The most prevalent form of cirrhosis of the liver, portal cirrhosis, appears most often in middle-aged males with a history of chronic alcoholism and is caused in part by protein deficiency (specifically choline), a type of malnutrition common in alcoholics. Protein deprivation is also responsible for kwashiorkor, a nutritional deficiency with symptoms resembling those of cirrhosis of the liver. A major cause of cirrhosis worldwide is infection by the hepatitis B virus. Biliary cirrhosis is a type caused by disruption of bile flow and is more common in women. Other causes include schistosomiasis and hemochromatosis, a hereditary iron storage disease.
Failure of liver function results in ascites (fluid accumulation in the abdominal cavity), increased albumin and blood protein, gastrointestinal disturbances, bleeding, emaciation, portal hypertension, enlargement of the liver and spleen, jaundice, edema, and obstruction of the venous circulation with distention of the veins. It is not uncommon for greatly distended veins in the esophagus to rupture and cause massive hemorrhage. Treatment is first aimed at any reversible underlying disease. Supportive measures include avoidance of alcohol, a diet with adequate protein, vitamin supplements, transfusions to replace any blood loss, and removal of accumulated fluid. Beta-blockers, such as propranolol, have been shown to be effective in reducing the rate of gastrointestinal bleeding, one of the most lethal complications of cirrhosis.
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