โรคตับแข็ง Liver cirrhosis

ตับเป็นอวัยวะที่ใหญ่ที่สุดในร่างกาย ตับมีหน้าที่ทำลายสารพิษ poison หรือของเสียออกจากเลือด สร้างภูมิคุ้มกัน immune เพื่อต่อต้านเชื้อโรค สร้างสารเพื่อให้เลือดแข็งตัว clotting factors  สร้างน้ำดี  bile เพื่อย่อยอาหารและดูดซึมวิตามินที่ละลายในน้ำมัน fat soluble vitamin

โรคตับแข็ง

โรคตับแข็งเป็นผลพวงจากโรคหรือภาวะที่มีการทำลายหรือการอักเสบ เช่นการดื่มสุราหรือโรคไวรัสตับอักเสบทำให้โครงสร้างของตับ และการทำหน้าที่ของตับผิดไป เมื่อตับได้รับความเสียหายตับก็พยายามที่จะซ่อมตัวเอง หรือจำกัดความเสียหายโดยการสร้างผังผืด ซึ่งทำให้เนื้อตับทำงานได้น้อยลงเกิดภาวะตับแข็ง

ตับแข็ง

 

สาเหตุโรคตับแข็ง

ตับแข็งเกิดจากหลายสาเหตุ ในประเทศไทยโดยมากเกิดจาก สุรา ไวรัสตับอักเสบ บี

  1. Alcoholic cirrhosis ตับแข็งที่เกิดจากสุรามักเกิดหลังจากที่ได้ดื่มสุราเป็นปริมาณมากมาในระยะเสลาหนึ่ง ปริมาณที่ดื่มขึ้นกับแต่ละบุคคล ผู้หญิงจะเกิดตับแข็งได้ง่ายกว่าผู้ชายผู้หญิงอาจจะดื่มเพียง 2-3 แก้วต่อวันก็ทำให้เกิดตับแข็ง ผู้ชายดื่ม 4-6 แก้วต่อวันก็สามารถทำให้เกิดตับแข็ง เชื่อว่าสุราทำให้การสันดาปของโปรตีน ไขมัน และ แป้งผิดไป
  2. Chronic hepatitis B,D ไวรัสตับอักเสบทำให้เกิดอักเสบของตับเป็นเป็นเวลาหลายปีก่อนที่จะมีตับแข็ง
  3. Chrinic hepatitis C เริ่มพบมากขึ้นทั่วโรคตับมีการอักเสบอย่างช้าก่อนเป็นตับแข็ง
  4. Autoimmune hepatitis เกิดจากโรคที่ภูมิคุ้มกันมีการทำลายเนื้อตับ
  5. Inherited diseases โรคกรรมพันธุ์บางโรคทำให้เกิดตับแข็ง เช่น hemochromatosis, Wilson's disease,galactosemia,
  6. Nonalcoholic steatohepatitis (NASH) มีการสร้างไขมันในตับเพิ่มทำให้กลายเป็นตับแข็ง เช่นผู้ป่วยเบาหวาน คนอ้วน
  7. Blocked bile ducts มีการอุดกั้นของทางเดินน้ำดี เช่นนิ่วของถุงน้ำดีถ้าหากอุดนานๆทำให้เกิดตับแข็ง
  8. ยา และสารพิษ หากไดัรับติดต่อกันเป็นเวลานานก็ทำให้เกิดตับแข็ง
  9. โรค Cystic fibrosis
  10. โรคที่มีการสะสมของเหล็กหรือทองแดง
  11. โรคแพ้ภูมิตัวเอง (autoimmune hepatitis)
  12. ยาเช่น methotrexate or isoniazid
  13.  


อาการโรคตับแข็ง

ผู้ป่วยตับแข็งในระยะเริ่มแรกจะไม่มีอาการ เมื่อตับเป็นมากขึ้นเรื่อยๆจึงเกิดอาการของตับแข็งได้แก่

  • อ่อนเพลีย
  • เลือดออกง่าย เกิดจ้ำเลือดตามผิวหนังได้ง่าย
  • คลื่นไส้ อาเจียน
  • บวมหลังเท้า หน้าแข็ง
  • เบื่ออาหาร
  • เหนื่อยง่าย
  • คันตามตัว
  • น้ำหนักลด
  • ผิวเหลือง ตาเหลือง
  • ปัสสาวะสีเข้ม
  • ท้องมาน
  • ขาดประจำเดือน
  • เต้านมโต
  • มีตุ่มเม็ดเลือดแดง

ถ้าหากโรคเป็นมากขึ้นผู้ป่วยบางรายอาจมาด้วยอาการของโรคแทรกซ้อน

โรคแทรกซ้อนของโรคตับแข็ง

  • ความดันขั้วตับสูงเนื่องจากมีผังผืดในตับทำให้เลือดไหลผ่านตับลำบาก ทำให้เกิดโรคหลอดเลือดในหลอดอาหารโป่งพอง ม้ามโต
  • บวมหลังเท้า และท้องมานเนื่องจากตับไม่สามารถสร้างไข่ขาว
  • ม้ามโตเนื่องจากความดันขั้วตับสูง การที่ม้ามโตจะทำให้เม็ดเลือดขาว และเกร็ดเลือดต่ำ
  • เลือดออกง่าย มีจ้ำเลือด เนื่องจากตับไม่สามารถสารที่ทำให้เลือดแข็งตัว
  • ตัวเหลืองและตาเหลือง เนื่องจากตับไม่สามารถขับน้ำดี
  • คันตามตัวเนื่องจากน้ำดีสะสมตามผิวหนัง
  • นิ่วในถุงน้ำดี
  • สูญเสียความสามารถเกี่ยวกับความจำ สติ เนื่องจากการคั่งของๆเสีย
  • ไวต่อยา การให้ยาในผู้ป่วยตับแข็งต้องระวังการเกิดยาเกินขนาด เนื่องจากตับไม่สามารถทำลายยา แม้ว่าจะให้ยาขนาดปกติ ยาบางชนิดอาจต้องลดปริมาณยา
  • อาเจียนเป็นเลือดเนื่องจากตับแข็ง จะทำให้ความดันในตับสูง ส่งผลให้หลอดเลือดดำในหลอดอาหารมีความดันสูง และถ้าสูงมากเกิดการแตกของหลอดเลือดดำ
  • ปัญหาต่อระบบอื่น เช่น ติดเชื้อง่ายเนื่องจากภูมิคุ้มกันลดลง ท้องมาน ไตวาย
  • ริดสีดวงทวาร
  • มีการติดเชื้อง่าย
  • ตับวาย มีการคั่งของเสีย
  • ขาดสารอาหาร
  • เพิ่มความเสี่ยงในการเกิดมะเร็งตับ

ปัจจัยเสี่ยงของการเกิดโรคตับแข็ง

  • ดื่มสุรามากเกินไป
  • อ้วนหรือน้ำหนักเกินซึ่งจะทำให้เกิดภาวะไขมันเกาะตับ
  • เป็นโรคตับอักเสบ

การป้องกันโรคตับแข็ง

การลดความเสี่ยงในการเกิดโรคตับแข็งโดยการดูแลตัวเองดังต่อไปนี้

  • หากคุณมีปัญหาดรคตับไม่ควรจะดื่มสุรา หากคนปกติก็ควรจะดื่มไม่เกิน1-2ยูนิตสุรา
  • รับประทานอาหารเพื่อสุขภาพ โดยการหลีกเลี่ยงน้ำตาล ไขมัน ให้บริโภคผักและผลไม้ หลีกเลี่ยงอาหารทอด
  • ควบคุมน้ำหนักให้เหมาะสม การที่มีน้ำหนักเกินจะทำให้เกิดภาวะไขมันเกาะตับ
  • ลดความเสี่ยงในการเกิดตับอักเสบโดยการฉีดวัคซีนป้องกันตับอักเสบ

การวินิจฉัยโรคตับแข็ง

แพทย์จะซักประวัติหาปัจจัยเสี่ยงต่อการเกิดตับแข็งและตรวจร่างเพื่อหาสิ่งแสดงว่าเป็นตับแข็งหรือไม่ เช่น ตัวเหลืองตาเหลือง ท้อง และเท้าบวม ฝ่ามือแดง palma erythema มีจุดแดง spider telangiectasia ตามตัวหรือไม่ คลำตับพบว่าผิวแข็งขรุขระ ขอบไม่เรียบ

การตรวจทางห้องปฏิบัติการ แพทย์จะเจาะเลือดตรวจการทำงานของตับความผิดปกติที่อาจพบได้คือ ไข่ขาวต่ำ มีการคั่งของน้ำดี bilirubin บางรายอาจตรวจ ultrasound หรือเจาะเนื้อตับ

การรักษาโรคตับแข็ง

หลักการรักษาโรคตับแข็งคือป้องกันตับมิให้เสียหน้าที่เพิ่มขึ้น รักษาภาซะแทรกซ้อนที่เกิดกับตับแข็ง และค้นหามะเร็งตับให้เร็ว

  1. รักษาสาเหตุ ขึ้นกับว่าต้นเหตุเกิดจากอะไรก็รักษาไปตามสาเหตุ เช่นถ้าเกิดจากสุราก็ให้หยุดสุรา เกิดจากยาก็ให้หยุดยา เกิดจากไวรัสก็ให้ยาบางชนิด โรคตับแข็งรักษาให้หายขาดไม่ได้แต่สามารถชะลอหรือหยุดการดำเนินของโรค
  • การหยุดสุรา
  • การรักษาโรคตับอักเสบ
  • การหลีกเลี่ยงสารพิษหรือยาที่เกิดผลเสียกับตับ
  • ปรับพฤติกรรม การรับประทานอาหาร การออกกำลังกาย
  • ตรวจการทำงานของตับเป็นระยะ
  1. รักษาโรคแทรกซ้อน
  • ท้องมานและบวมหลังเท้า แนะนำให้ลดอาหารเค็ม และจะให้ยาขับปัสสาวะเพื่อลดบวม
  • คันตามผิวหนัง ให้ลดอาหารพวกโปรตีน และให้ยาแก้แพ้
  • ลดของเสีย แพทย์จะให้ยาระบายเพื่อลดของเสียที่อยู่ในลำไส้ซึ่งจะถูกดูดซึมหากมีมากในลำไส้
  • ผู้ป่วยที่มีความดันในตับสูงแพทย์จะให้ยาลดความดันกลุ่ม beta-block เช่น propanolol
  1. การปลุกถ่ายตับ กรณีที่ที่ไม่สามารถทำงานได้การรักษาจำเป็นต้องได้รับการปลุกถ่ายตับ

