Nonalcoholic Cirrhosis: Symptoms, causes, treatment, and outlook

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What is Nonalcoholic Cirrhosis?

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.

Cirrhosis occurs in response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.

Most people associate cirrhosis with heavy drinking, but that’s not the whole story. While alcohol is the leading cause of cirrhosis, even teetotalers can develop the condition. Any scarring of the liver not caused by drinking is referred to by the broad term nonalcoholic cirrhosis.

How common is Nonalcoholic Cirrhosis?

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Nonalcoholic Cirrhosis?

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

• Fatigue
• Bleeding easily
• Bruising easily
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in your abdomen (ascites)
• Loss of appetite
• Nausea
• Swelling in your legs
• Weight loss
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
• Spiderlike blood vessels on your skin
• Redness in the palms of the hands
• Testicular atrophy in men
• Breast enlargement in men

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Nonalcoholic Cirrhosis?

One of the liver’s jobs is clearing germs from the blood. Occasionally, however, the germs get the upper hand. A chronic infection by the hepatitis C virus is the most common cause of nonalcoholic cirrhosis in the United States.

In most cases, it takes many years for the infection to lead to scarring. Still, only about 20 percent of people with chronic hepatitis C ever develop cirrhosis.

Chronic infections of hepatitis B can also lead to cirrhosis. Worldwide, this may be the most common cause of cirrhosis, but it is rare in the United States, where children are routinely vaccinated against hepatitis B. The virus that causes hepatitis A never sticks around long enough to cause cirrhosis.

Nonalcoholic steatohepatitis (NASH), a condition in which the liver contains extra fat and becomes inflamed, is another potential starting point for cirrhosis.

The cause of NASH isn’t well-understood, but obesity, diabetes, protein malnutrition, heart disease, and corticosteroid drugs all seem to raise the risk.

Some people can trace cirrhosis to an overactive immune system. For unknown reasons, they produce antibodies that attack liver cells as if they were intruders. The liver becomes damaged and inflamed, a condition known as autoimmune hepatitis.

Other rare causes of cirrhosis include blocked or inflamed bile ducts, severe reactions to medications or supplements such as methotrexate or Vitamin A, frequent bouts of heart failure, and inherited conditions such as cystic fibrosis, alpha-1-antitrypsin deficiency, hemochromatosis, and Wilson’s disease.

In up to 10 percent of all cases, no cause of cirrhosis can be found. Doctors call these cases “cryptogenic cirrhosis.” Increasingly, however, researchers theorize that many of these cases are actually caused by NASH.

Risk factors

What increases my risk for Nonalcoholic Cirrhosis?

There are many risk factors for Nonalcoholic Cirrhosis, such as:

• Chronic hepatitis B
• Chronic hepatitis C
• Chronic excessive alcohol intake
• Fatty liver disease (non-alcoholic steatohepatitis)
• Autoimmune liver disease (autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis)
• Wilson disease, hemochromatosis and other rare inherited liver diseases

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Nonalcoholic Cirrhosis diagnosed?

People with early-stage cirrhosis of the liver usually don’t have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more laboratory tests that may suggest a problem with your liver, such as cirrhosis.

Laboratory tests:

• Liver function. Your blood is checked for excess bilirubin, which is a product of red blood cells breaking down, as well as for certain enzymes that may indicate liver damage.
• Kidney function. Your blood is checked for creatinine as kidney function may decline in later stages of cirrhosis (decompensated cirrhosis).
• Tests for hepatitis B and C. Your blood is checked for the hepatitis viruses.
• Clotting. Your international normalized ratio (INR) is checked for your blood’s ability to clot.

Your doctor may order imaging and other tests to further diagnose cirrhosis:

• Magnetic resonance elastography or transient elastography. These noninvasive imaging tests detect hardening or stiffening of the liver and may eliminate the need for a liver biopsy.
• Other imaging tests. MRI, CT and ultrasound create images of the liver.
• Biopsy. A tissue sample (biopsy) is not necessarily needed to diagnose cirrhosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.

If you have cirrhosis, your doctor is likely to recommend regular diagnostic tests to monitor for signs of disease progression or complications, especially esophageal varices and liver cancer.

How is Nonalcoholic Cirrhosis treated?

Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.

Treatment for the underlying cause of cirrhosis

In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:

• Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels. It is important to maintain adequate protein intake while attempting weight loss in the setting of cirrhosis.
• Medications to control hepatitis. Medications may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.
• Medications to control other causes and symptoms of cirrhosis. Medications may slow the progression of certain types of liver cirrhosis. For example, for people with primary biliary cirrhosis (now known as primary biliary cholangitis) that is diagnosed early, medication may significantly delay progression to cirrhosis.
• Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent weak bones (osteoporosis).

Treatment for complications of cirrhosis

Your doctor will work to treat any complications of cirrhosis, including:

• Excess fluid in your body. A low-sodium diet and medication to prevent fluid buildup in the body may help control ascites and swelling. More-severe fluid buildup may require procedures to drain the fluid or other interventions to relieve pressure. At times, a small tube — a transjugular intrahepatic portosystemic shunt (TIPS) — is placed in the vein within the liver to reduce blood pressure in your liver and slow the rate of fluid accumulation.
• Portal hypertension. Certain blood pressure medications may control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding. Your doctor will perform an upper endoscopy at regular intervals to look for enlarged veins in the esophagus or stomach (varices) that may bleed. If you develop varices, you likely will need medication to reduce the risk of bleeding. If you are not able to tolerate medication and have signs that the varices are bleeding or are likely to bleed, you may need a procedure (band ligation) to stop the bleeding or reduce the risk of further bleeding. In severe cases, a TIPS can be placed in the vein within the liver to reduce blood pressure in your liver and to prevent further bleeding.
• Infections. You may receive antibiotics or other treatments for infections. Your doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.
• Increased liver cancer risk. Your doctor will recommend blood tests and ultrasound exams every six months to look for signs of liver cancer.
• Hepatic encephalopathy. You may be prescribed medications to help prevent the buildup of toxins in your blood due to poor liver function.

Liver transplantation

In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. People usually need to consider this option when they develop symptoms from cirrhosis, such as jaundice, significant fluid retention (ascites), bleeding varices, hepatic encephalopathy, kidney dysfunction, or liver cancer. A liver transplant replaces your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.

Candidates for liver transplant undergo extensive testing to determine whether they are healthy enough to have a good outcome following surgery.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Nonalcoholic Cirrhosis?

The following lifestyles and home remedies might help you cope with Nonalcoholic Cirrhosis:

• Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
• Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
• Eat a healthy diet. Cirrhosis leads to malnutrition and loss of muscle. The best defense against this development is to maintain a healthy diet, with a variety of fruits and vegetables. You also need protein, contrary to outdated but still circulating advice to limit this food group if you have cirrhosis. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
• Avoid infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by washing your hands frequently. Also, get vaccinated for hepatitis A and B, influenza, and pneumonia.
• Use over-the-counter medications carefully. Cirrhosis makes it more difficult for your liver to process drugs. For this reason, ask your doctor before taking any medications, including nonprescription drugs. Avoid drugs such as aspirin and ibuprofen (Advil, Motrin IB, others). If you have liver damage, your doctor may recommend you use a lower dose of acetaminophen (Tylenol, others).

If you have any questions, please consult with your doctor to better understand the best solution for you. Hello Health Group does not provide medical advice, diagnosis or treatment.

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