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  Cirrhosis of the Liver  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

In cases of cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the eighth leading cause of death by disease and the cost of cirrhosis in terms of human suffering, hospital costs and lost productivity is high because loss of liver function affects the body in many ways. In the United States, chronic alcoholism and hepatitis C are the most common of its many causes. Many people with cirrhosis have no symptoms in the early stages of the disease. However, as scar tissue replaces healthy cells, liver function starts to fail and a person may experience various symptoms. As the disease progresses, complications may develop.

Diagnosis
The doctor may diagnose cirrhosis on the basis of symptoms, laboratory tests, the patient's medical history and a physical examination. The doctor may, for example, notice that the liver feels harder or larger than usual and order blood tests that can show whether liver disease is present.

If a liver examination is necessary, the doctor might order a computerized axial tomography (CAT) scan, ultrasound, a scan of the liver using a radioisotope, or look at the liver using a laparoscope. A liver biopsy will confirm the diagnosis. For a biopsy, the doctor uses a needle to take a small sample of tissue from the liver, then examines it for scarring or other signs of disease.

Treatment
Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. Treatment depends on the cause of cirrhosis and any complications a person is experiencing. For example, cirrhosis caused by alcohol abuse is treated by abstaining from alcohol; treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis; cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with medications to remove the copper. Treatment will also include remedies for complications such as edema, infections and itching.

Some herbs thought to potentially benefit alcoholic liver disease were found to produce no benefit after six months of use. These included capers (Capparis spinosa), wild chicory (Cichorium intybus), black nightshade (Solanum nigrum), arjuna (Terminalia arjuna), negro coffee (Cassia occidentalis), yarrow (Achillea millefolium) and tamarisk (Tamarix gallica). [J Ethnopharmacol 2003;84(1): pp.47-50]

When complications cannot be controlled or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary.
 

 
 

Signs, symptoms & indicators of Cirrhosis of the Liver:
 
 
Lab Values - Cells  Macrocytic red cells

Symptoms - Environment

  Sensitive to medications
 Cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side-effects.


Counter-indicators:
  Not sensitive to medications
 Cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side-effects.

Symptoms - Food - General

  Weak appetite

Symptoms - Gas-Int - General

  Unexplained nausea

Symptoms - General

  Constant fatigue

Symptoms - Nails

  Nails that are mostly white
 Mainly white nails, or Terry's Nails, are a significant indicator of hepatic cirrhosis. [Terry (1954) Lancet, 1:757]

Symptoms - Skin - General

  Red palms/fingertips
 Red palms (palmar erythema - liver palms) are often found in patients with alcohol-induced cirrhosis and can be seen in patients with primary biliary cirrhosis.

Liver palms occur also during pregnancy and in a number of chronic diseases such as chronic polyarthritis (rheumatoid arthritis), chronic lung disease, subacute bacterial endocarditis, chronic febrile diseases, leukemia, and thyrotoxicosis. In a number of individuals the characteristic mottling and blotchy redness are of no clinical significance and palmar flushing may be familial.

  Itchy skin
 Some people with liver or biliary cirrhosis experience intense itching due to bile products that are deposited in the skin.
 
 

Conditions that suggest Cirrhosis of the Liver:
 
 
Circulation  Bleeding Tendency
 When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

  Bruising Susceptibility
 When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

Hormones

  Hyperprolactinemia
  Elevated SHBG
 Elevated levels of SHBG may be observed with hepatic cirrhosis.

Immunity

  Weakened Immune System
 Cirrhosis can cause immune system dysfunction leading to infection.

Lab Values

  Low Platelet Count
 Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension. When portal hypertension occurs, the spleen frequently enlarges and holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.

  Hypoalbuminemia (A low albumin level)
  Eosinophilia

Mental

  Poor Memory
 A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain. Once there, toxins can dull mental functioning and cause personality changes, coma, or even death. Signs of toxin buildup in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.

Metabolic

  Jaundice
 Jaundice is a yellowing of the skin and eyes that occurs when the diseased liver does not process enough bilirubin.

  Edema (Water Retention)
 When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

Organ Health

  Enlarged Spleen
 Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension. When portal hypertension occurs, the spleen frequently enlarges and holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.

  Gallbladder Disease
 If cirrhosis prevents bile from reaching the gallbladder, a person may develop gallstones as a result.

  Kidney Weakness / Disease
 Liver Cirrhosis can lead to kidney dysfunction and failure.
 
 

Risk factors for Cirrhosis of the Liver:
 
 
Addictions  Alcohol-related Problems
 To many people, cirrhosis of the liver is synonymous with chronic alcoholism. It is a major cause, but nevertheless one of several. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats and carbohydrates.

Autoimmune

  Ulcerative Colitis
 Cirrhosis of the liver can occur when the immune system triggers inflammation there as a result of ulcerative colitis.

