vena cava. This is the safest operation for a patient that might later require a liver transplant.

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Splenectomy: When the splenic vein thrombosis (clots) from pancreas inflammation, the back pressure from the spleen will go into the vessels of the stomach and cause gastric varicies. This is the simplest form of portal hypertension to control, because simple splenectomy relieves back pressure.

Suiguira Procedure: When there are no options for major vascular decompression of the stomach, direct division of the gastric vessels is chosen. In this procedure removal of all small feeding vessels to the stomach and esophagus are performed, including division of the esophagus.

Splenopneumopexy: This is the rarest form of vascular decompression. When the abdomen can not be approached, the spleen can be brought through the diaphragm and attached to the lung. Chronic collaterals will build and reroute the blood flow.