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The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver. In 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 twelfth leading cause of death by disease, killing about 26,000 people each year in the United States. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.
Symptoms and Complications
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 the following symptoms: •exhaustion •fatigue •loss of appetite •nausea •weakness •weight loss •abdominal pain •spider-like blood vessels (spider angiomas) that develop on the skin As the disease progresses, complications may develop. In some people, these may be the first signs of the disease. Complications of Cirrhosis Loss of liver function affects the body in many ways. Following are the common 1
Toxins in the blood or brain. Cirrhosis slows the liver's ability to filter medications from the blood. called varices.problems. Itching. This causes a person to be more sensitive to medications and their side effects. and type 2 diabetes develops as excess glucose builds up in the bloodstream. If cirrhosis prevents bile from reaching the gallbladder. a type of liver cancer commonly caused by cirrhosis. When blood flow through the portal vein slows. Cirrhosis causes resistance to insulin. Hepatocellular carcinoma. caused by cirrhosis. unresponsiveness. This condition is called portal hypertension. Normally. Jaundice. fat. The enlarged blood vessels. and even death. and liver cells do not use insulin properly. Jaundice is a yellowing of the skin and eyes that occurs when the diseased liver does not absorb enough bilirubin. But cirrhosis slows the normal flow of blood through the portal vein. Insulin resistance and type 2 diabetes. If you have insulin resistance. blood from the intestines and spleen is carried to the liver through the portal vein. Eventually. which increases the pressure inside it. forgetfulness. your muscle. Portal hypertension. The pancreas tries to keep up with the demand for insulin by producing more. Edema and ascites. Because the liver does not remove drugs from the blood at the usual rate. Gallstones. or changes in sleep habits. enables blood glucose to be used as energy by the cells of the body. Bruising and bleeding. the pancreas cannot keep up with the body's need for insulin. causing them to accumulate in the blood and eventually the brain. If they do burst. a person will bruise or bleed easily. Bile products deposited in the skin may cause intense itching. and thus are more likely to burst. A damaged liver cannot remove toxins from the blood. or complications. starts in the liver tissue itself. This hormone. Sensitivity to medication. When the liver loses its ability to make the protein albumin. Signs of the buildup of toxins in the brain include neglect of personal appearance. The palms of the hands may be reddish and blotchy with palmar erythema. produced by the pancreas. Liver cancer. they act longer than expected and build up in the body. water accumulates in the legs (edema) and abdomen (ascites). There. gallstones may develop. the result is a serious bleeding problem in the upper stomach or esophagus that requires immediate medical attention. trouble concentrating. When the liver slows or stops production of the proteins needed for blood clotting. These blood vessels may become enlarged because they are not meant to carry this much blood. It has a high mortality rate. 2 . have thin walls and carry high pressure. toxins can dull mental functioning and cause personality changes. Varices. blood from the intestines and spleen backs up into blood vessels in the stomach and esophagus. coma.
as few as two to three drinks per day have been linked with cirrhosis and in men. magnetic resonance imaging (MRI). fats. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. To many people. Causes Cirrhosis has many causes. Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. If looking at the liver is necessary to check for signs of disease. and a physical examination. Cirrhosis can cause immune system dysfunction. Hepatitis D is another virus that infects the liver. like hepatitis C. Chronic hepatitis B and D. alcoholism is only one of the causes. or a scan of the liver using a radioisotope (a harmless radioactive substance that highlights the liver). but only in 3 . ultrasound. but it is less common in the United States and the Western world. and osteoporosis. The amount of alcohol that can injure the liver varies greatly from person to person. the medical history. the doctor might order a computerized axial tomography (CAT) scan. Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines. laboratory tests. leading to infection. The hepatitis B virus is probably the most common cause of cirrhosis worldwide. the doctor may notice that the liver feels harder or larger than usual and order blood tests that can show whether liver disease is present. during a physical examination. kidney dysfunction and failure. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis. an instrument that is inserted through the abdomen and relays pictures back to a computer screen. In women. chronic alcoholism and hepatitis C are the most common ones. Hepatitis B. causes liver inflammation and injury that over several decades can lead to cirrhosis.Problems in other organs. Alcoholic liver disease. as few as three to four drinks per day. cirrhosis of the liver is synonymous with chronic alcoholism. Alcohol seems to injure the liver by blocking the normal metabolism of protein. and carbohydrates. For example. then examines it under the microscope for scarring or other signs of disease. For a biopsy. the doctor uses a needle to take a tiny sample of liver tissue. Or the doctor might look at the liver using a laparoscope. but in fact. In the United States. A liver biopsy will confirm the diagnosis. Diagnosis The doctor may diagnose cirrhosis on the basis of symptoms. Cirrhosis can also lead to impotence.
