Cirrhosis

What is cirrhosis?
Cirrhosis is a pattern of damage to the liver that occurs as a result of long-term injury. This injury can occur from multiple causes including alcohol, toxins, viruses or other conditions. Damaged liver tissue is replaced by fibrous tissues- which in turn leads to scarring. This scarring alters the blood flow through the liver, which may then cause some of the serious complications of cirrhosis. Cirrhosis is usually irreversible, but removing the cause can slow further damage. A diagnosis of cirrhosis does not necessarily mean the liver has lost all normal function.

Cirrhosis may be diagnosed when a person experiences the typical complications. However many people may have few or no symptoms in the early stages of cirrhosis. If present, early symptoms may include fatigue, loss of appetite, reddish and blotchy palms, and spider angiomas (pin head sized red spots with radiating blood vessels on the upper body and arms). With progressive scarring, symptoms include fluid accumulation in the abdomen (ascites) and legs (edema), loss of muscle bulk, fatigue, and jaundice.

What are the complications of cirrhosis?

Complications of cirrhosis may occur as the disease progresses. These may include fluid accumulation, infection, liver cancer, internal bleeding, and changes in thinking. 

Ascites is fluid accumulation in the abdomen. Fluid build-up in other areas, usually the legs, is called edema. Ascites formation is not completely understood. Ascites may be so minimal that a person is unaware of the fluid or so massive that it is difficult to breathe and eat adequate amounts of food. The most important key to control this fluid accumulation is limiting sodium (salt) to 2 grams (2000mg) per day. Specific diet recommendations are available. Diuretics (water pills) are frequently used. Spironolactone (Aldactone) and furosemide (Lasix) are two commonly used medications to treat ascites. If this is not successful, a procedure called a paracentesis can be performed to drain the fluid.

Occasionally, the ascites fluid may become infected and this is called spontaneous bacterial peritonitis (SBP). Symptoms may include fever, chills, abdominal pain, nausea, vomiting, and general malaise. If this occurs, antibiotics may be necessary. Once SBP occurs patients may be placed on a long-term dose of antibiotic to prevent future infection. 

The risk of liver cancer (hepatocellular carcinoma or HCC) is increased in many types of cirrhosis.  However screening for this can be done with a blood test for elevated alpha fetoprotein (AFP), and ultrasound (or other liver imaging tests) of the liver. These are typically are performed every six months. If HCC is found early, it can be treated and often cured.

In chronic liver disease, intestinal bleeding may develop from enlarged blood vessels in the esophagus or stomach. These blood vessels are called varices and bleeding from varices can be life threatening. Bleeding can be prevented with medications and endoscopic procedures. The liver specialist can help determine what works best for each individual patient.

If a person vomits red blood or has a bowel movement containing red or black stool, this could be a sign that enlarged varices in the stomach or esophagus are bleeding. The person should seek medical attention immediately. Endoscopy can be performed to stop the bleeding, either by placing rubber bands around bleeding varices or injecting medicine.

In more advanced cases of cirrhosis, changes in cognitive function can occur. This mental impairment called encephalopathy can range from forgetfulness and trouble concentrating to coma and death. This condition is not fully understood, but there are several medical treatments that can help improve cognitive function.

General Guidelines

• Get vaccinated for hepatitis A and hepatitis B if you are not already immune. Blood tests will be used to determine immunity.
• Pneumococcal vaccines are also suggested.
• Salt (sodium) restriction is very important to control fluid retention. Aim for less than 2000mg of sodium per day.
• Follow a balanced diet, attempting to get all nutrients from whole foods and extra doses of nutrients from vitamins.
• Even if you are not experiencing symptoms or complications of cirrhosis, office visits every six months are recommended to screen for cancer.
• Alcohol should be avoided.
• Avoid aspirin and non-steroidal anti-inflammatory drugs, other than 81 mg dose if recommended by your physician for the prevention of heart problems.
• Keep total acetaminophen dose at or below 2600 mg per day.

General Recommendations: http://www.hepatitis.va.gov/patient/complications/cirrhosis/decompensated.asp