What is the management of liver 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:

• Fatigue and weakness
• Lack of appetite and weight loss
• Nausea

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:

• Vomiting blood
• Severe muscle cramps
• Brownish urine
• Fever
• Enlarged spleen
• Bone disease, causing bones to break more easily

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.

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:

• Cystic fibrosis
• Diseases that make it hard for your body to process sugars
• Too much iron buildup in your body
• Wilson's disease, where too much copper is stored in the liver
• Autoimmune diseases that cause your body to attack liver cells
• Blockage of the bile duct, which carries digestive enzymes from your liver into the intestines
• Certain genetic digestive disorders
• Some infections, including syphilis and brucellosis
• Bad reactions to certain medications

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.

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 flu, pneumonia, 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 acetaminophen, aspirin, 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).

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.

Protect yourself against hepatitis. Most 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.

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 cholesterol, coronary 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 statins. These 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.

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).