Cirrhosis

Cirrhosis is a potentially life-threatening condition that occurs when inflammation and scarring damage the liver. No treatment will cure cirrhosis or repair scarring in the liver that has already occurred. But treatment can sometimes prevent or delay further liver damage. The main components of treatment include:

Treating the cause of cirrhosis, when possible, to prevent further liver damage.
Avoiding substances that may further damage the liver, especially alcohol.
Preventing and treating the symptoms and complications of cirrhosis.
Having a liver transplant if your liver damage becomes severe, as long as you are a suitable candidate for liver transplantation and a liver is available.

Initial treatment

If you have just been diagnosed with cirrhosis, which occurs when inflammation and scarring damage the liver, your doctor will recommend that you:

Stop drinking alcohol. You need to quit completely.
Talk to your doctor about all medicines you take, including nonprescription drugs such as acetaminophen, ibuprofen (Advil or Motrin) and naproxen (Aleve).
Begin following a low-sodium diet if fluid retention is occurring. Reducing your sodium intake can help prevent fluid buildup in your abdomen (ascites) and chest. For more information, see:
Cirrhosis: Eating a Low-Salt Diet.
Get immunized (if you have not already) against hepatitis A (What is a PDF document?) and hepatitis B (What is a PDF document?), influenza, and pneumococcus (What is a PDF document?).

Taking these steps may help prevent complications and further damage to your liver and help you control symptoms.

Initial treatment of cirrhosis will also include treatment for any complications that have already started. You may need medicines, surgery, or other treatment, depending on what complications you have.

Ongoing treatment

Cirrhosis is a potentially life-threatening condition that occurs when inflammation and scarring damage the liver. Ongoing treatment for the disease focuses on watching for, trying to prevent, and treating symptoms and complications.

You must continue to:

Avoid all alcohol.
Make sure your doctor knows all of the medicines you are taking, including nonprescription drugs.
Begin or stay on a low-sodium diet if fluid retention begins or continues, to help reduce fluid buildup and its complications. For more information, see:
Cirrhosis: Eating a Low-Salt Diet.

Depending on what complications you have, you may need medicines, surgeries, or other treatments.

Fluid buildup in the abdomen (ascites) is one of the most common problems for people with cirrhosis. It can become life-threatening if it is not controlled. Following a low-sodium diet can help reduce fluid buildup in the abdomen. But you may also need:

Diuretic medicines, such as spironolactone and furosemide, to help get rid of fluid that has built up in the belly and other parts of the body. These medicines can help both prevent and treat problems with ascites. Your doctor may prescribe a diuretic for you to take over the long term.
Paracentesis with or without a protein (albumin) infusion. Paracentesis is a procedure in which a needle is inserted through the abdominal wall to remove fluid from the abdominal cavity. It may be used to treat severe ascites that is causing symptoms and is not responding to standard treatment with diuretics and a low-sodium diet.
Antibiotics, such as ciprofloxacin or cefotaxime, if you have a bacterial infection in your abdomen (spontaneous bacterial peritonitis, or SBP) as a result of fluid buildup.
Transjugular intrahepatic portosystemic shunt (TIPS). This procedure can divert fluid from the abdominal cavity and may be used to treat ascites that does not respond to other forms of treatment.

Bleeding from enlarged veins in the digestive tract (variceal bleeding) is another common and potentially life-threatening problem for people with cirrhosis. Be sure that you avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen if you have variceal bleeding or are at high risk for it. You may also need:

Beta-blocker medicines, such as propranolol and nadolol. These medicines reduce the risk of variceal bleeding caused by portal hypertension. Beta-blockers may help lower the pressure in the portal veins, which can reduce your risk of having a first episode of variceal bleeding. These medicines also may be used to reduce the risk of recurrent bleeding.
Vasoconstrictor medicines such as octreotide. These medicines are used to treat a sudden (acute) episode of variceal bleeding. They reduce blood flow through the portal veins by temporarily narrowing the blood vessels.
Endoscopic variceal banding or sclerotherapy. These techniques may be used to treat and prevent variceal bleeding in the esophagus.
Shunts. These procedures redirect the flow of blood through other areas of the body. One type of shunt is a transjugular intrahepatic portosystemic shunt (TIPS). This procedure may be used to treat variceal bleeding that does not respond to other less invasive or less risky forms of treatment.
Balloon tamponade. A doctor inserts and inflates a balloon in the lower part of the esophagus or upper part of the stomach. The balloon presses against the enlarged veins to stop bleeding. Insertion of a balloon tamponade is a temporary treatment that may be done to stop severe variceal bleeding and help stabilize your condition before another therapy is tried or before you can be moved to a facility that can treat you. It also may be done if nothing else has worked to stop bleeding. This treatment is rarely needed.

