Cirrhosis

(Alcoholic, hepatic, and other forms of cirrhosis)

Cirrhosis refers to progressive scarring of the liver, in which fibrous bands and hard nodules replace healthy tissue and reduce normal liver function. This organ, which filters toxic substances from the blood and performs numerous other chemical and metabolic tasks, can function even when a large number of its cells are destroyed, but unchecked cirrhosis is eventually fatal.

The usual symptoms of cirrhosis are loss of weight and appetite, jaundice, nausea and vomiting, weakness, and abdominal pain. Generalized itching and intestinal bleeding may also occur.

Excessive alcohol intake is the most common cause of cirrhosis; a liver infection, chronic hepatitis, and a congenital defect are other possible causes. A variant called biliary cirrhosis, which affects the ducts that transport bile from the fiver to the intestines, can be due to disease of the bile ducts.

Diagnostic Studies and Procedures

A physical examination is the first step in diagnosis. The abdomen is palpated, or pressed, to determine if the liver feels hard and the spleen is enlarged. Such findings generally suggest the presence of cirrhosis. Diagnostic studies include blood and urine tests, X-rays, and ultrasound scans. A definitive diagnosis may require a biopsy, in which a needle is used to take a sample of liver tissue.

Medical Treatments

Medical treatment depends upon the underlying cause. Alcoholic cirrhosis is treated mainly by non-medical means, such as cessation of drinking and dietary changes. Biliary cirrhosis may involve surgery if a bile duct is obstructed. Sometimes, congenital cirrhosis can be controlled, but because scarring is irreversible, a liver transplant is the only cure in many cases.

Alternative Therapies

These therapies cannot cure cirrhosis, but some may be useful in minimizing symptoms and preventing any further deterioration of liver tissues.

Herbal Medicine. Many herbal preparations are said to improve liver function and promote regeneration of liver cells. These include milk thistle extract, available as silymarin pills, and cynarin, a substance in artichokes that is believed to reduce liver inflammation. Garlic capsules are promoted to detoxify the liver. Other herbal remedies include barberry, black radish, dandelion, and echinacea.

Naturopathy and Nutrition Therapy. A clinical nutritionist or dietitian can provide dietary guidance, especially in cases of alcoholism where malnutrition often contributes to deterioration of the liver. Anyone with cirrhosis must consume precisely the correct amount of protein, since too much can lead to a buildup of ammonia and the risk of a coma, while too little prevents the liver from manufacturing new cells.

Some naturopaths and nutritionists recommend that protein be derived mostly from vegetable sources, such as beans and nuts, rather than from meat. Sufficient carbohydrates and fat must be consumed to provide for the body's energy needs, so that protein can go toward repairing the liver. Vitamin B complex and other supplements are usually needed too.

Self-Treatment

Total abstention from alcohol is critical but abstaining can be very difficult. Detoxification should be carried out under careful medical supervision. After that, a support group such as Alcoholics Anonymous provides the best chance of long-term success in overcoming alcoholism.

People vary regarding how much alcohol it takes to induce cirrhosis, but it's usually in the range of a pint or more of whiskey or other spirits a day (or the equivalent in beer or wine) over several years. Limiting alcohol consumption to one or two drinks at a time on an occasional basis is probably safe. Other self-care measures include:

• Taking only those medications, including over-the-counter preparations, that your doctor feels are necessary. Most drugs are metabolized by the liver, and unneeded ones increase its workload.
• Avoid working with chemicals that give off fumes toxic to the liver.
• Minimize the danger of hepatitis by avoiding raw shellfish and other potentially contaminated foods.

Other Causes of Cirrhosis

Cirrhosis can be inborn. It can also be the result of Wilson's disease, a hereditary disorder in which copper accumulates in the liver; hemochromatosis, a genetic tendency to conserve iron; and cystic fibrosis.