Cirrhosis

Alcohol abuseHepatitis infectionUse of drugs toxic to the liverBeing overweightDiabetes that is poorly controlledIngestion of too much iron SymptomsCirrhosis often causes no symptoms early in the disease process. Symptoms start when the liver begins to fail, as scar tissue replaces healthy cells. Symptom severity depends on the extent of liver damage. Early symptoms include: FatiguePoor appetiteAbdominal swelling, tenderness, and painNauseaWeight lossWeaknessEnlarged breasts in men Later symptoms, some due to complications, include: Yellowing of the skin or eyes ( jaundice ) Reddened palmsLoss of body hairShrunken testiclesEnlarged liverEnlarged spleenAppearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navelDark urineWater retention and swelling in the legs and abdomenBleeding and bruisingVomiting bloodItchingMenstrual problemsAbdominal infectionsImpotenceForgetfulnessConfusionAgitationTremorsComaInability to fully process drugsEnlarged, twisted, thin-walled blood vessels called varices that bleed easily and sometimes catastrophically (usually located in the esophagus)Liver cancerOsteoporosisGallstonesArrhythmiasSleep disturbancesUlcersBreathing problemsInsulin resistance DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:Blood teststo assess how well the liver is working and determine a causeCT scan , ultrasound , or liver/spleen scanto identify changes in the liver Liver biopsy analyzing a sample of liver tissue removed via a thin needle inserted through the abdomen and into the liver Laparoscopy looking at the liver via a thin tube with a lighted tip inserted through a small incision near the belly button Other tests may include: Inserting a catheter into the liver vein and measuring the pressure within that vein (this is rarely necessary)Removing fluid from the abdomen and examining itOther tests to determine what has caused the cirrhosis and what complications may occur Treatment There is no treatment to cure cirrhosis. The goals of treatment are to: Control the causePrevent additional damageTreat symptoms and complicationsTreat underlying medical conditionsTreatments include: Medication Doctors prescribe drugs to: Treat hepatitis and complications that ariseReduce the absorption of waste products and toxins in the digestive systemReduce the risk of a blood vessel breakingFight infectionsShed excess fluids SurgeryLiver transplant may be performed if:

Complications can no longer be controlled using medical therapyThe liver stops functioningEndoscopyThis is used to tie off bleeding blood vessels (varices) or inject drugs to cause clotting. A thin tool with a lighted tip is inserted down the throat to help the doctor see and access the varices, which are located in the esophagus. Self-careBe careful not to further damage your liver.Stop drinking alcohol.Do not take any medications without your doctor's approval, including over-the-counter drugs.Eat a balanced diet. You may need extra calories and a generous amount of protein to help your liver regenerate.If your liver disease is more advanced, you may need to limit protein intake, because your weakened liver won't be able to process it properly.You may need to limit salt in your diet because it increases water retention.Take any vitamin supplements your doctor recommends.Put your feet and legs up to decrease swelling. Due to increased risk of infections, doctors recommend: Vaccines for flu , pneumonia , and hepatitisAvoiding raw seafood Prevention To decrease the risk of cirrhosis: Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.Practice safe sex to lower your chance of getting hepatitis B.If you use IV drugs, do not share needles, which can spread hepatitis B, C, or D.Receive hepatitis vaccines.Follow your doctor's recommendations about blood tests when taking medications that may damage the liver. RESOURCES:

American College of Gastroenterologyhttp://www.acg.gi.org American Gastroenterological Associationhttp://www.gastro.org American Liver Foundationhttp://www.liverfoundation.org CANADIAN RESOURCES: Canadian Liver Foundationhttp://www.liver.ca References: American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed October 11, 2005. American Gastroenterological Association website. Available at: http://www.gastro.org . Accessed October 11, 2005. Cirrhosis. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=7054 . Accessed October 11, 2005. Dambro MR. Griffith's 5-Minute Clinical Consult, 1999 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed October 11, 2005. Last reviewed October 2007 by Daus Mahnke, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.