การแบ่งความรุนแรงของโรคตับแข็ง

การแบ่งความรุนแรงของดรคตับแข็งก็เพื่อใช้วางแผนในการรักาา หรือประเมินว่าเกิดดรคแทรกซ้อนอะไรบ้าง ซึ่งแบ่งออกเป้นสี่ระยะได้แก่

  • Stage 1 cirrhosis  ระยะมี่1 ระยะนี้ตับมีผังผืด แต่ไม่มีอาการหรือมีแต่น้อยมาก ระยะนี้ตับที่เหลือยังทำงานทดแทนตับที่เสียหายได้
  • Stage 2 cirrhosis ระยะที่สอง ความดันขั้วตับเพิ่มทำให้เกิดหลอดเลือดดำในหลอดอาหารโป่งพอง ซึ่งอาจจะมีอาการอาเจียนเป็นเลือด หรือทราบจากการส่งกล้อง
  • Stage 3 cirrhosisระยะที่3 จะมีท้องมานระยะนี้ตับจะทำงานลดลงไม่สามารถสร้างโปรตีนได้เพียงพอจึงเกินภาวะโปรตีนในเลือดต่ำทำให้มีอาการบวมเท้า และท้อง
  • Stage 4 cirrhosis ระยะที่4 ตับทำหน้าที่ลดลงมากไม่สามารถสร้างโปรตีนที่สำคัญ ไม่สามารถทำลายของเสียทำให้มีจ้ำเลือด ซึมลง เกิดภาวะตับวาย

โรคแทรกซ้อนของตับแข็ง

บวมเท้าและบวมท้อง Ascitis

คนที่เป็นโรคตับแข็งตับจะทำงานน้อยลงจึงมีการสร้างโปรตีนลดลง ร่างกายจึงมีการดูดซึมน้ำเน้ำและเกลือจากไตเข้ากระแสเลือดเพิ่มขึ้น ทำให้เกิดการบวมน้ำ เริ่มแรกจะบวมเที่เท้าก่อน หากโรคตับแข็งเป็นมากขึ้นก็จะมีการบวมที่ท้อง อ่านเรื่องท้องมาน

เยื่อบุช่องท้องอักเสบแบบปฐมภูมิ Spontaneous bacterial peritonitis (SBP)

ปกติในช่องท้องจะมีน้ำปริมาณเล็กน้อย เมื่อมีเชื้อโรคเล็ดรอดเข้าไปก็จะถูกทำลาย สำหรับโรคตับแข็งน้ำในช่องท้องไม่สามารถฆ่าเชื้อแบคทีเรียได้ นอกจากนั้นก็พบปริมาณเชื้อในน้ำในช่องท้องปริมาณมาก เชื้อนี้มาจากลำไส้ ผู้ป่วยจะมีไข้สูง หนาวสั่น ปวดท้อง

เลือดออกจากหลอดเลือดดำโป่งพอง Bleeding from esophageal varices

ผู้ป่วยโรคตับแข็งจะมีผังผืดทำให้เลือดไหลเข้าตับลำบากเกิดภาวะที่เรียกว่าความดันขั้วปอดสูง portal hypertension ทำให้หลอดเลือดดำที่คอโป่ง หากความดันในหลอดเลือดดำที่คอสูงมากก็อาจจะแตกและมีเลือดออกหทางเดินอาหาร

ม้ามโต

ม้ามมีหน้าที่กำจัดเม็ดเลือดแดงที่หมดอายุ เมื่อความดันขั้วตับสูงทำให้ม้ามมีขนาดโตขึ้น ทำให้ม้ามกำจัดเม็ดเลือดแดง เกล้ดเลือด และเม็ดเลือดขาว ทำให้เกิดภาวะโลหิตจางและเกล็ดเลือดต่ำซึ่งเรียกว่าภาวะ Hypersplenism

มะเร็งตับ

ผู้ป่วยโรคตับแข็งจะมีความเสี่ยงต่อการเกิดมะเร็งตับ ผู้ที่เป็นมะเร็งตับจะมีตับโต ปวดท้อง น้ำหนักลด มีไข้ น้ำตาลในเลือดต่ำ อ่านเรื่องมะเร็งตับ

โรคสมองจากตับ Hepatic encephalopathy

 

 

 

 

Some of the protein in food that escapes digestion and absorption is used by bacteria that are normally present in the intestine. While using the protein for their own purposes, the bacteria make substances that they release into the intestine to then be absorbed into the body. Some of these substances, such as ammonia, can have toxic effects on the brain. Ordinarily, these toxic substances are carried from the intestine in the portal vein to the liver where they are removed from the blood and detoxified.

When cirrhosis is present, liver cells cannot function normally either because they are damaged or because they have lost their normal relationship with the blood. In addition, some of the blood in the portal vein bypasses the liver through other veins. The result of these abnormalities is that toxic substances cannot be removed by the liver cells, and instead accumulate in the blood.

When the toxic substances accumulate sufficiently in the blood, the function of the brain is impaired, a condition called hepatic encephalopathy. Sleeping during the day rather than at night (reversal of the normal sleep pattern) is an early symptom of hepatic encephalopathy. Other symptoms include irritability, inability to concentrate or perform calculations, memory lossconfusion, or depressed levels of consciousness. Ultimately, severe hepatic encephalopathy causes coma and death.

The toxic substances also make the brains of patients with cirrhosis very sensitive to drugs that are normally filtered and detoxified by the liver. Doses of many drugs may have to be reduced to avoid a toxic buildup in cirrhosis, particularly sedatives and drugs used to promote sleep. Alternatively, drugs may be used that do not need to be detoxified or eliminated from the body by the liver, such as drugs eliminated by the kidneys.

Hepatorenal syndrome

Patients with worsening cirrhosis can develop hepatorenal syndrome. This syndrome is a serious complication in which the function of the kidneys is reduced. It is a functional problem in the kidneys, meaning there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves. The hepatorenal syndrome is defined as progressive failure of the kidneys to clear substances from the blood and produce adequate amounts of urine while other important functions of the kidney, such as retention of salt, are maintained. If liver function improves or a healthy liver is transplanted into a patient with hepatorenal syndrome, the kidneys usually begin to work normally again. This suggests that the reduced function of the kidneys is the result of either the accumulation of toxic substances in the blood or abnormal liver function when the liver fails. There are two types of hepatorenal syndrome. One type occurs gradually over months. The other occurs rapidly over a week or two.

Hepatopulmonary syndrome

Rarely, some patients with advanced cirrhosis can develop hepatopulmonary syndrome. These patients can experience difficulty breathing because certain hormones released in advanced cirrhosis cause the lungs to function abnormally. The basic problem in the lung is that not enough blood flows through the small blood vessels in the lungs that are in contact with the alveoli (air sacs) of the lungs. Blood flowing through the lungs is shunted around the alveoli and cannot pick up enough oxygen from the air in the alveoli. As a result, the patient experiences shortness of breath, particularly with exertion.

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A senior man drinking heavily exhibiting signs of alcohol abuse.
There are 12 common causes of cirrhosis.Source: iStock

What are common causes of cirrhosis?

Common causes of cirrhosis of the liver include:

  1. Alcohol
  2. Nonalcoholic fatty liver disease
  3. Cryptogenic causes
  4. Chronic viral hepatitis (A, B, and C)
  5. Autoimmune hepatitis
  6. Inherited (genetic) disorders
  7. Primary biliary cirrhosis (PCB)
  8. Primary sclerosing cholangitis (PSC)
  9. Infants born without bile ducts

Less common causes of cirrhosis include:

  1. Unusual reactions to some drugs
  2. Prolonged exposure to toxins
  3. Chronic heart failure (cardiac cirrhosis).

In certain parts of the world (particularly Northern Africa), infection of the liver with a parasite (schistosomiasis) is the most common cause of liver disease and cirrhosis.

IMAGES

Cirrhosis (Liver)See a medical illustration of the liver plus our entire medical gallery of human anatomy and physiologySee Images
High alcohol consumption can injure liver cells and is one of the main causes of cirrhosis.
Alcohol and nonalcoholic fatty liver disease are common causes of cirrhosis.Source: iStock

Alcohol and nonalcoholic fatty liver disease

Alcohol

Alcohol is a very common cause of cirrhosis, particularly in the Western world. Chronic, high levels of alcohol consumption injure liver cells. Thirty percent of individuals who drink daily at least eight to sixteen ounces of hard liquor or the equivalent for fifteen or more years will develop cirrhosis. Alcohol causes a range of liver diseases, which include simple and uncomplicated fatty liver (steatosis), more serious fatty liver with inflammation (steatohepatitis or alcoholic hepatitis), and cirrhosis.

Nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver diseases that, like alcoholic liver disease, range from simple steatosis, to nonalcoholic steatohepatitis (NASH), to cirrhosis. All stages of NAFLD have in common the accumulation of fat in liver cells. The term nonalcoholic is used because NAFLD occurs in individuals who do not consume excessive amounts of alcohol, yet in many respects the microscopic picture of NAFLD is similar to what can be seen in liver disease that is due to excessive alcohol. NAFLD is associated with a condition called insulin resistance, which, in turn, is associated with metabolic syndrome and diabetes mellitus type 2. Obesity is the main cause of insulin resistance, metabolic syndrome, and type 2 diabetes. NAFLD is the most common liver disease in the United States and is responsible for up to 25% of all liver disease. The number of livers transplanted for NAFLD-related cirrhosis is on the rise. Public health officials are worried that the current epidemic of obesity will dramatically increase the development of NAFLD and cirrhosis in the population.

