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Cirrhosis of the liver

Cirrhosis is a condition that affects the liver, characterized by the scarring of normal cell tissue.    The liver is located in the upper right-hand side of the abdomen, below the ribs.  A normal liver weighs about 3 lbs. and is the largest organ in the body.  The liver has several important functions including:

bulletPurifies blood.  The liver is responsible for breaking down harmful substances that could be present in alcohol, drugs or even food, into harmless substances that can excreted with the body's urine or stool.
bulletProduces compounds, especially proteins, that are necessary for proper bodily function. 
bulletStores sugars, fat and vitamins for the body to use when needed.
bulletTransforms small substances into larger compounds that are needed elsewhere in the body.  For example, the liver is responsible for the building up and breaking down of cholesterol.

A damaged liver cannot process drugs and toxins properly.  The scar tissue also interferes with the flow of blood.  Improper liver function resulting from cirrhosis causes severe complications which can be very serious.  Complications to cirrhosis include:

bulletinternal bleeding
bulletkidney failure
bulletmental confusion
bulletcoma
bulletbody fluid accumulation
bulletinfection

In the U.S., alcoholism is a major cause of cirrhosis.  There are several other causes of cirrhosis including:

bulletviral infection.  Hepatitis B and C are common causes of cirrhosis.
bulletbile duct damage.  Bile is a substance produced by the liver, which is sent to the large intestine via bile ducts to aid in the absorption of fat.  There are three conditions characterized by bile duct damage: 1) primary biliary cirrhosis, which is characterized by bile duct inflammation or destruction, 2) primary sclerosing cholangitis, which is also characterized by inflammation and obstruction of bile ducts resulting in symptoms such as jaundice and infection, 3) biliary artresia, a condition that occurs in infants and is characterized by blockage of bile ducts.  Bile duct damage may also occur due to surgery on the liver or other organs such as the gallbladder.

Less common causes of cirrhosis include:

bulletinherited diseases such as cystic fibrosis
bulletalpha-1 antitrypsin deficiency: absence of specific enzymes.
bullet hemochromatosis: a condition characterized by too much iron being absorbed by the liver.
bulletWilson's disease: a condition that is characterized by too much copper being stored in the liver and other organs.
bullet galactosemia
bulletglycogen storage disease
bulletreaction to certain drugs such as Vitamin A, methotrexate, amedarone
bulletexposure to environmental toxins
bulletrepeated bouts with heart failure complicated by liver congestion.

If a cause cannot be determined then the condition is called cystogenic cirrhosis.  This occurs in approximately 10% of cases.

Symptoms

There are few symptoms associated with cirrhosis and many of them are non-specific.  These include:

bulletjaundice
bulletfatigue
bulletweakness
bulletloss of appetite
bulletweight loss
bulletitching: caused by a build-up of bile
bulletimpotence
bulletloss of sex drive
bulletlack of protein, which is made by a normally-functioning liver, may result in fluid accumulation in the abdominal cavity (ascites) or legs (edema).
bulletpoor blood flow caused by improper liver function and scarring will cause blood returning to the liver to look for alternative routes.  Therefore, the engorgement of veins in the stomach and esophagus are also symptoms.  These veins could rupture causing an individual to vomit blood, have black stools or go into shock.
bulletaccumulation of toxins such as ammonia caused by poor liver function could cause mental dysfunction such as: confusion, personality changes, loss of concentration and forgetfulness.  These symptoms can be further aggravated causing an individual to go into coma or experience impaired breathing.
bulletkidney failure, which is characterized by diminished amounts of urine.  During the end stages of cirrhosis, if left totally untreated, the kidneys could shut down completely, which would result in death.
bulletindividuals suffering from cirrhosis are very sensitive to medications and frequently experience severe side effects because the liver cannot breakdown the drugs properly.

Diagnosis

Cirrhosis is a permanent condition; therefore, the primary goal of treatment is to stop further scarring and prevent the development of complications.  If an individual shows signs of cirrhosis, a physician will conduct a physical examination with a combination of blood tests in order to determine whether cirrhosis has occurred and if so, what may be the cause.  During the physical examination the physician will see whether the liver is enlarged or tender.  The physician is also looking for small, red, spider-like marking on the skin called telangiectasias, and signs of jaundice.  The lab tests may show signs of decreased protein levels, elevated bilirubin and enzyme levels or a diminished amount of blood clotting factors, all of which would lead to diagnosing cirrhosis.  Elevated iron levels would point to hemochromatosis as the cause of cirrhosis.  Diminished levels of a substance called cerulplasmin would ultimately point to Wilson's disease as a possible cause of cirrhosis.  Or, the presence of antibodies may suggest that autoimmune hepatitis is the cause of cirrhosis.

In order to confirm the diagnosis of cirrhosis, the physician may perform a liver biopsy by inserting a needle through the skin and into the liver, removing a piece of tissue.  Other procedures that may be used to diagnose cirrhosis are CAT Scan, ultrasound, radioisotope liver/spleen scan, or laparoscopy, which involves sticking a lighted viewing tube through the abdomen in order to inspect the liver.

Treatment

Unfortunately, liver scarring resulting from cirrhosis is permanent.  Therefore, the objective of treatment is to discontinue scarring and prevent the onset of complications such as internal bleeding or mental confusion.  In general, individuals suffering from liver damage should follow a healthy diet that is not rich in fat and cholesterol.  Substances that aggravate the liver such as alcohol, acetaminophen, NSAIDs and large amounts if vitamin A, should be avoided.  Individuals with cirrhosis are also recommended to avoid seafood, as it could lead to liver infection.  Most treatment methods focus on the cause of cirrhosis.  If viral infection is the cause of cirrhosis, Interferon treatment for Hepatitis B or C may be an option, if the condition is not too advanced.  Individuals with cirrhosis should be immunized for Hepatitis as well as other conditions such as influenza and pneumococcal pneumonia.  If the cause of cirrhosis is due to an overload of metal in the body, such as Wilson's disease, then bloodletting or medication to increase urine excretion may be recommended.  For patients with Autoimmune Hepatitis resulting in cirrhosis, medications to suppress immunity such as prednisone or azathioprine may be prescribed.  Ascites and Edema may be treated with diuretics to increase urine production.  Itching can be treated with medications such as cholestyramine.  In cases resulting in loss of mental function, protein ingestion should be restricted and medications such as lactulose, which help bind toxins, may be prescribed.  If internal bleeding occurs, resulting from ruptured veins in the esophagus, sclerosing agents may be prescribed, which will scar the veins closed.  For advanced cases of vein rupture, surgery may be necessary in order to create a bypass for blood away from the liver. 

In cases of advanced cirrhosis, liver transplant may be an option.  Liver transplantation has progressed tremendously in the recent years.  New medications that prevent infection and graft rejection give transplant patients and 80% survival rate over five years.  Many individuals who have undergone liver transplant surgery return to work and normal life conditions. 

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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