The liver is the site of bile formation. Bile contains bile salts,
fatty acids, cholesterol, bilirubin and other compounds. The components
of bile are synthesized and modified in the hepatocytes (the main cell
type in the liver) and secreted into small bile ducts within the liver
itself. These small bile ducts form a branching network of progressively
larger ducts that ultimately become the common bile duct that takes
bile to the small intestine.
Bilirubin is a yellow pigment that is made up from old red blood cells.
Bilirubin is taken up from the blood by hepatocytes, modified in the
hepatocytes to a water soluble form and secreted into the bile.
Although very often associated with alcohol abuse, cirrhosis of the
liver can result from may causes. Almost any chronic liver disease can
lead to cirrhosis. Here are some of the causes:
- Alcoholic liver disease
- Chronic viral hepatitis B, C and D
- Autoimmune hepatitis
- Inherited metabolic diseases (eg. haemochromatosis, Wilsons
- Chronic bile duct diseases
- Congestive heart failure
- Parasitic infections
- Liver inflammation caused by fatty liver disease
- Long exposure to toxins or drugs
Cirrhosis does take many years to develop. In patients who are infected
with Hepatitis C, somewhere between 2% and 20% of these patients will
be found to have cirrhosis twenty years after infection. Even in regard
to heavy alcohol consumption, it usually takes many years for cirrhosis
As cirrhosis is forming, and soon after it has formed, there are often
no symptoms at all. The symptoms associated with cirrhosis generally
occur when the condition is well advanced. These include:
1. Jaundice: This is caused by a build up of bile in the blood as the
liver is unable to secrete this substance.
2. Bleeding: The liver is unable to produce the proteins necessary to
help blood clotting.
3. Fluid retention: This can occur in the legs (peripheral oedema)
or in the abdomen (ascites).
4. Intense itching: This tends to occur when there are blockages in
the bile ducts.
5. Muscle cramping: A common problem in patients with advanced cirrhosis.
6. Changes in mental function: The liver does process toxins which
are absorbed from the intestine. When these toxins bypass the liver,
they can act as false transmitters in the brain resulting in a confusional
state and problems with sleep.
7. Bleeding from the oesophagus: Engorged veins in the bottom of the
oesophagus (oesophageal varices) can bleed profusely. This condition
is a medical emergency and has a high mortality rate.
Early on in the course of cirrhosis, some non specific symptoms such
as lethargy and tiredness can be present. These symptoms however, may
or may not be due to the liver function and are suffered by all of us
at some time or another.
How does Cirrhosis progress?
Cirrhosis of the liver can only rarely be reversed but treatment
of the underlying liver disease may slow or stop the progression.
Treatment for Hepatitis C and B.
Termination of alcohol intake will often stop the progression in alcoholic
cirrhosis and for this reason it is important to make this diagnosis
Similarly, discontinuation of a hepatotoxic drug or removal of an environmental
toxin can stop progression.
Treatment of Cirrhosis
The diagnosis if cirrhosis can be suspected by your doctor when he
examines you. There can also be clues found in blood test results and
in an upper abdominal ultrasound examination.
The gold standard of diagnosis is a liver biopsy. However, as some
patients with advanced cirrhosis will have a significant decrease in
clotting factors, liver biopsy sometimes
cannot be done in the usual manner.
In people with cirrhosis of the liver, treatment must also be directed
at the complications.
• Bleeding oesophageal varices can be treated with a tying off or banding
of the bleeding area.
• Ascites and oedema
are often treated with a low sodium diet plus sometimes medication
to reduce the build up of fluid. (Diuretics)
• Certain infections in the abdominal fluid must be treated
• Bleeding disorders will sometimes respond to vitamin K or
When iron is being retained in the body as in haemochromatosis, removal
of a portion of blood every so often, can decrease the amount of iron
and often the amount of inflammation in the liver.
If a patient has chronic active hepatitis, then steroids (prednisone)
will frequently reduce the inflammation and scarring.
In some instances, patients with hepatitis C related cirrhosis can
be treated with medication to reduce the progression of the virus (see
section on Hepatitis C Treatment).
Liver transplantation can be an effective treatment of end-stage cirrhosis.
Active drug or alcohol abuse is a contraindication to liver transplantation.
However, if people abstain from alcohol for an extended period (usually
more than 6 months) and participate in rehabilitation and support groups,
they may be considered for liver transplant and will often have a good