From WebMD Logo

An illustration of the hepatitis B virus.
Primary biliary cirrhosis (PBC) is a liver disease caused by an abnormality of the immune system that is found predominantly in women.Source: iStock

Hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis

Chronic viral hepatitis (hep B and C)

Chronic viral hepatitis is a condition in which hepatitis B or hepatitis C virus infects the liver for years. Most patients with viral hepatitis will not develop chronic hepatitis and cirrhosis. The majority of patients infected with hepatitis A recover completely within weeks, without developing chronic infection. In contrast, some patients infected with hepatitis B virus and most patients infected with hepatitis C virus develop chronic hepatitis, which, in turn, causes progressive liver damage and leads to cirrhosis, and, sometimes, liver cancers.

Autoimmune hepatitis

Autoimmune hepatitis is a liver disease found more commonly in women that is caused by an abnormality of the immune system. The abnormal immune activity in autoimmune hepatitis causes progressive inflammation and destruction of liver cells (hepatocytes), leading ultimately to cirrhosis.

Primary biliary cirrhosis (PBC)

Primary biliary cirrhosis (PBC) is a liver disease caused by an abnormality of the immune system that is found predominantly in women. The abnormal immunity in PBC causes chronic inflammation and destruction of the small bile ducts within the liver. The bile ducts are passages within the liver through which bile travels to the intestine. Bile is a fluid produced by the liver that contains substances required for digestion and absorption of fat in the intestine, as well as other compounds that are waste products, such as the pigment bilirubin. (Bilirubin is produced by the breakdown of hemoglobin from old red blood cells.). Along with the gallbladder, the bile ducts make up the biliary tract. In PBC, the destruction of the small bile ducts blocks the normal flow of bile into the intestine. As the inflammation continues to destroy more of the bile ducts, it also spreads to destroy nearby liver cells. As the destruction of the hepatocytes proceeds, scar tissue (fibrosis) forms and spreads throughout the areas of destruction. The combined effects of progressive inflammation, scarring, and the toxic effects of accumulating waste products culminates in cirrhosis.

Primary sclerosing cholangitis (PSC)

Primary sclerosing cholangitis (PSC) is an uncommon disease frequently found in patients with Crohn's disease and ulcerative colitis. In PSC, the large bile ducts outside of the liver become inflamed, narrowed, and obstructed. Obstruction to the flow of bile leads to infections of the bile ducts and jaundice, eventually causing cirrhosis. In some patients, injury to the bile ducts (usually because of surgery) also can cause obstruction and cirrhosis of the liver.

MedicineNet
Different liver diseases should be diagnosed by specialists and different tests such as liver blood test, biopsy, and others.Source: iStock

Inherited disorders, cryptogenic cirrhosis, and biliary atresia in infants

Inherited (genetic) disorders

Inherited (genetic) disorders that result in the accumulation of toxic substances in the liver, which leads to tissue damage and cirrhosis. Examples include the abnormal accumulation of iron (hemochromatosis) or copper (Wilson disease). In hemochromatosis, patients inherit a tendency to absorb an excessive amount of iron from food. Over time, iron accumulation in different organs throughout the body causes cirrhosis, arthritis, heart muscle damage leading to heart failure, and testicular dysfunction causing loss of sexual drive. Treatment is aimed at preventing damage to organs by removing iron from the body through phlebotomy (removing blood). In Wilson disease, there is an inherited abnormality in one of the proteins that control copper in the body. Over time, copper accumulates in the liver, eyes, and brain. Cirrhosis, tremor, psychiatric disturbances, and other neurological difficulties occur if the condition is not treated early. Treatment is with oral medication, which increases the amount of copper that is eliminated from the body in the urine.

Cryptogenic cirrhosis

Cryptogenic cirrhosis (cirrhosis due to unidentified causes) is a common reason for liver transplantation. It is termed called cryptogenic cirrhosis because for many years doctors have been being unable to explain why a proportion of patients developed cirrhosis. Doctors now believe that cryptogenic cirrhosis is due to NASH (nonalcoholic steatohepatitis) caused by long-standing obesity, type 2 diabetes, and insulin resistance. The fat in the liver of patients with NASH is believed to disappear with the onset of cirrhosis, and this has made it difficult for doctors to make the connection between NASH and cryptogenic cirrhosis for a long time. One important clue that NASH leads to cryptogenic cirrhosis is the finding of a high occurrence of NASH in the new livers of patients undergoing liver transplant for cryptogenic cirrhosis. Finally, a study from France suggests that patients with NASH have a similar risk of developing cirrhosis as patients with long-standing infection with hepatitis C virus. (See discussion that follows.) However, the progression to cirrhosis from NASH is thought to be slow and the diagnosis of cirrhosis typically is made in people in their sixties.

Biliary atresia

Infants can be born without bile ducts (biliary atresia) and ultimately develop cirrhosis. Other infants are born lacking vital enzymes for controlling sugars that lead to the accumulation of sugars and cirrhosis. On rare occasions, the absence of a specific enzyme can cause cirrhosis and scarring of the lung (alfa-1 antitrypsin deficiency).
Less common causes of cirrhosis include unusual reactions to some drugs and prolonged exposure to toxins, as well as chronic heart failure (cardiac cirrhosis). In certain parts of the world (particularly Northern Africa), infection of the liver with a parasite (schistosomiasis) is the most common cause of liver disease and cirrhosis.

A doctor performs a liver biopsy on a female patient.
Different liver diseases should be diagnosed by specialists and different tests such as liver blood test, biopsy, and others.Source: iStock

How is cirrhosis diagnosed and evaluated?

The single best test for diagnosing cirrhosis is a biopsy of the liver. Liver biopsies carry a small risk for serious complications, and biopsy often is reserved for those patients in whom the diagnosis of the type of liver disease or the presence of cirrhosis is not clear. The history, physical examination, or routine testing may suggest the possibility of cirrhosis. If cirrhosis is present, other tests can be used to determine the severity of the cirrhosis and the presence of complications. Tests also may be used to diagnose the underlying disease that is causing the cirrhosis. Examples of how doctors diagnose and evaluate cirrhosis are:

  • The patient's history. The doctor may uncover a history of excessive and prolonged intake of alcohol, a history of intravenous drug abuse, or a history of hepatitis. This can suggest the possibility of liver disease and cirrhosis.
  • Patients who are known to have chronic viral hepatitis B or C have a higher probability of having cirrhosis.
  • Some patients with cirrhosis have enlarged livers and/or spleens. A doctor can often feel (palpate) the lower edge of an enlarged liver below the right rib cage and feel the tip of the enlarged spleen below the left rib cage. A cirrhotic liver also feels firmer and more irregular than a normal liver.
  • Some patients with cirrhosis, particularly alcoholic cirrhosis, have small red spider-like markings (telangiectasias) on the skin, particularly on the chest that are made up of enlarged, radiating blood vessels. However, these spider telangiectasias also can be seen in individuals without liver disease.
  • Jaundice (yellowing of the skin and the whites of the eyes due to elevated bilirubin in the blood) is common among patients with cirrhosis, but jaundice can occur in patients with liver diseases without cirrhosis and other conditions such as hemolysis (excessive break down of red blood cells).
  • Swelling of the abdomen (ascites) and/or the lower extremities (edema) due to retention of fluid is common among patients with cirrhosis, although other diseases can cause them commonly, for example, congestive heart failure.
  • Patients with abnormal copper deposits in their eyes or certain types of neurologic disease may have Wilson disease, a genetic disease in which there are abnormal handling and accumulation of copper throughout the body, including the liver, which can lead to cirrhosis.
  • Esophageal varices may be found unexpectedly during upper endoscopy (EGD), strongly suggesting cirrhosis.
  • Computerized tomography (CT or CAT) or magnetic resonance imaging (MRI) scans and ultrasound examinations of the abdomen done for reasons other than evaluating the possibility of liver disease may unexpectedly detect enlarged livers, abnormally nodular livers, enlarged spleens, and fluid in the abdomen, which suggest cirrhosis.
  • Advanced cirrhosis leads to a reduced level of albumin in the blood and reduced blood clotting factors due to the loss of the liver's ability to produce these proteins. Reduced levels of albumin in the blood or abnormal bleeding suggest cirrhosis.
  • An abnormal elevation of liver enzymes in the blood (such as ALT and AST) that are obtained routinely as part of yearly health examinations suggests inflammation or injury to the liver from many causes as well as cirrhosis.
  • Patients with elevated levels of iron in their blood may have hemochromatosis, a genetic disease of the liver in which iron is handled abnormally and which leads to cirrhosis.
  • Autoantibodies (antinuclear antibody, anti-smooth muscle antibody, and anti-mitochondrial antibody) sometimes are detected in the blood and maybe a clue to the presence of autoimmune hepatitis or primary biliary cirrhosis, both of which can lead to cirrhosis.
  • Liver cancer (hepatocellular carcinoma) may be detected by CT and MRI scans or ultrasound of the abdomen. Liver cancer most commonly develops in individuals with underlying cirrhosis.
  • Elevation of tumor markers such as alfa-fetoprotein suggests the presence of liver cancer.
  • If there is an accumulation of fluid in the abdomen, a sample of the fluid can be removed using a long needle to be examined and tested. The results of testing may suggest the presence of cirrhosis as the cause of the fluid.
Some options to prevent further damage to the liver from cirrhosis includes a balanced diet with multivitamin, avoiding drugs and alcohol, taking antiviral medications, and removal of blood to lower iron levels.
There are four types of treatment of cirrhosis.Source: Getty Images/iStock

What are treatment options for cirrhosis?

Treatment of cirrhosis includes

  1. preventing further damage to the liver,
  2. treating the complications of cirrhosis,
  3. preventing liver cancer or detecting it early, and
  4. liver transplantation.