Changes in mental function (encephalopathy) may occur when the liver cannot filter poisons from the bloodstream, especially substances produced by bacteria in the large intestine. As these toxins build up in your blood, they can affect your brain function. To prevent or treat encephalopathy, you may need to:

Take lactulose, a medicine that helps prevent the buildup of ammonia and other natural toxins in the large intestine. Your doctor may also have you take another medicine called rifaximin.
Eat a modest amount of protein. Your body needs protein to function well but, if your liver damage is severe, your body may not be able to use protein properly. This can contribute to the buildup of harmful toxins. A registered dietitian can help you learn to eat a healthy diet.
Avoid sedative medicines, such as sleeping pills, antianxiety medicines, and narcotics. These can make symptoms of encephalopathy worse.

Working with your doctor to monitor your condition is also important, especially because symptoms may not start until a problem has become severe. In addition to regular checkups and lab tests, you will also need periodic screening for enlarged veins (varices) and liver cancer (hepatocellular carcinoma).

The American College of Gastroenterology recommends testing for varices with endoscopy for all people who have been diagnosed with cirrhosis. If your initial test does not find any varices, you can be tested again in 2 to 3 years. If you already have large varices, you may need more frequent testing and treatment with beta-blocker medicines to try to prevent future bleeding episodes. If you have had an episode of variceal bleeding, you may need more frequent testing and beta-blocker medicine. Or your doctor may recommend variceal banding to help prevent future bleeding.¹
Testing to check for liver cancer should take place every 6 months. You will likely have a test for alpha-fetoprotein and a liver ultrasound.²

Cirrhosis is usually a progressive condition. Before your condition becomes severe, you may want to talk to your doctor about future treatment options. You may want to discuss:

Whether you will be a good candidate for a liver transplant if your disease becomes advanced. Talk about what steps you can take now to improve your overall health so that you can increase your chances of being considered a good candidate.
What level of medical intervention you want as you approach the end of life. Some people want every possible medical treatment to sustain life. Others prefer measures to maintain comfort without prolonging life. Advanced cirrhosis can affect your brain function, so it makes sense to think about these issues while you are still able to make and communicate decisions.

Treatment if the condition gets worse

Cirrhosis is a potentially life-threatening condition that occurs when inflammation and scarring damage the liver. As cirrhosis and liver damage get worse, you may have more problems with fluid buildup in the abdomen (ascites), bleeding from enlarged veins in the digestive tract (variceal bleeding), changes in mental function (encephalopathy), and other complications. You may need a combination of medicines, surgeries, and other treatments, depending on the nature and severity of the problems.

Receiving a liver from an organ donor (liver transplantation) is the only treatment that will restore normal liver function and cure portal hypertension. Liver transplantation is usually considered only when liver damage is severe and threatening your life. Most people who receive liver transplants have end-stage cirrhosis and severe complications of portal hypertension.

Liver transplant surgery is very expensive. You may have to wait a long time for a transplant because so few organs are available. Even if a transplant occurs, it may not be successful. With these things in mind, doctors must decide who will benefit most from receiving a liver transplant.

Liver transplantation may be an option if you have end-stage cirrhosis and are a good candidate for the surgery. Good candidates include those who:
- Have not abused alcohol or illegal drugs for the previous 6 months.
- Have a good support system of family and friends.
- Can stay on a complicated regimen of post-transplant medicines to prevent the body from rejecting the liver.
Liver transplant may not be a good option if you have other serious medical conditions (such as heart or lung conditions) that reduce your chance of surviving surgery or that would reduce your life expectancy even if you received a new liver.

Palliative care

If your cirrhosis gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Palliative care can be combined with curative care.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans concerning your medical care, or help your family better understand your illness and how to support you.

If you want to know more about palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

If you have not already made decisions about the issues that may arise at the end of life, consider doing so now. Many people find it helpful and comforting to state their health care choices in writing (with an advance directive such as a living will) while they are still able to make and communicate these decisions. You may also think about who you would choose as your health care agent to make and carry out decisions about your care if you were unable to speak for yourself. For more information, see the topics:

If you made some health care decisions earlier in your disease, you may want to revisit them with your family and your doctor to make sure they still represent what you want.

A time may come when your goals change from treating or curing an illness to maintaining comfort and dignity. Your primary doctor will be able to address questions or concerns about maintaining comfort when cure is no longer an option. Hospice care health professionals can provide palliative care and comforting surroundings for someone who is preparing to die.

For more information, see the topic Hospice Care.

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By:	Healthwise Staff	Last Revised: August 10, 2010
Medical Review:	Kathleen Romito, MD - Family Medicine W. Thomas London, MD - Hepatology

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