When chronic diseases cause the liver to become permanently injured and
scarred, the condition is called cirrhosis. The scar tissue that forms in
cirrhosis harms the structure of the liver, blocking the flow of blood
through the organ. The loss of normal liver tissue slows the processing
of nutrients, hormones, drugs, and toxins by the liver. Also slowed is
production of proteins and other substances made by the liver.
People with liver cirrhosis may develop many problems beyond the liver. When
the liver is scarred, the blood cannot easily get through the liver, and
backs up under higher than normal pressure (portal hypertension). This
often causes ascites, which is yellow fluid that leaks out of the
bloodstream into the abdominal cavity.
If the ascites becomes tense, it can cause an umbilical hernia (a protruding
belly button). The backed-up blood also often creates varices, in which
the pressure causes the blood vessels around the esophagus to burst
causing significant blood loss. Varices can be treated with beta
blockers, or can be obliterated using endoscopically-placed rubber bands
or injections of liquid that cause the varices to scar. If endoscopy
fails to stop bleeding, a TIPS (transjugular intrahepatic portosystemic
shunt) can be created by inserting a short metal mesh tube through a neck
vein into the liver and connecting the portal vein in the liver to a
regular vein in the liver. Another alternative is to surgically redirect
some of the blood flow around the liver.
People with cirrhosis sometimes may develop jaundice (a yellowing of the whites
of the eyes or the skin) due to an accumulation of bilirubin in the
blood. If the bilirubin is excreted in the urine, the urine may turn
dark.
People with cirrhosis are also at risk for hepatic encephalopathy, which is
fatigue or confusion caused by ammonia and other products of protein
digestion which are inadequately cleared from the bloodstream by the
liver.
People with cirrhosis often bruise easily because the liver manufactures
reduced amounts of clotting factors. Additionally, platelets may be lower
than normal in the circulation if the spleen is enlarged.
A spleen enlarged from portal hypertension may hold onto too many platelets.
Chronic HCV infection leads to cirrhosis in at least 20 percent of patients within 2 decades of the onset of infection. Cirrhosis and end-stage liver disease may occasionally develop rapidly, especially among patients with concomitant alcohol use. - National Institutes of Health Consensus Statement on Hepatitis C 1997