Preventing further damage to the liver

Consume a balanced diet and one multivitamin daily. Patients with PBC with impaired absorption of fat-soluble vitamins may need additional vitamins D and K.

Avoid drugs (including alcohol) that cause liver damage. All patients with cirrhosis should avoid alcohol. Most patients with alcohol-induced cirrhosis experience an improvement in liver function with abstinence from alcohol. Even patients with chronic hepatitis B and C can substantially reduce liver damage and slow the progression towards cirrhosis with abstinence from alcohol.

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen). Patients with cirrhosis can experience worsening of liver and kidney function with NSAIDs.

Eradicate hepatitis B and hepatitis C virus by using anti-viral medications. Not all patients with cirrhosis due to chronic viral hepatitis are candidates for drug treatment. Some patients may experience serious deterioration in liver function and/or intolerable side effects during treatment. Thus, decisions to treat viral hepatitis have to be individualized, after consulting with doctors experienced in treating liver diseases (hepatologists).

Remove blood from patients with hemochromatosis to reduce the levels of iron and prevent further damage to the liver. In Wilson's disease, medications can be used to increase the excretion of copper in the urine to reduce the levels of copper in the body and prevent further damage to the liver.

Suppress the immune system with drugs such as prednisone and azathioprine (Imuran) to decrease inflammation of the liver in autoimmune hepatitis.

Treat patients with PBC with a bile acid preparation, ursodeoxycholic acid (UDCA), also called ursodiol (Actigall). Results of an analysis that combined the results from several clinical trials showed that UDCA increased survival among PBC patients during 4 years of therapy. The development of portal hypertension also was reduced by the UDCA. It is important to note that despite producing clear benefits, UDCA treatment primarily retards progression and does not cure PBC. Other medications such as colchicine and methotrexate also may have benefits in subsets of patients with PBC.

Immunize patients with cirrhosis against infection with hepatitis A and B to prevent a serious deterioration in liver. There are currently no vaccines available for immunizing against hepatitis C.

Retaining salt and water can lead to swelling of the ankles and legs (edema) or abdomen (ascites) in patients with cirrhosis.
Treatment for edema, ascites, and hypersplenism complications.Source: iStock

Treatment for edema, acites, and hypersplenism complications

Edema and ascites

Retaining salt and water can lead to swelling of the ankles and legs (edema) or abdomen (ascites) in patients with cirrhosis. Doctors often advise patients with cirrhosis to restrict dietary salt (sodium) and fluid to decrease edema and ascites. The amount of salt in the diet usually is restricted to 2 grams per day and fluid to 1.2 liters per day. In most patients with cirrhosis, salt and fluid restriction is not enough and diuretics have to be added.

Diuretics are medications that work in the kidneys to promote the elimination of salt and water into the urine. A combination of the diuretics spironolactone (Aldactone) and furosemide (Lasix) can reduce or eliminate the edema and ascites in most patients. During treatment with diuretics, it is important to monitor the function of the kidneys by measuring blood levels of blood urea nitrogen (BUN) and creatinine to determine if too much diuretic is being used. Too much diuretic can lead to kidney dysfunction that is reflected in elevations of the BUN and creatinine levels in the blood.

Sometimes, when the diuretics do not work (in which case the ascites is said to be refractory), a long needle or catheter is used to draw out the ascitic fluid directly from the abdomen, a procedure called abdominal paracentesis. It is common to withdraw large amounts (liters) of fluid from the abdomen when the ascites is causing painful abdominal distension and/or difficulty breathing because it limits the movement of the diaphragms.

Another treatment for refractory ascites is a procedure called transjugular intravenous portosystemic shunting (TIPS).

Hypersplenism

The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets (small particles important for the clotting of blood). The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood "backs-up," accumulating in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so enlarged it causes abdominal pain.

As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced. Hypersplenism is the term used to describe this condition, and it is associated with a low red blood cell count (anemia), low white blood cell count (leukopenia), and/or a low platelet count (thrombocytopenia). Anemia can cause weakness, leucopenia can lead to infections, and thrombocytopenia can impair the clotting of blood and result in prolonged bleeding.

Patients with cirrhosis are at risk for serious bleeding due to rupture of the esophagus or upper stomach.
Once varices have bled, they tend to rebleed and the probability that a patient will die from each bleeding episode is high (30% to 35%). Treatment is necessary to prevent the first bleeding episode as well as rebleeding.Source: itock

Treatment for bleeding from varices complications

If large varices develop in the esophagus or upper stomach, patients with cirrhosis are at risk for serious bleeding due to rupture of these varices. Once varices have bled, they tend to rebleed and the probability that a patient will die from each bleeding episode is high (30% to 35%). Treatment is necessary to prevent the first bleeding episode as well as rebleeding. Treatments include medications and procedures to decrease the pressure in the portal vein and procedures to destroy the varices.

  • Propranolol (Inderal), a beta-blocker, is effective in lowering the pressure in the portal vein and is used to prevent initial bleeding and rebleeding from varices in patients with cirrhosis. Another class of oral medications that lower portal pressure is nitrates, such as isosorbide dinitrate (Isordil). Nitrates often are added to propranolol if propranolol alone does not adequately lower portal pressure or prevent bleeding.
  • Octreotide (Sandostatin) also decreases portal vein pressure and has been used to treat variceal bleeding.
  • During upper endoscopy (EGD) sclerotherapy or band ligation can be performed to obliterate varices, stop active bleeding, and prevent rebleeding. Sclerotherapy is less commonly used due to a higher risk of complications as compared to band ligation. Band ligation involves applying rubber bands around the varices to obliterate them. (Band ligation of the varices is analogous to rubber banding of hemorrhoids.)
  • Transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical, radiologic procedure to decrease the pressure in the portal vein. TIPS is performed by a radiologist who inserts a stent (tube) through a neck vein, down the inferior vena cava, and into the hepatic vein within the liver. The stent then is placed so that one end is in the high-pressure portal vein and the other end is in the low-pressure hepatic vein. This tube shunts blood around the liver and by so doing lowers the pressure in the portal vein and varices and prevents bleeding from the varices. TIPS is particularly useful in patients who fail to respond to beta-blockers or variceal banding. TIPS also is useful in treating patients with ascites that do not respond to salt and fluid restriction and diuretics. TIPS can be used in patients with cirrhosis to prevent variceal bleeding while the patients are waiting for liver transplantation. The most common side effect of TIPS is hepatic encephalopathy. Another major problem with TIPS is the development of narrowing and blocking (occlusion) of the stent, causing recurrence of portal hypertension and variceal bleeding and ascites. Fortunately, there are methods to open blocked stents. Other complications of TIPS include bleeding due to inadvertent puncture of the liver capsule or a bile duct, infection, heart failure, and liver failure.
  • A surgical operation to create a shunt (passage) from the high-pressure portal vein to veins with lower pressure can lower blood flow and pressure in the portal vein and prevent varices from bleeding. One procedure is called distal splenorenal shunt (DSRS). A surgical shunt may be considered for patients with portal hypertension who have early cirrhosis. The risks of major shunt surgery in these patients are less than in patients with advanced cirrhosis. During DSRS, the surgeon detaches the splenic vein from the portal vein and attaches it to the renal vein. Blood is then shunted from the spleen around the liver, lowering the pressure in the portal vein and varices and preventing bleeding from the varices.
Patients with hepatic encephalopathy are usually treated with a low protein diet and oral lactulose.
Hepatic encephalopathy usually should be treated with a low protein diet and oral lactulose.Source: iStock

Treatment for hepatic encephalopathy

Hepatic encephalopathy

Patients with an abnormal sleep cycle, impaired thinking, odd behavior, or other signs of hepatic encephalopathy usually should be treated with a low protein diet and oral lactulose. Dietary protein is restricted because it is a source of toxic compounds that cause hepatic encephalopathy. Lactulose, which is a liquid, traps toxic compounds in the colon so they cannot be absorbed into the bloodstream, and thus cause encephalopathy. Lactulose is converted to lactic acid in the colon, and the acidic environment that results is believed to trap the toxic compounds produced by the bacteria. To be sure adequate lactulose is present in the colon at all times, the patient should adjust the dose to produce 2 to 3 semiformed bowel movements a day. Lactulose is a laxative, and the effectiveness of treatment can be judged by loosening or increasing the frequency of stools. Rifaximin (Xifaxan) is an antibiotic taken orally that is not absorbed into the body but rather remains in the intestines. It is the preferred mode of treatment of hepatic encephalopathy. Antibiotics work by suppressing the bacteria that produce the toxic compounds in the colon.

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Patients suspected of having spontaneous bacterial peritonitis usually will undergo paracentesis.
Most patients with spontaneous bacterial peritonitis are hospitalized and treated with intravenous antibiotics.Source: iStock

Treatment for spontaneous bacterial peritonitis complications

Patients suspected of having spontaneous bacterial peritonitis usually will undergo paracentesis. The fluid that is removed is examined for white blood cells and cultured for bacteria. Culturing involves inoculating a sample of the ascites into a bottle of nutrient-rich fluid that encourages the growth of bacteria, thus facilitating the identification of even small numbers of bacteria. Blood and urine samples also are often obtained for culturing because many patients with spontaneous bacterial peritonitis also will have infections in their blood and urine. Many doctors believe the infection may have begun in the blood and the urine and spread to the ascitic fluid to cause spontaneous bacterial peritonitis. Most patients with spontaneous bacterial peritonitis are hospitalized and treated with intravenous antibiotics such as cefotaxime (Claforan). Patients usually treated with antibiotics include:

  • Ascites fluid cultures that contain bacteria.
  • Patients without bacteria in their blood, urine, and ascitic fluid but who have elevated numbers of white blood cells (neutrophils) in the ascitic fluid (greater than 250 neutrophils/cc). Elevated neutrophil numbers in ascitic fluid often mean there is a bacterial infection. Doctors believe the lack of bacteria with culturing in some patients with increased neutrophils is due either to a very small number of bacteria or ineffective culturing techniques.

