DEAR DR. DONOHUE: Are there any symptoms of liver cirrhosis? – C.J.

DEAR DR. DONOHUE: Please furnish information on cirrhosis: causes and symptoms. Is it curable? If not, how can it be treated? – D.T.

ANSWER: A cirrhotic liver is scarred and lumpy. The scars replace dead liver cells. The lumps are islands of new but ineffective liver cells that are put down in a haphazard fashion.

Some of the conditions that lead to cirrhosis are constant, immoderate use of alcohol, liver infections like hepatitis, and inherited liver diseases such as untreated hemochromatosis. An immune attack on the liver and the bile ducts also produces cirrhosis.

When there is extensive scarring and when the liver is no longer able to perform its many essential functions, then symptoms arise. The liver makes proteins; a protein deficit leads to fluid retention in the abdomen. A grossly distended stomach is a sign of cirrhosis. Muscle wasting is another consequence of inadequate protein. The liver produces clotting factors; a scarcity of those factors leads to bruising and bleeding.

The liver detoxifies drugs and waste products. One waste product of daily metabolism is bilirubin, which comes from worn-out red blood cells. It’s a pigment, and when its blood level rises, the skin and whites of the eyes turn yellow. In addition, palms can turn beet red. Males might experience breast enlargement. The large salivary glands in the cheeks often swell.

Cirrhosis is not curable. However, there are degrees of it. If some of the liver still functions, then matters are not so critical. If the entire liver is affected, the full-blown picture develops. Medicines can ease some of the symptoms. Diuretics, for example, can get rid of much of the abdominal fluid. The ultimate treatment for a nonfunctioning, cirrhotic liver is liver transplantation.

DEAR DR. DONOHUE: My husband has bleeding from the rectum about three times a month. It is bright red and just runs out of him with no warning. He had a colonoscopy about a year ago and had two polyps removed. The bleeding has been going on for about five years. It is more frequent now than it used to be. What can be causing this? – I.H.

ANSWER: Bright-red rectal bleeding indicates that blood is coming from a place in the terminal part of the colon, the rectum or the anus. Hemorrhoids are the first suspects. Rectal fissures – tears in the rectal lining – are another possible cause. Diverticula of the colon, which are grapelike protrusions from the colon wall, can also be the source of red rectal bleeding.

Everyone’s thoughts turn to cancer. Cancer can cause such bleeding. Your husband has been dealing with this for five years, and that makes cancer less likely. Furthermore, he had a colonoscopy only one year ago, and no cancer was found.

All the same, the cause has to be found, even if it requires an exhaustive search. A scope exam of the anus, rectum and colon should be repeated. He might need special kinds of X-rays to find the bleeding source. If for no other reason, your husband could lose so much blood that he becomes anemic.

DEAR DR. DONOHUE: I am a 70-year-old man in good health but in desperate need of your advice. I don’t know what to do.

What would cause blood in the seminal fluid? I have never experienced anything so scary in all my life as when I saw it. I have never heard of such a thing. – B.B.

ANSWER: Blood in seminal fluid is not a rarity. It freaks out every man it happens to. The blood can be red or brown. Brown blood occurs when the bleeding happens some time before ejaculation. It’s almost never a sign of any serious condition. The blood comes from tiny blood vessels in the genital tract that have spontaneously broken.

Report this to your doctor, who can, with a few simple office tests, reassure you that you have no cause to worry.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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