Light physical activity can help stop or delay cirrhosis as well. for ascites and edema. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis. Severe reactions to prescription drugs. the most common cause is primary biliary cirrhosis. blocked. In NASH. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured. Cirrhosis caused by Wilson's disease. and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces. Treatment will also include remedies for complications. and eventually scarring and cirrhosis. galactosemia. protein malnutrition. Liver damage from cirrhosis cannot be reversed. Drugs. and infections. For example. In adults. the doctor may recommend a low-sodium diet or the use of diuretics. This disease appears to be caused by the immune system attacking the liver and causing inflammation. The doctor may also prescribe laxatives to help absorb the toxins and remove them from the intestines. In babies. and scarred. the parasitic infection schistosomiasis. and various medications can help with itching. and stores enzymes. and repeated bouts of heart failure with liver congestion can all lead to cirrhosis. coronary artery disease. a disease in which the ducts become inflamed. fat builds up in the liver and eventually causes scar tissue. but treatment can stop or delay further progression and reduce complications. in which copper builds up in organs.people who already have hepatitis B. Alpha-1 antitrypsin deficiency. and alcohol will only lead to more liver damage. metals. bile backs up and damages liver tissue. and treatment with corticosteroid medications. This type of hepatitis appears to be associated with diabetes. proteins. These are just a few examples—treatment for cirrhosis resulting from other diseases depends on the underlying cause. Wilson's disease. prolonged exposure to environmental toxins. processes. such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. and other substances the body needs to function properly. hemochromatosis. Blocked bile ducts. cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Nonalcoholic steatohepatitis (NASH). which are drugs that remove fluid from the body. Autoimmune hepatitis. following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get. Treatment depends on the cause of cirrhosis and any complications a person is experiencing. a disease in which the bile ducts are absent or injured. For example. toxins. damage. Inherited diseases. Protein causes toxins to form in the digestive tract. regardless of the cause. blocked bile ducts are most commonly caused by biliary atresia. the doctor may prescribe a blood pressure medication such as a 4 . so eating less protein will help decrease the buildup of toxins in the blood and brain. Antibiotics will be prescribed for infections. For portal hypertension. obesity. In all cases. is treated with medications to remove the copper. When the ducts that carry bile out of the liver are blocked.
In this way. the muscle wall that separates the stomach from the chest. which over time can lead to cancer. About 80 to 90 percent of patients survive liver transplantation. or reflux. the doctor may either inject them with a clotting agent or perform a so-called rubber-band ligation. a diseased liver is removed and replaced with a healthy one from an organ donor.beta-blocker. Other factors that may contribute to GERD include •alcohol use 5 . but actually it has nothing to do with the heart. it is easier for the acid to come up. many otherwise healthy people over 50 have a small one. A hiatal hernia may contribute. Inflammation of the esophagus from stomach acid may cause bleeding or ulcers. scars from tissue damage can narrow the esophagus and make swallowing difficult. Occasional heartburn is common but does not necessarily mean one has GERD. When a hiatal hernia is present. Heartburn is a painful or burning sensation in the chest or upper abdomen. A hiatal hernia can happen in people of any age. Sometimes GERD can cause serious complications. Heartburn occurs when refluxed stomach acid touches the lining of the esophagus. The diaphragm helps the LES keep acid from coming up into the esophagus. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm. a liver transplant is necessary. into the esophagus. In liver transplantation surgery. Some people even develop Barrett's esophagus. Causes The causes of GERD are not clear. occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The symptom is similar to heart attack. If varices bleed. The fluid may even be tasted in the back of the mouth. When complications cannot be controlled or when the liver becomes so damaged from scarring that it completely stops functioning. which suppress the immune system and keep it from attacking and damaging the new liver. Heartburn that occurs more than twice a week may be considered GERD. which uses a special device to compress the varices and stop the bleeding. and this is called acid indigestion. Survival rates have improved over the past several years because of drugs such as cyclosporine and tacrolimus. or GERD. Heartburn and GERD Gastroesophageal reflux disease. In addition. a hiatal hernia can cause reflux.