Spontaneous bacterial peritonitis is a serious infection. It often occurs in patients with advanced cirrhosis whose immune systems are weak, but with modern antibiotics and early detection and treatment, the prognosis of recovering from an episode of spontaneous bacterial peritonitis is good.

In some patients, oral antibiotics (norfloxacin [Noroxin] or sulfamethoxazole and trimethoprim [Bactrim]) can be prescribed to prevent spontaneous bacterial peritonitis. Not all patients with cirrhosis and ascites should be treated with antibiotics to prevent spontaneous bacterial peritonitis, but some patients are at high risk for developing spontaneous bacterial peritonitis and warrant preventive treatment.

  • Patients with cirrhosis who are hospitalized for bleeding varices have a high risk of developing spontaneous bacterial peritonitis and should be started on antibiotics early during the hospitalization to treat presumed spontaneous bacterial peritonitis
  • Patients with recurring episodes of spontaneous bacterial peritonitis
  • Patients with low protein levels in the ascitic fluid (ascitic fluid with low levels of protein is more likely to become infected).
Most patients with cirrhosis, particularly hepatitis B and C, are screened yearly or every six months.
The prognosis and life expectancy for cirrhosis of the liver varies and depends on the cause, the severity, any complications, and any underlying diseases.Source: iStock

Prevention and early detection for liver cancer, and liver transplantation

Prevention and early detection of liver cancer

Several types of liver disease that cause cirrhosis (such as hepatitis B and C) are associated with a high incidence of liver cancer. It is useful to screen for liver cancer in patients with cirrhosis, as early surgical treatment or transplantation of the liver can cure the patient of cancer. The difficulty is that the methods available for screening are only partially effective, identifying at best only half of patients at a curable stage of their cancer. Despite the partial effectiveness of screening, most patients with cirrhosis, particularly hepatitis B and C, are screened yearly or every six months with ultrasound examination of the liver and measurements of cancer-produced proteins in the blood, for example, alfa-fetoprotein.

Liver transplantation

Cirrhosis is irreversible. Liver function usually gradually worsens despite treatment, and complications of cirrhosis increase and become difficult to treat. When cirrhosis is far advanced liver transplantation often is the only option for treatment. Recent advances in surgical transplantation and medications to prevent infection and rejection of the transplanted liver have greatly improved survival after transplantation. On average, more than 80% of patients who receive transplants are alive after five years. Not everyone with cirrhosis is a candidate for transplantation. Furthermore, there is a shortage of livers to transplant, and they're usually is a long (months to years) wait before a liver for transplanting becomes available. Measures to slow the progression of liver disease, and treat and prevent complications of cirrhosis are vitally important.

What is the prognosis and life expectancy for cirrhosis of the liver?

The prognosis and life expectancy for cirrhosis of the liver varies and depends on the cause, the severity, any complications, and any underlying diseases.

  • In compensated cirrhosis, patients have not developed any major complications and the average survival rate is more than 12 years.
  • The prognosis for is worse for patients who have decompensated cirrhosis and have developed complications such as ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome, or hepatopulmonary syndrome. Patients with decompensated cirrhosis often require liver transplantation and in those who are unable to receive an organ transplant, life expectancy may be less than 6 months.

What research is ongoing to prevent and treat cirrohsis of the liver?

Progress in the management and prevention of cirrhosis continues. Research is ongoing to determine the mechanism of scar formation in the liver and how this process of scarring can be interrupted or even reversed. Newer and better treatments for viral liver disease are being developed to prevent the progression to cirrhosis. Prevention of viral hepatitis by vaccination, which is available for hepatitis B, is being developed for hepatitis C. Treatments for the complications of cirrhosis are being developed or revised, and tested continually. Finally, research is being directed at identifying new proteins in the blood that can detect liver cancer early or predict which patients will develop liver cancer.

 

Cirrhosis and Your Liver

Reviewed by Hansa D. Bhargava, MD  on December 08, 2020

ARTICLES ONLIVER CIRRHOSIS

If your doctor tells you that you have cirrhosis, it means you have a condition that causes scar tissue to gradually replace your healthy liver cells. It usually happens over a long period of time because of infection or alcohol addiction. Most of the time, you can't fix the damage to your liver, but if you catch it early, there are treatments that can keep problems in check.

Your liver is an organ that's about the size of a football with an important job. It filters toxins from your blood, makes enzymes that help you digest food, stores sugar and nutrients, and helps you fight infections.

Each time your liver gets hurt, it repairs itself and forms tough scar tissue. When too much scar tissue builds up, the organ can't work right.

Symptoms

You may not have any symptoms at first. But as time goes on, and the damage to your liver gets worse, you may notice things like:

Continued

You could also bleed or bruise easily and have swelling in your legs or belly. You may also notice changes in your skin, such as:

  • Jaundice (when your skin and eyes turn yellow)
  • Intense itching
  • Spider web-like blood vessels in your skin
  • Redness in the palms of your hands or whitening of your nails

You could have some changes to the way you think, such as problems with concentration or memory. If you're a woman, you may stop having periods. If you're a man, you could lose your sex drive, start to develop breasts, or see some shrinkage in your testicles.

Some other symptoms you might get include:

Keep in mind that you may not get all these symptoms, and some of these problems are also signs of other conditions. (Learn more about the symptoms of cirrhosis.)

Causes, and Things That Make It More Likely

Cirrhosis always develops because of another liver problem or disease. If you don't treat the cause of your cirrhosis, it'll get worse, and over time your healthy liver cells won't be able to keep up. You might start to get tired, feel like you don't want to eat, and lose weight without trying. After a while, your liver may not be able to work well or at all.

Continued

It's important to know the cause of your cirrhosis so you can get the right treatment and keep it from getting worse. The most common causes are:

Alcohol abuse. If you have a drinking problem, it's important to get help. Alcohol harms your liver. Talk to your doctor. They may refer you to a treatment program.

Nonalcoholic fatty liver disease.Obesity raises your chances of this condition. If your cirrhosis is caused by this disease, you may improve your liver health if you lose weight and keep your blood sugar levels under control.

Hepatitis B or hepatitis C. Medicines for these diseases can stop more damage from happening to your liver.

Other conditions that can lead to cirrhosis include:

Diagnosis and Stages of Cirrhosis

Since you might not feel symptoms right away, you may not find out that you have cirrhosis until you get a routine checkup. When you visit your doctor, they'll ask about your alcohol use and medical history. They'll also examine you to check if your liver is tender or larger than it should be.

Tests. If your doctor suspects cirrhosis, they’ll do a blood test. It will check for signs that your liver isn't working right, such as:

  • High levels of certain liver enzymes
  • Buildup of bilirubin, which forms from the metabolism of heme. Heme iron comes from hemoglobin and is found in foods from animals such as chicken and red meat.
  • Low levels of proteins in your blood
  • Abnormal blood count
  • Infection with a virus
  • Antibodies that appear when you have an autoimmune liver disease

Your doctor may also do an imaging test of your belly, like an MRI or ultrasound. You may also need a procedure called a biopsy, which removes a sample of your liver tissue to see how much damage has been done and potentially learn the cause of your liver disease. (Get more information on tests for cirrhosis.)

Stages of Cirrhosis

If you find out that you have cirrhosis, your doctor will tell you what stage you're in. Depending on how well your liver is working, they'll say it's either "compensated" or "decompensated." Which one it is makes a difference in the kind of treatment you get.

Compensated cirrhosis

If you have compensated cirrhosis, you won't have any symptoms. Your liver can still do its job because there are enough healthy cells to make up for the damaged cells and scar tissue caused by cirrhosis. You can stay in this stage for many years.

Decompensated cirrhosis

Decompensated cirrhosis is the stage that comes after compensated cirrhosis. At this point, your liver has too much scarring and you develop complications.

Your doctor will know you have decompensated cirrhosis if you show signs of one or more of these conditions:

Jaundice. It's caused when your liver can't get rid of bilirubin, a blood waste product, which can make your skin and eyes yellow.

Ascites. This is fluid buildup in your belly.

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Bleeding varices. Varices are enlarged blood vessels. Signs that you have bleeding varices are black, tarry, or bloody stools or throwing up blood. This is an emergency that needs treatment right away.

Hepatic encephalopathy (HE). Toxins can build up in your brain and make you confused and very tired, and have trouble doing daily activities like driving or writing.

Your liver disease can also lead to a kidney disease called hepatorenal syndrome, a lung disease called hepatopulmonary syndrome, and liver cancer.

Treatment: Home Care, Medications, and Surgery

Your treatment depends on how badly your liver is injured. The goal is to protect the healthy tissue you have left.

The first step is to treat the condition that's causing your cirrhosis to prevent any more damage. Some things you may need to do include:

  • Stop drinking alcohol right away. Your doctor can suggest a treatment program for addiction.
  • Lose weight if you are obese, especially if your cirrhosis is caused by fat buildup in your liver.
  • Take medications if you have hepatitis B or C.
  • Keep all your doctor's appointments.
  • Eat enough protein. People with cirrhosis need more than most folks.
  • Get shots for flupneumonia, and hepatitis A and B.
  • Practice good hygiene. Wash your hands often.
  • Ask your doctor if it's OK to take over-the-counter medicines like acetaminophenaspirin, or ibuprofen. You cannot take these medications if you have ascites.
  • Drink enough fluids, even if you have ascites, so you don't get dehydrated.
  • Eat a low-salt diet if you have ascites.
  • Eat a high-protein, high-calorie diet.
  • Take a diuretic (a water pill) if your doctor prescribes one to help manage ascites.
  • Take medicine your doctor prescribes if you have constipation (trouble moving your bowels).

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Your doctor will also want to treat any complications that can happen with cirrhosis. They may suggest things like:

Low-sodium diet. This can help control swelling. Your doctor may also ask you to take medications for this problem. If you have a severe fluid buildup, you may need to get it drained.

Blood pressure medications. They can lessen bleeding inside your body that's caused by swollen and burst blood vessels. You may need surgery if you have severely enlarged veins.

Antibiotics and vaccinations. They can treat and prevent other infections.

