WHAT IS CIRRHOSIS?

The liver is an incredibly resilient organ, but unfortunately it isn’t indestructible. Sometimes the damage that occurs as a result of excessive alcohol, a virus, or some other chronic disease overwhelms the liver’s capacity to function. Healthy liver cells are destroyed, and scarring occurs. Scarring, known as fibrosis, is the liver’s effort to keep the damage done by alcohol or the hepatitis C virus (HCV), for example, contained. But, scar tissue can block the blood flow through the liver, resulting in an inability of the liver to perform its normal duties. If alcohol, or HCV, is not eliminated from the body, scarring becomes extensive. The liver becomes rock hard and nodular (lumpy). This condition is known as cirrhosis. Although the presence of cirrhosis does not signify that health problems will inevitably develop, a person with cirrhosis should be aware that he is at an increased risk of suffering many serious complications.

 Cirrhosis is the end product of any one of a number of different liver diseases.  These diseases which will be discussed elsewhere in my book. Regardless of the cause, the potential consequences of cirrhosis are the same. Whereas a healthy liver typically repairs and regenerates itself when injured (see page xx), once cirrhosis has occurred, the damage may never be undone. 

     When I was a student at Mount Sinai Medical School in the early 1980’s, I was taught that cirrhosis was irreversible.   In fact, even as recently as the publication of the first edition of this book – the year 2000, it was still the gospel belief among most liver disease experts that while cirrhosis could occasionally be slowed, or even halted, it could never reverse.  However, some recent studies have shown that with removal of the cause of the underlying liver disease – alcohol or the hepatitis C virus (HCV) for example, and with effective treatment, cirrhosis can be reversed, - at least in its very early stages, when scarring is minimal.  The point at which cirrhosis becomes irreversible is not clear. But, there is a broad consensus among liver disease experts that once cirrhosis has advanced to its late stages -- when complications from extensive scaring have occurred  (known as decompensated cirrhosis), it can never be reversed.

Recent progress has made in the control and the reversal of cirrhosis. This is confirmed by the decline in the number of cirrhosis-related death rates in the United States over the last twenty years. Therapies such as interferon and ribavirin for chronic hepatitis C, and Epivir and Hepsera for chronic hepatitis B, have been shown to reverse cirrhosis in its early stages. There have been anecdotal reports of scarring being reversed after treatment in people with autoimmune hepatitis (chapter 14), primary biliary cirrhosis (Chapter 15) and hemochromatosis (chapter 18). Thus, cirrhosis, should no longer be considered as an irreversible condition.  Still, cirrhosis continues to be the eighth most common cause of death overall in the United States and the fourth leading cause of death among Americans between the ages of thirty and sixty. But being diagnosed with cirrhosis is not necessarily a death sentence. Usually, when cirrhosis is fatal, it is because it has proceeded unchecked and untreated for many years. If, however, it is caught in its early stages, there will often be steps that the patient and doctor can take to control, and possibly even reverse, its progression.

Despite having cirrhosis, many people have lived well past the age of ninety. Of course, prevention remains the best medicine; therefore, most of the treatments doctors prescribe, as well as the nutrition and exercise tips discussed in Chapter 23, are aimed at trying to keep the liver from progressing to cirrhosis in the first place.

LIVER DISEASES THAT CAN LEAD TO CIRRHOSIS

Not all liver diseases cause cirrhosis—only those that cause chronic, ongoing damage to the liver can lead to permanent scarring of liver tissue. For example, someone with hepatitis A will usually recover completely after a few weeks, and as such, will not be at risk for developing cirrhosis. But someone who has lived for decades with a chronic liver condition, such as hepatitis C or hemochromatosis, would be a prime candidate for cirrhosis.

Fortunately, in most cases, cirrhosis takes many years to develop. Therefore, just because a person is at risk for cirrhosis, it doesn’t necessarily mean that he will definitely develop this condition over the course of a normal life span. Also, the slow pace at which cirrhosis develops allows a person to obtain treatment from a liver specialist before cirrhosis occurs.

Alcoholic liver disease and chronic hepatitis C are the two most common causes of cirrhosis in the United States. However, there are other circumstances that can give rise to permanent liver damage. Even some herbal remedies and medications can trigger massive scarring of the liver (see Chapters 21 and 24 respectively). Although a discussion of every condition that has the potential to cause cirrhosis is beyond the scope of this book, some causes include the following:

• Viral hepatitis—hepatitis B, C, and D (see Part Two).

• Autoimmune hepatitis (see Chapter 14).

• Primary biliary cirrhosis (see Chapter 15).

• Nonalcoholic fatty liver disease (see Chapter 16).

• Excess alcohol consumption (see Chapter 17).

• Hemochromatosis (see Chapter 18).

• Excessive intake of vitamins, such as vitamin A (see Chapter 23).

• Certain herbal remedies, such as comfrey (see Chapter 21).

• Certain medications, such as methotrexate, isoniazid, Aldomet (see Chapter 24).

• Primary sclerosing cholangitis (see Chapter 15).

• Vascular anomalies—for example, Budd-Chiari syndrome (see Chapter 21).

•   Congestive heart failure (see your doctor for more information).

•    Wilson’s disease, a genetic disorder of copper overload (see your doctor for more information).

All contents of this article are Copyright © Melissa Palmer, MD

Melissa Palmer, MD is the author of " Dr. Melissa Palmer's Guide of Hepatitis and Liver Disease". (Published 2004. Penguin Putnam).

Dr. Palmer is an internationally renowned hepatologist who has been practicing medicine since 1985. Prior to 2012, she maintained perhaps the largest medical practice devoted to liver disease in the United States. Dr. Palmer is Clinical Professor of Medicine at New York University Medical Center. Dr. Palmer graduated from Columbia University with a B.A. and was trained in hepatology (as well as medical school) at the Mount Sinai School of Medicine in New York City.

Dr. Palmer is Board Certified in Gastroenterology and in Internal Medicine.

She has authored numerous scientific publications in the field of hepatology in such peer-reviewed journals as Hepatology, Gastroenterology, Seminars of Liver Disease, Transplantation and Archives of Internal Medicine.

She is frequently called upon by the media for her opinion on various topics related to liver disease. Dr. Palmer has appeared many times on television as a liver disease expert and has been quoted in such publications as TIME magazine, Cosmopolitan magazine, Prevention magazine, the Los Angeles Times, and Newsday. She also has appeared in numerous videos and CD-Roms aimed at educating doctors and the public about hepatitis C and other liver diseases, such as primary biliary cirrhosis. Dr. Palmer lectures to the medical and general public on liver disease-related topics on a regular basis.

Dr. Palmer has performed numerous clinical trials on various experimental medications for the treatment of hepatitis.

Dr. Palmer is currently available for lecturing, investor and hedge-fund consultations, consultations to industry, and media interviews and appearances-- including television. For such matters, she can be contacted through hepatitismedia@gmail.com.

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