usually no other tests are needed to confirm GERD. •Barium swallow radiograph. Some people have GERD without heartburn. chili. or trouble swallowing. including •citrus fruits •chocolate •drinks with caffeine •fatty and fried foods •garlic and onions •mint flavorings •spicy foods •tomato-based foods. hoarseness in the morning. GERD can also cause a dry cough and bad breath.•overweight •pregnancy •smoking Also. If the heartburn does not improve with lifestyle changes or drugs. and pizza Symptoms and Diagnosis The main symptoms for GERD are persistent heartburn and acid regurgitation. and other problems will. The doctor may use tiny tweezers (forceps) in the endoscope to remove a small 6 . Mild irritation will not appear on this test. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. hiatal hernia. although narrowing of the esophagus—called stricture—ulcers. Instead. •Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. one of the following procedures may be necessary to look for abnormalities in the esophagus. certain foods can be associated with reflux events. The doctor will spray your throat to numb it and slide down a thin. you drink a solution and then x rays are taken. With this test. flexible plastic tube called an endoscope. they experience pain in the chest. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus. It uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. like spaghetti sauce.
•Eat small meals. and aluminum . •Ambulatory pH monitoring examination. •Wear loose-fitting clothes. however. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found. Lifestyle Changes •Stop smoking. it measures when and how much acid comes up into your esophagus. Foaming agents. Many brands on the market use different combinations of three basic salts . •Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help. such as Tums. Aluminum and magnesium salts are often combined in a single product to balance these effects. treatment may involve one or more of the following lifestyle changes and medications or surgery. which you can buy without a prescription. such as Gaviscon. have side effects. While you go about your normal activities. Calcium carbonate antacids. The procedure is also helpful in detecting whether respiratory symptoms. Depending on how severe the gastroesophageal reflux disease (GERD) is. Antacids are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. calcium. and aluminum salts can cause constipation. 7 . This test is useful in people with GERD symptoms but no esophageal damage. can also be a supplemental source of calcium. including wheezing and coughing. and Alka-2. Antacids. The doctor puts a tiny tube into the esophagus that will stay there for 24 hours. work by covering your stomach contents with foam to prevent reflux. Titralac. are triggered by reflux.magnesium. •Do not drink alcohol. •Lose weight if needed. Medications Doctors may recommend over-the-counter antacids. These drugs may help those who have no damage to the esophagus. •Avoid lying down for 3 hours after a meal.piece of tissue for biopsy. They can cause constipation as well. or medications that stop acid production or help the muscles that empty your stomach. Magnesium salt can lead to diarrhea.with hydroxide or bicarbonate ions to neutralize the acid in the stomach.
and esomeprazole (Nexium). Your doctor is the best source of information on how to use medications for GERD. surgeons use small instruments that hold a tiny camera. Another group of drugs. the scar tissue helps toughen the muscle. Proton pump inhibitors include omeprazole (Prilosec). Fundoplication. This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. The Stretta system uses electrodes to create tiny cuts on the LES. Implant 8 . Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. which are all available by prescription. and ranitidine (Zantac 75). They are effective for about half of those who have GERD symptoms. but these drugs have frequent side effects that limit their usefulness. When performed by experienced surgeons. rabeprazole (Aciphex). the procedure is reported to be as good as standard fundoplication. Metoclopramide also improves muscle action in the digestive tract. Laparoscopic fundoplication has been used safely and effectively in people of all ages. Surgery Surgery is an option when medicine and lifestyle changes do not work. is the standard surgical treatment for GERD. famotidine (Pepcid AC). The antacids work first to neutralize the acid in the stomach. the U. usually a specific variation called Nissen fundoplication. nizatidine (Axid AR). By the time the antacid stops working. impede acid production. To perform the fundoplication. pantoprazole (Protonix). Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor. These drugs provide short-term relief. while the H2 blockers act on acid production. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. Furthermore. such as cimetidine (Tagamet HB). The long-term effects of these two procedures are unknown. prokinetics. They are available in prescription strength and over the counter. In 2000. The upper part of the stomach is wrapped around the lower esophageal sphincter (LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. even babies. helps strengthen the sphincter and makes the stomach empty faster. but over-the-counter H2 blockers should not be used for more than a few weeks at a time. This group includes bethanechol (Urecholine) and metoclopramide (Reglan).H2 blockers. people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.S. combinations of drugs may help control symptoms. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD. People who get heartburn after eating may take both antacids and H2 blockers. the H2 blocker will have stopped acid production. When the cuts heal. Because drugs work in different ways. lansoprazole (Prevacid).
Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. The long-term effects of the implant are unknown. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors.Recently the FDA approved an implant that may help people with GERD who wish to avoid surgery. 9 . It is injected during endoscopy.
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