Your doctor may also suggest medications to lessen a buildup of toxins, if that's a problem for you. And if you have inflammation in your liver, steroids can help.

Your doctor may recommend regular testing to make sure you don't get liver cancer, which can be a complication of cirrhosis.

If your cirrhosis is severe, you may need a liver transplant. It's a major operation. You'll likely need to get on a waiting list for a new liver from an organ donor who has died. Sometimes people with cirrhosis can get part of a liver that is donated from someone who is living. (Learn more about treatment options for cirrhosis.)

What to Expect

Usually, the damage that's already been done by cirrhosis can't be undone. But your liver can still work and bounce back even if two-thirds of it has been destroyed or removed.

If your cirrhosis is caused by long-term hepatitis, treating the infection can lower your chances of more problems if the damage is caught early. Most people with cirrhosis that's found in its early stage can live healthy lives.

If you are obese or have diabetes, losing weight and controlling your blood sugar can lessen damage caused by fatty liver disease. If the damage is caused by alcohol abuse, you can manage the cirrhosis better if you stop drinking right away.

Prevention

A healthy lifestyle is a key part of preventing cirrhosis.

Go easy on alcohol. Consuming too much alcohol causes your liver to swell. Over time, this leads to cirrhosis. But this doesn’t happen overnight. Alcohol-related cirrhosis is often the result of 10 or more years of heavy drinking, but some people are more prone to the disease than others. Women who drink heavily are more likely to get cirrhosis than men. To lower your chances of getting the disease, limit your drinking to no more than 14 units of alcohol a week. Here are how many units you consume, roughly, when you drink common alcoholic beverages:

  • A small shot (25 milliliters, or 0.85 ounces) of hard alcohol is 1 unit.
  • A small glass (125 milliliters, or 4.2 ounces) of wine is 1.5 units.
  • 20 ounces of normal-strength lager is 2 units.

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Protect yourself against hepatitisMost often, a virus causes this inflammation of the liver. The most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Chronic hepatitis B and C can cause cirrhosis. Hepatitis B is passed from one person to another through blood, semen, or other body fluids. Hepatitis C is caused by blood-to-blood contact. If you have chronic hepatitis C, there’s a higher chance you'll develop cirrhosis.

To lower your chances of becoming infected with hepatitis, you should avoid unprotected sex, and don’t share needles to inject drugs. Stay away from getting tattoos or body piercings in unclean environments. If you do get a tattoo, make sure the instruments are properly sterilized and needles are not shared.

Get vaccinated. If you work in health care, law enforcement, or any other profession where you might come in contact with people who have hepatitis, you should consider getting vaccinated against hepatitis B. There’s no vaccine for hepatitis C.

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In the United States, a vaccine for hepatitis B is also recommended for the following people:

  • Anyone under 19
  • Anyone who has unprotected sex or uses intravenous drugs
  • Anyone who’s been infected with hepatitis C or HIV
  • Kidney patients on hemodialysis
  • People with liver disease
  • Gay men
  • People with diabetes who are between ages 19 and 59
  • People traveling to areas with a higher incidence of hep B, such as South Asia and Africa

Watch what you eat. Fatty buildup in your liver can cause nonalcoholic steatohepatitis (NASH) and lead to cirrhosis. NASH is linked to high cholesterolcoronary artery disease, obesity, and diabetes.

If you stick to a healthy diet, limit your portions, and maintain a healthy weight, you’ll lower your chance of developing both NASH and cirrhosis.

Talk to your doctor about statinsThese drugs are typically used to treat high cholesterol. They may also help protect you from developing cirrhosis if you have hepatitis C and hepatitis B. Studies found people with hepatitis B who took statins were less likely to develop cirrhosis than those with hepatitis who weren’t on statins.

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Get tested. If you were born in South Asia, Africa, or other parts of the world where hepatitis B and C are common, you should be screened for cirrhosis. Early treatment can prevent the onset of the disease.

Anyone who needs a vaccine for hepatitis B should also be screened, along with baby boomers (born between 1945 and 1965).

WebMD Medical Reference

Overview-Cirrhosis

Contents

  1. Overview
  2. Symptoms
  3. Treatment

Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver working properly.

Cirrhosis is sometimes called end-stage liver disease because it happens after other stages of damage from conditions that affect the liver, such as hepatitis.

Your liver may keep working even when you have cirrhosis. However, cirrhosis can eventually lead to liver failure, and you can get serious complications, which can be life threatening.

Treatment may be able to stop cirrhosis from getting worse.

Symptoms of cirrhosis

You may not have any symptoms during the early stages of cirrhosis.

As your liver becomes more damaged, you may:

  • feel very tired and weak
  • feel sick (nausea)
  • lose your appetite
  • lose weight and muscle mass
  • get red patches on your palms and small, spider-like blood vessels on your skin (spider angiomas) above waist level

If cirrhosis gets worse, some of the symptoms and complications include:

See a GP if you think you may have cirrhosis.

Diagnosing cirrhosis

If a GP suspects cirrhosis, they'll check your medical history and do a physical examination to look for signs of long-term liver disease.

You may have tests to confirm the diagnosis, such as:

  • blood tests
  • scans, such as an ultrasoundCTMRI, or transient elastography scan
  • a liver biopsy, were a fine needle is used to remove a sample of liver cells so they can be examined under a microscope

If tests show that you have cirrhosis, a GP should refer you to see a doctor who specialises in liver problems (hepatologist).

If you have complications from cirrhosis, or a high chance of getting complications, you may be referred to a specialist liver centre.

Treating cirrhosis

There's no cure for cirrhosis at the moment. However, there are ways to manage the symptoms and any complications and slow its progression.

Treating the problem that led to cirrhosis (for example, using anti-viral medicines to treat hepatitis C) can stop cirrhosis getting worse.

You may be advised to cut down or stop drinking alcohol, or to lose weight if you're overweight. 

A GP can help you get support if you need help to stop drinking or to lose weight.

If your liver is severely damaged, a liver transplant may be the only treatment option.

What causes cirrhosis

In the UK, the most common causes of cirrhosis are:

Cirrhosis can also be caused by a problem affecting your bile ducts (such as primary biliary cholangitis) or immune system (such as autoimmune hepatitis), some inherited conditions, and the long-term use of certain medicines.

Alcohol-related liver disease

Drinking too much alcohol damages the liver. Over time, this can lead to alcohol-related liver disease.

Cirrhosis is the final stage of alcohol-related liver disease. It usually happens after many years of heavy drinking.

How to prevent cirrhosis

Limit alcohol

The best way to prevent alcohol-related cirrhosis is to drink within the recommended limits.

The guidelines recommend:

  • men and women should not regularly drink more than 14 units of alcohol a week
  • you should spread your drinking over 3 days, or more, if you drink as much as 14 units a week

Stop drinking alcohol immediately if you have alcohol-related cirrhosis. Drinking alcohol speeds up the rate at which cirrhosis progresses, regardless of the cause.

A GP can offer help and advice if you're finding it difficult to cut down the amount you drink. 

Read more about where to get alcohol support.

Protect yourself from hepatitis

Hepatitis B and C are infections in the liver caused by a virus.

The hepatitis B virus is spread in blood and body fluids. The hepatitis C virus is usually spread in blood.

Common ways of spreading these viruses include having sex with an infected person without using a condom, or close contact with an infected person's blood, such as sharing their toothbrush or sharing needles to inject drugs.

Vaccination for hepatitis B is part of the NHS childhood vaccination schedule. The vaccine is also available to anyone who has an increased chance of getting hepatitis B.

There is no vaccine for hepatitis C at the moment.

Aim for a healthy weight

To reduce your chance of getting non-alcoholic fatty liver disease (NAFLD), which can lead to cirrhosis, make sure you're a healthy weight by eating a healthy, balanced diet and exercising regularly.

The liver

The liver is an important organ that does hundreds of jobs that are vital for sustaining life.

For example, the liver:

  • stores glycogen, a type of fuel the body needs for energy
  • makes bile, which helps us digest fats
  • makes substances that help blood to clot and repair damaged tissues
  • processes and removes alcohol, toxins or medicines from the blood
  • helps the body fight infections

Your liver is very tough. It'll keep working even when it's damaged and can continue to repair itself until it's severely damaged.

 

Cirrhosis of the Liver

Cirrhosis is a late-stage result of liver disease and its complications. You may not have symptoms in the beginning stages of the disease. Common causes include alcohol abuse, hepatitis and nonalcoholic fatty liver disease. Treatment depends on the cause of cirrhosis and how much damage exists. Liver transplantation may be an option if your liver is failing.

OVERVIEW

Cirrhosis of the liver causes scarring of the liver with visible bumpy nodules throughout the tissue.Cirrhosis causes scaring and nodules to form throughout the liver.

What is cirrhosis of the liver?

Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Scar tissue keeps your liver from working properly.

Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.

The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Late-stage cirrhosis is life-threatening.

A normal liver, brown to reddish-brown in color, has a smooth exterior surface.

How common is cirrhosis?

Scientists estimate that cirrhosis of the liver affects about one in 400 adults in the U.S. It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis. Cirrhosis causes about 26,000 deaths each year in the U.S. and is the seventh leading cause of death in the U.S. among adults 25 to 64 years of age.

Who gets cirrhosis, who is most at risk?

You are more likely to get cirrhosis of the liver if you:

  • Abuse alcohol for many years.
  • Have viral hepatitis.
  • Have diabetes.
  • Are obese.
  • Inject drugs using shared needles.
  • Have a history of liver disease.
  • Have unprotected sex.

Is cirrhosis cancer?

No, cirrhosis of the liver isn’t cancer. However, most people who have liver cancer have cirrhosis. If you have cirrhosis, you have an increased risk of liver cancer. If you have hepatitis B or hepatitis C, you have an increased risk of liver cancer because these diseases often lead to cirrhosis. Any cause of liver disease can lead to cirrhosis, which increases your chance of liver cancer. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.)

Is cirrhosis a hereditary disease?

