Cirrhosis of the Liver

What are the signs and symptoms of cirrhosis?

Your child may not have signs or symptoms in the early stages of cirrhosis. Symptoms often start when there is portal hypertension (increased pressure within the portal vein, which carries blood from the digestive organs to the liver) or the liver begins to fail, as scar tissue replaces healthy cells.

The severity of symptoms depends on the extent of liver damage. Some of the signs and symptoms include:

• Being tired (fatigue) or feeling weak
• Poor appetite and weight loss
• Water retention and swelling in the legs and abdomen (ascites)
• Abdominal pain caused by an enlarged liver or spleen
• Yellow skin (jaundice) or yellow eyes (icterus)
• Itching
• Bleeding or bruising easily
• Vomiting blood
• Dark, tar-like stools
• The appearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the belly button
• Reddened palms
• Tremors
• Forgetfulness or confusion
• Certain medications can become ineffective due to the inability process them
• Enlarged, twisted, thin-walled blood vessels (varices) in the esophagus or stomach that can rupture and lead to life-threatening bleeding, known as gastroesophageal varices

What tests are used to diagnose cirrhosis?

Children who are suspected of having cirrhosis of the liver will undergo blood tests to assess how well the liver is working and help determine a cause. They may also need imaging tests such as an ultrasound, CT scan, FibroScan or MRI. These imaging tests will allow doctors to get a clear picture of the liver and identify changes that are associated with cirrhosis. Finally, a liver biopsy will help to diagnose liver cirrhosis and determine to what stage the liver disease has progressed.

Why choose us to test for liver cirrhosis?

At Children’s Hospital Colorado, we have a multidisciplinary team of specialists who are able to rapidly complete the testing and evaluation needed to understand the reason for cirrhosis. Our team of radiologists is experienced in performing a variety of imaging tests and understands how to speak to children and help ease their anxiety for such tests.

We’ve also designed our hospital to be calming and our staff have techniques to help children get through exams such as blood tests and liver biopsies. By completing these tests accurately and quickly, we can determine the specific reason for cirrhosis and begin treating the underlying liver disease.

What to expect from a liver biopsy

A board-certified pediatric hepatologist and pediatric anesthesiologist from our gastrointestinal (GI) procedure center perform the liver biopsy under general anesthesia, so the child experiences no pain or discomfort. They remove a small piece of the liver and a board-certified pediatric pathologist with extensive experience evaluating pediatric liver biopsies examines it.

How do we make a diagnosis for cirrhosis?

We diagnose liver cirrhosis by reviewing a thorough medical history, performing a physical exam and testing. Typically, we use a liver biopsy to identify liver cirrhosis, but we also have alternative, non-invasive methods to determine the amount of scar tissue present in a child’s liver.

How is cirrhosis treated?

Treatment for cirrhosis involves treating the underlying liver disease that is causing liver scarring. It also involves treating the complications of cirrhosis such as nutritional support for malnutrition, an endoscopic (small camera) evaluation for gastrointestinal bleeding due to gastroesophageal varices and prescribing medications for the fluid buildup in the abdominal cavity (ascites). In some cases, liver transplantation is necessary.

Why choose us for treatment of cirrhosis?

The Pediatric Liver Center at Children’s Colorado has extensive experience caring for children with liver cirrhosis. Our multidisciplinary team addresses all the liver diseases that lead to cirrhosis, as well as any complications that occur. If a liver transplant is necessary, we will care for your child in our Pediatric Liver Transplant Program, where our multidisciplinary team can provide both living and deceased liver transplantation options.

Helpful resources

• The Children’s Liver Association for Support Services (CLASS) helps children affected with liver disease by addressing the emotional, educational and financial needs of families.
• The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) facilitates research that creates knowledge about and treatments for diseases that are among the most chronic, costly and consequential for patients, their families and the nation, including liver cirrhosis.