Cirrhosis

Cirrhosis is a progressive disease. In cases of alcoholic cirrhosis, it begins with a condition called alcoholic fatty liver. In this condition, fat accumulates in the liver. The liver enlarges, sometimes to as much as 10 lb (5000 g), and appears yellow and greasy. Patients with this condition often have no symptoms beyond low blood sugar or some digestive upset. Some patients have more severe symptoms, such as jaundice (a condition caused by the accumulation of a yellowish bile pigment in the blood; patients with jaundice have yellow-tinged skin) and weight loss. Complete recovery is possible at this stage of liver disease if the patient abstains from alcohol.

The next stage in the progression of cirrhosis is often a condition called hepatitis. Hepatitis is a general term meaning inflammation of the liver. Hepatitis may be caused by alcohol, a virus, or other factors. In acute alcoholic hepatitis, the inflammation is caused by alcohol. Fibrous tissue is deposited in the liver, the liver cells degenerate, and a type of connective tissue called hyaline infiltrates the liver cells. Regardless of the cause, patients with hepatitis have serious symptoms, including general debilitation, loss of muscle mass, jaundice, fever, and abdominal pain. The liver is firm, tender, and enlarged. Vascular "spiders," or varicose veins of the liver, are present. Again, no definitive treatment is available, although some patients respond well to corticosteroids. General treatment for this condition includes treatment of symptoms and complications.

Acute alcoholic hepatitis often progresses to cirrhosis. In cirrhosis, the fibrous tissue and fat accumulation is prominent. Collagen is deposited around the veins of the liver, leading to impairment of blood flow. The liver cells degenerate further and die, leading to formation of nodules in the liver, and the liver atrophies (shrinks). Symptoms of cirrhosis include nausea, weight loss, jaundice, and esophageal varices. Gastrointestinal symptoms, such as diarrhea and gastric distention, are also features of cirrhosis. The mortality rate of cirrhosis is high. Five year survival of patients with cirrhosis is 64% for patients who stop drinking, and 40% for patients who continue to drink. Death results from kidney failure, coma, malnutrition, and cardiac arrest.

Treatment of cirrhosis depends on the type and cause. For patients with alcoholic cirrhosis, it includes general support, treatment of complications, a nutritious diet, and abstention from alcohol consumption. In selected patients, liver transplant may be indicated. Although the liver has a remarkable ability to regenerate, the damage that cirrhosis inflicts on the liver may be so severe that recovery is not possible. In cirrhosis caused by viral hepatitis, the use of experimental drugs has had some success.