Cirrhosis of the liver
What is cirrhosis? — Cirrhosis is a disease that scars the liver. The liver is a big organ in the upper right side of the belly (figure 1). Damage to the liver can cause heavy bleeding, swelling, and breathing problems.
What are the symptoms of cirrhosis? — Some people with cirrhosis have no symptoms. When symptoms do occur, they can include:
Swelling in the belly and legs, and fluid buildup in the lungs
Heavy bleeding from blood vessels in the esophagus, the tube that connects the mouth to the stomach
Bruising or bleeding easily
Trouble getting enough sleep or sleeping too much
Yellowing of the skin or whites of the eyes, called jaundice
Confusion that can come on suddenly
Cirrhosis also makes it more likely that you will get infections, and it can increase your risk of liver cancer.
What causes cirrhosis? — When something harms the liver, the organ tries to fix itself. In the process, scars form. Causes of liver damage include:
Heavy alcohol use – People who abuse alcohol or who are addicted to it are most at risk for cirrhosis.
Hepatitis B or hepatitis C – Viruses cause these liver diseases. People can catch the viruses by sharing needles or having sex with people who are infected.
Nonalcoholic steatohepatitis (NASH) – People with this condition often don't drink alcohol. Doctors aren't sure what causes NASH, but many people who have it are overweight and have diabetes.
Is there a test for cirrhosis? — Yes. Tests include:
Biopsy – In this test, a doctor puts a needle into your liver and takes out a small sample of tissue. The sample will show how severe the damage is.
Blood tests – Results can show what is causing the disease.
Imaging – Your doctor might take pictures of your liver with an ultrasound machine or with a MRI.
Is there anything I can do to prevent further liver damage? — Yes. To help protect your liver:
Talk to your doctor before you start taking any new medicines, including pain killers such as ibuprofen (sample brand names: Advil, Motrin), naproxen (sample brand name: Aleve), or acetaminophen (sample brand name: Tylenol). Also talk to your doctor before taking any herbs, vitamins, or supplements. Some medicines and supplements can damage the liver.
Get vaccinated against hepatitis A and B if you have not had the infections before
How is cirrhosis treated? — Treatments depend on the cause of cirrhosis, how severe it is, and what symptoms you have. Treatments fall into a few main categories, including those that:
Treat the cause of the disease – Some causes of cirrhosis can be treated. For example, people with cirrhosis caused by alcohol abuse can try to stop drinking. People with chronic hepatitis C or B can take medicines.
Lower the risk of bleeding – Cirrhosis can cause the blood vessels around the esophagus to swell or even burst and bleed (figure 2). To prevent that from happening, doctors can:
•Prescribe medicines called "beta blockers." These medicines reduce blood pressure in the liver, and help reduce the chance of bleeding.
•Place tiny bands around the swollen blood vessels (this procedure is called "variceal band ligation")
Decrease fluid buildup in the belly – In people with cirrhosis, the belly sometimes fills with fluid. To decrease fluid buildup, doctors can:
•Prescribe medicines called "diuretics." These medicines make you urinate a lot. People who take diuretic medicines often must also reduce the amount of salt they eat.
•Drain the fluid from your belly using a needle (this procedure is called a "paracentesis")
•Implant a device in the liver that reduces fluid buildup in the belly (this procedure is called "TIPS")
Treat or prevent infection – People with cirrhosis have a higher than normal chance of getting infections. When they get an infection, they can also get much sicker than people without cirrhosis. As a result, people with cirrhosis sometimes need antibiotics to either treat or prevent infection. Most people with cirrhosis should also get the flu vaccine and other vaccines to prevent common infections.
Treat confusion – Advanced cirrhosis can lead to confusion. Doctors usually use lactulose (a medicine that softens stool) or certain antibiotics to treat the confusion.
Will I need a new liver? — People with severe cirrhosis need a new liver. Talk to your doctor about the surgery before you get too sick, to find out if a liver transplant might be an option for you. People often have to wait for up to 2 years to get a new liver.
Can cirrhosis be prevented? — You can reduce your chances of getting cirrhosis by:
Getting help if you have an alcohol problem
Getting the vaccines for hepatitis B and hepatitis A, if you haven't already
Using condoms when having sex
Not sharing drug needles
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15380 Version 15.0
Release: 28.2.2 - C28.105
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