Cirrhosis quietly swaps living liver for scar and nodules
Over months or years, chronic liver disease replaces working tissue with fibrosis and regenerative nodules until the organ fails. In 2015 about 2.8 million people lived with cirrhosis and 1.3 million died—alcohol, hepatitis B and hepatitis C each driving roughly a quarter to a third of those deaths.
Cirrhosis is what happens when a liver injured for years keeps repairing itself with scar. Working tissue, the parenchyma, gives way to fibrosis and clumps of regenerating cells called nodules, and the organ gradually loses function. Doctors split the course into a compensated stage, when the body still copes, and a decompensated stage, when it no longer does. Early complaints are vague: fatigue, weakness, poor appetite, weight loss, nausea and an ache under the right ribs.
Many of the telltale skin signs trace back to hormones. A scarred liver converts more androgens into estrogen, which helps explain spider-shaped blood vessels on the skin in roughly a third of patients, reddened palms in about 23%, and breast enlargement in men in up to two-thirds. Scar also resists blood flowing through the portal vein, raising pressure there. That backlog drives fluid into the abdomen, swells veins in the esophagus and stomach that can burst and bleed fatally, and can fan veins across the belly into the pattern nicknamed caput medusae.
Worldwide, hepatitis B accounts for about 30% of cases and hepatitis C for about 27%, with heavy alcohol use behind roughly 20 to 40%. Only 10 to 20% of people who drink heavily for a decade or more develop alcoholic cirrhosis, and 20 to 30% of those with chronic hepatitis C do. Fatty liver disease linked to obesity and diabetes, now called MASH, is another route, as are autoimmune and inherited conditions such as iron overload.
No drug reverses the scarring itself, but treating the cause can slow or stop it: antivirals for hepatitis B and C, avoiding alcohol in every case, and a hepatitis B vaccine that blocks that pathway altogether. The global toll is large: millions live with the disease, and in 2015 alone it killed more than a million. Hippocrates described it in the fifth century BCE; the name was coined in 1819 from a Greek colour word.
Source: Cirrhosis