Cirrhosis itself is not an inherited (passed from parent to child) disease. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases.

Can cirrhosis be reversed?

Generally no. If you have been told you have cirrhosis, you have a late-stage liver disease and the damage that is already done is permanent. There are many liver diseases and complications of liver diseases that can lead to cirrhosis. If your liver disease or complication is caught early and successfully managed, it may be possible to slow or stop the progression of disease.

Is cirrhosis fatal?

Having a diagnosis of cirrhosis of the liver doesn’t mean you have an immediately fatal condition. However, as cirrhosis continues, more scarring occurs and liver function continues to decline. Eventually, your failing liver may become a life-threatening condition. Yet there’s still hope. You and your medical team will discuss if you are a candidate for a liver transplant. If so, you will begin the process of being placed on a national liver transplant recipient list.

SYMPTOMS AND CAUSES

What are the symptoms of cirrhosis?

The symptoms of cirrhosis depend on the stage of your disease. In the beginning stages, you may not have any symptoms. If you do have symptoms, some are general and could easily be mistaken for symptoms of many other diseases and illnesses.

Early symptoms and signs of cirrhosis include:

As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including:

  • Easy bruising and bleeding.
  • Yellow tint to your skin or the whites of your eyes (jaundice).
  • Itchy skin.
  • Swelling (edema) in your legs, feet and ankles.
  • Fluid buildup in your belly/abdomen (ascites).
  • Brownish or orange color to your urine.
  • Light-colored stools.
  • Confusion, difficulty thinking, memory loss, personality changes.
  • Blood in your stool.
  • Redness in the palms of your hands.
  • Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
  • In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles.
  • In women: premature menopause (no longer having your menstrual period).

Is cirrhosis painful?

Yes, cirrhosis can be painful, especially as the disease worsens. Pain is reported by up to 82% of people who have cirrhosis and more than half of these individuals say their pain is long-lasting (chronic).

Most people with liver disease report abdominal pain. Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs. General abdominal pain and discomfort can also be related to swelling from fluid retention and enlargement of your spleen and liver caused by cirrhosis.

Pain can come both from the diseases that lead to cirrhosis and/or cirrhosis can make the pain from existing diseases worse. For instance, if you have non-alcoholic fatty liver disease and are obese, you may also have osteoarthritis and cirrhosis makes your bone and joint pain worse. Cirrhosis also causes an inflammatory state in your entire body. Inflammation and your body’s reaction to inflammation can cause general pain.

What causes cirrhosis?

The most common causes of cirrhosis of the liver are:

  • Alcohol abuse (alcohol-related liver disease caused by long-term [chronic] use of alcohol).
  • Chronic viral infections of the liver (hepatitis B and hepatitis C).
  • Fatty liver associated with obesity and diabetes and not alcohol. This condition is called non-alcoholic steatohepatitis.

Anything that damages the liver can lead to cirrhosis. Other causes include:

  • Inherited diseases:
  • Autoimmune hepatitis (your body’s own immune system attacks healthy liver tissue causing damage).
  • Diseases that damage or block bile ducts in the liver (tubes that carry bile from the liver to other parts of digestive system; bile helps digest fats):
    • Primary biliary cholangitis (bile ducts become injured, then inflamed, then permanently damaged).
    • Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver).
    • Blocked bile duct (can cause infections, backup of products in the liver).
    • Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing damage, scarring, loss of liver tissue and cirrhosis).
  • Chronic heart failure (causes fluid to back up in your liver, swelling in other areas of your body and other symptoms).
  • Rare diseases, such as amyloidosis, in which abnormal deposits in the liver of an abnormal protein called amyloid disrupts normal liver function.

Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if injury – from whatever cause – continues, liver cells start to die. Over time, scar tissue replaces the damaged liver cells and the liver can’t function properly.

What are the complications of cirrhosis?

There are many complications of cirrhosis of the liver. Because cirrhosis develops over many years, some of these complications may be your first noticeable signs and symptoms of the disease.

Portal hypertension: This is the most common serious complication. Portal hypertension is an increase in the pressure in your portal vein (the large blood vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through your liver as a result of cirrhosis. When blood flow through veins is partially blocked, veins in your esophagus, stomach or intestines can become enlarged (a condition called varices). As the pressure in these veins builds, the veins can bleed or even burst, causing severe internal bleeding.

Additional complications of portal hypertension include:

  • Swelling (edema) in your legs, ankles or feet.
  • Buildup of fluids in your abdomen (called ascites).
  • Swelling/enlargement of your spleen (splenomegaly).
  • Formation and dilation (expansion) of blood vessels in the lungs (hepatopulmonary syndrome), leading to low levels of oxygen in the blood and body and shortness of breath.
  • Failure of kidney function as a result of having portal hypertension as a complication of cirrhosis (hepatorenal syndrome). This is a type of kidney failure.
  • Confusion, difficulty thinking, changes in your behavior, even coma. This occur when toxins from your intestines aren’t removed by your damaged liver and circulate in the bloodstream and buildup in your brain (a condition called hepatic encephalopathy).

Hypersplenism: Hypersplenism is an overactive spleen. This condition causes quick and premature destruction of blood cells.

Infections: Cirrhosis increases your risk of getting and fighting serious infections, such as bacterial peritonitis (infection of the tissue that lines the inner wall of your abdomen).

Malnutrition: Your liver processes nutrients. A damaged liver makes this more difficult and leads to weight loss and general weakness.

Liver cancer: Most people who develop liver cancer have cirrhosis of the liver.

Liver failure: Many diseases and conditions cause liver failure including cirrhosis of the liver. As its name implies, liver failure occurs when your liver isn’t working well enough to perform its many functions.

DIAGNOSIS AND TESTS

How is cirrhosis of the liver diagnosed?

Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol abuse, injectable drug abuse or have had hepatitis B or C and have the symptoms listed in this article.

To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:

  • Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).
  • Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
    • Lower than normal levels of albumin and blood clotting factors (lower levels means your liver has lost its ability to make these proteins).
    • Raised levels of liver enzymes (suggests inflammation).
    • Higher level of iron (may indicate hemochromatosis).
    • Presence of autoantibodies (may indicate autoimmune hepatitis or primary biliary cirrhosis).
    • Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood).
    • High white blood cell count (indicates an infection).
    • High creatinine level (a sign of kidney disease that suggests late-stage cirrhosis).
    • Lower levels of sodium (is an indicator of cirrhosis).
    • Raised level of alfa-fetoprotein (indicates presence of liver cancer).

In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.

  • Imaging tests: Imaging test show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered include computerized tomography (CT) scanabdominal ultrasound and magnetic resonance imaging (MRI). A special ultrasound, called a transient elastography, measures the fat content and amount of stiffness in your liver. Two different types of endoscopies might be ordered: an endoscopic retrograde cholangiopancreatography to detect bile duct problems, and/or upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach or intestines.
  • Biopsy: A sample of liver tissue (biopsy) is removed from your liver and examined under the microscope. A liver biopsy can confirm a diagnosis of cirrhosis, determine other causes or extent of liver damage or enlargement or diagnosis liver cancer.

Are there stages of cirrhosis?

If you have been diagnosed with cirrhosis of the liver, you are already beyond the early stages of liver disease. Having cirrhosis means your liver has scar tissue in it because it has been damaged.

Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Some specific liver diseases also have their own scoring systems. However, not every liver disease has a scoring system and there’s no scoring system if you happen to have more than one liver disease at the same time.

For these reasons, perhaps it’s easier to talk about cirrhosis according to a classification system you are more likely to hear from your healthcare provider. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis.

Compensated cirrhosis means you have cirrhosis but you don’t yet have noticeable symptoms (you are asymptomatic). Your lab work and imaging findings may not be abnormal. A liver biopsy may be the only way to confirm a diagnosis of cirrhosis. Median survival in patients with compensated cirrhosis is approximately nine to 12 years. (Median is the middle point in set of numbers, so an equal number of individuals survived less than 9 to 12 years as the number of individuals who survived over this time range.)

Decompensated cirrhosis means your cirrhosis has worsened to the point that you have noticeable symptoms. Your healthcare provider recognizes your condition based on your history, physical and lab findings. You have at least one complication, which includes jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome, variceal bleeding or liver cancer. You are usually admitted to the hospital for care. Median survival in patients with decompensated cirrhosis is approximately two years.

MANAGEMENT AND TREATMENT

Is there a cure for cirrhosis of the liver?

No, there is no cure for cirrhosis. The damage already done to your liver is permanent. However, depending on the underlying cause of your cirrhosis, there may be actions you can take to keep your cirrhosis from getting worse. These actions include:

  • Stop drinking alcohol.
  • Treat chronic hepatitis (if you have it).
  • Avoid medications that stress the liver.
  • Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet.

Follow other tips listed under the Prevention section in this article.

What are the goals of cirrhosis treatment?

The goals of treatment for cirrhosis of the liver are to:

  • Slow further damage to your liver.
  • Prevent and treat symptoms.
  • Prevent and treat complications.

How is cirrhosis of the liver treated?

Treatment depends on what’s causing your cirrhosis and how much damage exists.

Although there is no cure for cirrhosis, treatments can delay or stop its progress and reduce complications.

