Cirrhosis: Symptoms and Risk Factors

Cirrhosis is a chronic, irreversible liver disease. It is caused by repeated damage to the liver, most commonly due to excessive alcohol intake over several years. Ultimately, the liver tissue is destroyed and unable to complete its normal functions, which include synthesis of various molecules and processing of foods, drugs, and toxins.

The majority of cases are due to chronic alcohol use or viral hepatitis, especially hepatitis C. However, any chronic liver disease can lead to cirrhosis.

The initial symptoms include weight loss, anorexia, fatigue, weakness, nausea, dull abdominal pain, and constipation or diarrhea. As the disease progresses, symptoms become more severe and may include jaundice (a yellow discoloration of the skin), gynecomastia (excessive growth of men’s breasts), shrinkage of the testicles, bruising, poor blood coagulation, ascites (fluid accumulation in the abdomen), and peripheral edema (fluid accumulation in the legs).

Complications of advanced disease can be fatal. Because the damaged liver is unable to neutralize toxic substances, particularly ammonia, a build–up of toxins in the bloodstream can cause a condition called hepatic encephalopathy, resulting in delirium, lethargy, confusion, slurred speech, hallucinations, and coma. In addition, the damaged liver loses its ability to produce clotting proteins, which can contribute to uncontrolled bleeding. Further, infection, kidney failure, and liver cancer are far more common in these patients.

Risk Factors

• Chronic alcohol abuse: As little as two drinks per day for women or four drinks per day for men, ingested over 10 years or more, can cause cirrhosis. Alcoholic liver disease results in 12,000 deaths per year in the United States. Unfortunately, many patients become symptomatic only after severe liver disease has occurred.
• Unprotected intercourse: Hepatitis B and C infections are easily transmitted through unprotected sexual intercourse.
• Intravenous drug use: Hepatitis B and C transmission is also common through intravenous drug use.
• Inherited or acquired chronic liver disease: Hemochromatosis, Wilson’s disease, and autoimmune hepatitis are strong risk factors for cirrhosis.