Lab Values - Chemistries

  (Very) low TIBC

Lab Values - Hormones

  Having low-normal/having low TT4 level

Metabolic

  Hemochromatosis (Iron overload)
 Cirrhosis is the most common severe consequence of hemochromatosis.

Organ Health

  Hepatitis
 The hepatitis C virus ranks with alcohol as the major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Hepatitis B is probably the most common cause of cirrhosis worldwide, but in the United States and Western world it is less common. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis.

The hepatitis D virus is another virus that infects the liver, but only in people who already have hepatitis B.

  Fatty Liver
 Fatty liver may be associated with or may lead to inflammation of the liver. This can cause scarring and hardening of the liver. When scarring becomes extensive, it is called cirrhosis, a very serious condition.

Symptoms - Food - Beverages

Counter-indicators:
  Never having consumed alcohol or very low alcohol consumption
 Chronic, heavy alcohol consumption is the number one cause of liver cirrhosis. Cirrhosis is much less likely to occur to those without a history of alcohol consumption.

Symptoms - Metabolic

  Recent unexplained weight loss

Symptoms - Nails

  Some/possible clubbing of digits or clubbing of toes and fingers

Counter-indicators:
  Absence of clubbing
 
 

Cirrhosis of the Liver suggests the following may be present:
 
 
Nutrients  Zinc Requirement
 Cirrhosis of the liver may increase the need for zinc or affect how the body absorbs or uses this mineral.


Counter-indicators:
  Manganese Requirement
 Preliminary research suggests that individuals with cirrhosis may not be able to properly excrete manganese. Until more is known, these people should not supplement manganese. [Lancet 1995;346: pp.270-4]
 
 

Cirrhosis of the Liver can lead to:
 
 
Circulation  Bleeding Tendency
 When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

  Bruising Susceptibility
 When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily.

Hormones

  Elevated SHBG
 Elevated levels of SHBG may be observed with hepatic cirrhosis.

Mental

  Poor Memory
 A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain. Once there, toxins can dull mental functioning and cause personality changes, coma, or even death. Signs of toxin buildup in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.

Metabolic

  Edema (Water Retention)
 When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

Organ Health

  Kidney Weakness / Disease
 Liver Cirrhosis can lead to kidney dysfunction and failure.

Risks

  Increased Risk of Liver Cancer
 When a patient develops cirrhosis, the chance of liver cancer rises sharply (25 to 40 times higher than normal) and in a very advanced stage the liver is no longer able to function.
 
 

Recommendations for Cirrhosis of the Liver:
 
 
Amino Acid / ProteinNot recommended:
  Glutamine
 Individuals with liver toxicity tend to accumulate ammonia in their blood and brain. Until recently, it was assumed that it was the ammonia that caused liver disease-associated brain injury and that glutamine was protective. Newer studies indicate that actually it is the glutamine that is causing the brainís injury. Increasing glutamine in the diet would significantly aggravate this damage. Russell L. Blaylock, M.D.

Botanical

  Silymarin/Milk Thistle (Silybum marianum)
  Chlorella / Algae Products

Not recommended:
  Kava

Diet

  Alcohol Avoidance
 In all cases, regardless of cause, following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get.

  Vegetarian/Vegan Diet
 Protein intake should be between about 60 - 120gm a day in patients with hepatitis C, unless a complication of cirrhosis known as encephalopathy occurs. Encephalopathy is an altered mental status. The exact cause is not fully understood and is probably multifactorial. It has been shown that restriction of the diet of animal protein and maintaining a total vegetarian diet, helps reverse this condition and improve mental capacity.

Obtain your protein by combining grains, raw nuts, raw seeds, sprouts and legumes and use of a quality whey protein powder. The cirrhotic liver cannot handle large amounts of concentrated protein and for this reason minimize, or even better, avoid the consumption of red meat and poultry. If you eat too much animal protein, ammonia levels will build up in the blood stream causing mental fatigue and confusion.


Not recommended:
  High/Increased Protein Diet
 Protein consumption tends to cause toxins to form in the digestive tract, so eating less protein will help decrease the buildup of toxins in the blood which must be processed by the liver..

  Increased Water Consumption
 When ascites is present, water intake should be limited to about 1500ml ( 6 cups) per day.

Lab Tests/Rule-Outs

  Tests, General Diagnostic
 Today, the only way to detect cirrhosis is through a biopsy - where a tissue sample is taken by injecting a needle through the skin into the liver. Biopsy is not entirely risk-free and is very expensive.

VIB researcher Nico Callewaert and his colleagues in the team of Roland Contreras (Dept. for Molecular Biomedical Research, Ghent University) have developed a new method that only requires a little blood in order to detect the cirrhosis stage reliably. In a test group of patients, the researchers succeeded in detecting 70 to 80% of the early liver cirrhoses. Not a single patient was diagnosed incorrectly.