Treatments for the causes of cirrhosis are as follows:

  • Alcohol-related liver disease: If you’ve developed cirrhosis from alcohol abuse, stop drinking alcohol. If you need help, ask your healthcare provider for recommendations for alcohol addiction treatment programs.
  • Hepatitis B or C: Several approved antiviral medications are available to treat hepatitis types B and C.
  • Nonalcoholic fatty liver disease: Management of nonalcoholic fatty liver disease includes losing weight, following a healthy diet, getting physical exercise and following your provider’s instructions for managing your diabetes.
  • Inherited liver diseases: Treatment depends on the specific inherited disease. Treatments are aimed at treating symptoms and managing complications. Treatment of alfa-1 antitrypsin deficiency may include medicine to reduce swelling in your abdomen and legs, antibiotics to treat infections and other medicines for complications. For hemochromatosis, treatment is to remove blood to reduce the level of iron in your blood. For Wilson disease, treatment is medicines to remove copper from your body and zinc to prevent absorption of cooper. For cystic fibrosis, medications are prescribed to improve lung function, methods to clear mucous and treatment of complications. Treatment for glycogen storage diseases that involve the liver is to keep glucose at the right level.
  • Autoimmune hepatitis: Treatment includes medications to suppress your immune system.
  • Diseases that damage or block bile ducts in the liver: Treatments include medications such as ursodiol (Actigall®) or surgery to open narrowed or blocked bile ducts.
  • Heart failure: Treatment depends on the cause and stage of your heart failure. Medications include drugs to treat high blood pressure, reduce cholesterol, remove excess fluids (edema) from your body and improve heart pumping function. Other treatments include implantation of devices to help pump blood or monitor heart rhythm, surgeries to unblock arteries or replace or repair heart valves and transplant surgery to replace your heart.
  • Medications that may be contributing to cirrhosis: Your provider will review all of your medications to determine if any are causing problems for your liver and if so, stop the drug, lower the dosage or change to a different drug if possible.

How are the complications of cirrhosis treated?

Portal hypertension: Portal hypertension is mainly the result of chronic end-stage liver disease. Treatment consists of treating its many complications. Treatments of portal hypertension include:

  • Giving beta blockers or nitrates to lower blood pressure in your veins.
  • Cutting off blood flow through the varices to stop or reduce further bleeding with procedure using tiny elastic bands (band ligation) or with sclerotherapy.
  • Redirecting blood from the portal vein to reduce pressure in the portal vein and to control variceal bleeding. This is achieved using either one of two techniques – distal splenorenal shunt or transjugular intrahepatic portosystemic shunt.
  • Prescribing lactulose to absorb toxins in the blood that result from hepatic encephalopathy, which cause symptoms including confusion and other mental changes.
  • Draining excess fluid in your abdomen (ascites) in a procedure called paracentesis or taking a diuretic medication to decrease extra fluids (edema) in your legs and other areas of your body.

Bacterial peritonitis: Antibiotics and infusion of a protein (albumin) will be prescribed. Typically patients are admitted to the hospital for treatment and monitoring. Following a diagnosis of bacterial peritonitis, an oral antibiotic will be prescribed for daily use to prevent recurrence of infection.

Liver cancer: Treatment depends on the stage of your cancer and other factors. One or more treatments may be tried. Options include surgery to remove part of your liver or your whole liver (to be replaced with a new liver as part of a liver transplantation) and nonsurgical tumor-destroying methods including ablationchemotherapy, targeted therapy (drugs zero in on cancer genes or tissue), immunotherapy and radiation bead therapy (inject bead that give off radiation into the blood vessels that feed the tumor).

Kidney failure: Treatment may include medication, dialysis and kidney transplant, depending on the cause and extent of failure.

Liver failure: Treatment depends on if you have acute or chronic failure. For chronic liver failure, diet and lifestyle changes include stopping alcohol and medications that harm the liver; eating less red meat, cheese and eggs; losing weight; controlling high blood pressure and diabetes and cutting down on salt.

Acute treatments for liver failure include intravenous fluids to maintain blood pressure, laxatives to help flush toxins from the body and blood glucose monitoring.

If you have either acute or chronic liver failure, your liver specialist may recommend a liver transplant. Liver transplants can come from a living or deceased donor. Only a portion of the donor liver needs to be transplanted. The liver is the only human organ capable of growing back.

Many tests are required of both you (the liver transplant recipient) and the person donating a portion of their liver or the cadaver liver (liver from a deceased person). If your doctors determine that you need a liver transplant, you will be placed on a national liver transplant waiting list, which lists patients by blood type, body size and severity of end-stage liver disease.

PREVENTION

How can I prevent cirrhosis of the liver?

Food and drink issues:

  • Don't abuse alcohol. If you do drink alcohol, limit how much you drink and how often. If you drink more than two drinks a day if you are a man or more than one if you are a woman, you are increasing your risk. A drink is a glass of wine or a 12-ounce can of beer or a 1.5 ounce serving of hard liquor. If you have liver disease, you should not drink alcohol at all.
  • Eat a well-balanced, low-fat diet, such as the Mediterranean diet. A well-balanced healthy diet consists of fruits, vegetables, lean proteins and whole grains.
  • Don’t eat raw seafood, especially oysters and clams. These foods can contain a bacteria that can cause serious illness.
  • Cut back on the amount of salt in your diet. Use other seasonings to flavor your foods.

Healthy body habits:

  • Maintain a healthy weight. Excess body fat can damage your liver. Ask your healthcare provider for a weight loss plan if you are overweight.
  • Exercise regularly.
  • See your healthcare provider regularly for check-ups. Follow medical recommendations to control obesity, diabetes, hypertension (high blood pressure) and cholesterol (high bad cholesterol [LDL] and/or low good cholesterol [HDL]) and high triglycerides.
  • Quit smoking if you smoke.

Healthy liver practices:

  • Avoid high-risk behaviors that can lead to infection with hepatitis B or C, such as sharing needles for illegal drug use or having unprotected sex.
  • Get vaccinated against hepatitis B. If you already have hepatitis, ask your provider if drug treatment is appropriate for you.
  • Get your annual flu shot and ask if a pneumonia vaccine makes sense for you (people with cirrhosis are more likely to get infections).
  • Avoid nonsteroidal anti-inflammatory drugs (such as ibuprofen [Advil®, Motrin®] indomethacin [Indocin®] celecoxib [Celebrex®] and aspirin) and high doses of acetaminophen (Tylenol®). Acetaminophen can be taken safely at a dose up to 2,000 mg daily. These drugs can cause or worsen liver function.
  • Take all medications and keep all appointments as recommended by your healthcare provider.

OUTLOOK / PROGNOSIS

What can I expect if I have cirrhosis?

Damage already done to your liver is permanent. But your liver is a large organ. If part of your liver is still working, you might be able to slow the progression of disease, depending on its cause. For instance, if your cirrhosis is caused by alcohol abuse, you need to stop drinking immediately. If you are obese or have diabetes, you will need to lose weight and manage your blood sugar so you can lower the damage caused by fatty liver disease.

You and your healthcare provider or team will work together to determine what’s causing your cirrhosis and what complications may have resulted from your cirrhosis and treat them accordingly.

What’s the life expectancy for people with cirrhosis?

Life expectancy depends on several factors including the cause and severity of your cirrhosis, your response to treatments, presence of cirrhosis complications, your age and any other existing general health problems. Ask your liver specialist about your life expectancy since every person is unique, with unique overall health issues and specific liver health issues.

If your cirrhosis is advanced, liver transplantation may be an option. You and your doctors will discuss if this is an option for you.

What’s a Child-Turcotte-Pugh score and MELD score?

A Child-Turcotte-Pugh (CTP) score, also known simply as the Child-Pugh score, is a clinical score that tells your doctors how severe your liver disease is and forecasts your expected survival rate. The scoring system provides a score on the presence of five clinical measures (the lab values of bilirubin, serum albumin and prothrombin time; presence of ascites and hepatic encephalopathy) and the degree of severity of each of these measures.

Child-Turcotte-Pugh Score
Class Status Severity of Liver Disease Two-Year Survival Rate
Class A Mild 85%
Class B Moderate 60%
Class C Severe 35%

The Model for End-stage Liver Disease (MELD) score is a score that is used to rank the urgency for a liver transplant. The worse your liver function is, the higher your MELD score and the higher your position is on the transplant list. The Pediatric End-stage Liver Disease (PELD) score is similar to MELD but is a scoring system for children under the age of 12.

LIVING WITH

When should I call 911 or go to the emergency room?

If you have cirrhosis and experience the following, call 911:

  • Your poop (stools) are black and tarry or contain blood (may be maroon or bright red in color).
  • You are vomiting blood.
  • The whites of your eyes are turning yellow.
  • You have difficulty breathing.
  • You have abdominal swelling.
  • You have muscle tremors or shakiness.
  • You are confused, irritable, disoriented, sleepy, forgetful or “foggy.”
  • You have a change in your level of consciousness or alertness; you pass out.

What type of healthcare providers will treat my cirrhosis?

Depending on the stage of your cirrhosis, different healthcare providers may be involved in your care. Healthcare professionals likely to be part of your care team include:

  • Your primary care provider.
  • Gastroenterologist (doctor who specializes in conditions of your digestive tract).
  • Hepatologist (doctor who specializes in conditions of your liver).
  • Nephrologist (doctor who specializes in conditions of your kidney).
  • Dietitian.
  • Members of a liver transplant team include: hepatologist, transplant surgeon, anesthesiologist, infectious disease specialist, nephrologist, dietitian, transplant pharmacist, physical and occupational therapist, case manager/social worker and nurses.

A note from Cleveland Clinic

Cirrhosis of the liver is a late-stage result of liver disease and its complications. Cirrhosis causes your liver to not function properly. Your liver plays a vital role in many of the processes and functions that keep you alive.

Although scarring from liver disease causes permanent damage, it’s still possible to live a long life. Depending on the underlying cause, it’s possible to slow or stop cirrhosis from worsening. Many of the causes and complications that lead to cirrhosis are treatable or manageable. If you drink alcohol, stop. If you have nonalcoholic fatty liver disease, lose weight and control your metabolic risk factors. If you have diabetes, make sure you are following your healthcare provider’s management recommendations. Take all medications for all your medical conditions as directed by your healthcare team. Get vaccinated for hepatitis A and B.

If you have end-stage cirrhosis, don’t lose hope. You and your healthcare team will work together to closely manage your condition and put you on a wait list for a donor liver.

 

 

 

 

 

 

ท้องมาน การรักษา

การตรวจการทำงานของตับ ตับอักเสบ ไขมันพอกตับ

https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

https://www.nhs.uk/conditions/cirrhosis/

https://www.webmd.com/digestive-disorders/understanding-cirrhosis-basic-information

https://www.medicinenet.com/cirrhosis/article.htm

https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487