The new test detects changes in the quantities of the various sugars that are produced by the liver, which occur in the transition from fibrosis to cirrhosis. The researchers have been able to measure the sugar changes quite accurately with advanced instrumentation that is already being used in clinical laboratories, but for genetic tests.

The test is now being perfected. Through future collaborations with industry, the researchers hope to arrive at a test that is easy to use and that shows 100% specificity for cirrhosis of the liver. The test could then be used to follow people with chronic hepatitis C viral infection. [8-Mar-2004 Prof. Roland Contreras, Flanders Interuniversity Institute of Biotechnology ]

  Test/Monitor Liver Function

Mineral

  Salt Intake Reduction
 Advanced scarring of the liver [cirrhosis] may lead to an abnormal accumulation of fluid in the abdomen referred to as ascites. Patients with hepatitis C who have ascites must be on sodium [salt] restricted diets. Every gram of sodium consumed results in the accumulation of 200 ml of fluid. The lower the salt content in the diet, the better this excessive fluid accumulation is controlled. While often difficult, sodium intake should be restricted to 1000mg each day, and preferably to 500mg per day.

Vitamins

  Vitamin Niacinamide
 Niacinamide can protect the liver against alcohol-induced damage.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences
Reasonably likely to cause problems







GLOSSARY

Autoimmune Disease:  One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Bile:  A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.

Biopsy:  Excision of tissue from a living being for diagnosis.

Bruise:  Injury producing a hematoma or diffuse extravasation of blood without breaking the skin.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Carbohydrates:  The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.

CAT Scan:  (Computerized Axial Tomography scan). A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Copper:  An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.

Edema:  Abnormal accumulation of fluids within tissues resulting in swelling.

Fatty Liver:  Accumulation of triglycerides in the liver.

Febrile:  Having to do with a fever.

Gallbladder:  A small, digestive organ positioned under the liver, which concentrates and stores bile. Problems with the gallbladder often lead to "gallbladder attacks", which usually occur after a fatty meal and at night. The following are the most common symptoms: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.

Gallstone:  (Biliary Calculus): Stone-like objects in either the gallbladder or bile ducts, composed mainly of cholesterol and occasionally mixed with calcium. Most gallstones do not cause problems until they become larger or they begin obstructing bile ducts, at which point gallbladder "attacks" begin to occur. Symptoms usually occur after a fatty meal and at night. The following are the most common ones: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.

Hemochromatosis:  A rare disease in which iron deposits build up throughout the body. Enlarged liver, skin discoloration, diabetes mellitus, and heart failure may occur.

Hepatitis:  Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.

Hepatitis B:  A serious viral infection with the potential for long term consequences. It is caused by a DNA virus that has been found in virtually all body secretions and excretions. However, only blood, saliva, semen and vaginal fluids have been shown to be infectious. Transmission occurs through sexual contact, blood-to-blood contact (blood products, needle sharing, etc.), and from infected mother to infant. Virtually all affected infants and children, and many adults, receive a lesser, even symptom-free, infection. Symptoms, when present, tend to be more severe and prolonged than those for Hepatitis A: initially flu-like, with malaise, fatigue, muscle pain and chest pain on the right side. This is followed by jaundice (slight skin yellowing), anorexia, nausea, fatigue, pale stools, dark urine and tender liver enlargement, but usually no fever.

Hepatitis C:  Caused by an RNA flavivirus. Transmission is predominantly through broken skin on contact with infected blood or blood products, especially through needle sharing. Sexual transmission is relatively rare. Symptoms are almost always present, and very similar to those for Hepatitis B: initially flu-like, with malaise, fatigue, muscle pain and chest pain on the right side. This is followed by jaundice (slight skin yellowing), anorexia, nausea, fatigue, pale stools, dark urine and tender liver enlargement, but usually no fever.

Herbs:  Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.

Hypertension:  High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Interferon:  A protein formed by the cells of the immune system in the presence of a virus, etc. It prevents viral reproduction, and is capable of protecting noninfected cells from viral infection. Several kinds of interferon exist including alpha, beta, and gamma.

Jaundice:  Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.

Laparoscope:  An instrument inserted into the body that relays pictures back to a computer screen.

Leukemia:  Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).

Manganese:  An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Mineral:  Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Radioisotope:  A radioactive substance used to highlight internal organs.

Rheumatoid Arthritis:  A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

Scar Tissue:  Fibrous tissue replacing normal tissues destroyed by injury or disease.

Thyrotoxicosis:  Also known as Graves' disease, is a disorder of excess thyroid hormone production. It is usually linked to an enlarged thyroid gland and bulging eyes (exophthalmos).

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.

Virus:  Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.

Zinc:  An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.