Cirrhosis

What is cirrhosis?

Cirrhosis is scarring of the liver. In its later stages, cirrhosis prevents the liver from performing its proper functions.  The liver plays a role in producing certain blood factors involved with clotting, removal of toxic substances from the blood, and fluid regulation. As the liver scars, its functions are weakened, which leads to a variety of symptoms that may include the following:

• Fluid retention that causes swelling in the abdomen and legs and buildup of fluid in the lungs
• Bleeding from blood vessels in the esophagus
• Easy bruising or bleeding anywhere in the body
• Shortness of breath
• Feeling full
• Feeling tired
• Insomnia
• Jaundice (yellowing of the skin)
• Confusion
• Coma

In addition, individuals with cirrhosis are more likely to get infections. They also have an increased risk of liver cancer.

What Causes Cirrhosis?

The liver tries to fix itself when it’s been damaged. This process creates scars. Causes of liver damage include:

• Heavy alcohol use: people who abuse alcohol or who are addicted to it have the highest risk for cirrhosis
• Infection with hepatitis B or hepatitis C viruses: These viruses can be spread by sharing needles or through sexual contact. If your cirrhosis is caused by a hepatitis infection, learn more about hepatitis here.
• 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 obese and have diabetes.

Are There Tests 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 be studied in a laboratory to measure liver damage.
• Blood tests: These tests look for elevated levels of enzymes that are associated with liver damage.
• Imaging: Your doctor may use MRI, CT, and ultrasound to take images of your liver.

Is There Anything I Can Do to Prevent Further Liver Damage?

Yes. To help protect your liver:

• Avoid alcohol.
• Talk to your doctor before you start taking any new medicines, including over-the-counter drugs, herbs, vitamins, or supplements. Some medicines and supplements can damage the liver.

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. One example is stopping alcohol in people with cirrhosis caused by alcohol abuse.
• Treat hepatitis infections: In cases where cirrhosis is caused by chronic hepatitis C or B infections, these infections can be treated. Antiviral rugs approved by the U.S. Food and Drug Administration include:

• For hepatitis C: interferons—including Pegasys® (peginterferon alfa-2a), Intron® A (interferon alfa-2b), Rebetol® (ribavirin); and direct-acting antivirals—including Olysio® (simeprevir), Sovaldi® (sofosbuvir) and a combination pill (Harvoni®) containing sofosbuvir with a third drug, ledipasvir
• For hepatitis B: antiviral medications—including Epivir® (lamivudine), Hepsera® (adefovir), Tyzeka® (telbivudine), and Baraclude® (entecavir)—as well as Intron A

• Lower the risk of bleeding: Cirrhosis can cause the blood vessels around the esophagus to swell or even burst and bleed. To prevent that from happening doctors can:
  • Prescribe medicines called beta blockers. These medicines reduce blood pressure in the liver and help reduce the risk of bleeding.
  • Tie tiny bands around the swollen blood vessels (this procedure is called variceal band ligation).

• Decrease fluid buildup in the stomach: In people with cirrhosis, the stomach sometimes fills with fluid. To decrease fluid buildup, doctors can:

• Prescribe medicines called diuretics. These medicines help you urinate out the extra fluid. People who take diuretic medicines often must also reduce the amount of salt they eat.
• Drain the fluid from your belly (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 risk 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 are also encouraged to get the flu vaccine and other vaccines to prevent common infections.
• Improve confusion: Advanced cirrhosis can lead to confusion due to a buildup of toxins that are normally cleared out by the liver. Doctors may recommend that you change your diet or that you take lactulose (a medicine that softens stool) or certain antibiotics to prevent toxins from building up.

Will I Need a New Liver?

People with severe cirrhosis will need a new liver (liver transplant). If you’re at risk for cirrhosis becoming severe, talk to your doctor immediately to find out if a liver transplant might be an option for you. That way you can get on the waiting list for a new liver early. People often have to wait for up to two years. 

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
• Using condoms
• Not sharing drug needles

Can a Healthy Diet and Lifestyle Help Manage Cirrhosis?

Yes. It’s important that you eat well to get enough nutrients and make healthy choices to limit further liver damage.

Because people with cirrhosis might eat less due to loss of appetite and other symptoms and because their bodies may not be properly absorbing nutrients when they do eat, a well balanced meal plan is important. Your healthcare providers can help you choose foods that provide the right amount of calories and protein and work with any food restrictions you may have. Some providers also recommend supplements, such as calcium and vitamin D to help prevent osteoporosis.

It’s also recommended that people with cirrhosis follow these guidelines for a healthy lifestyle:

• Avoid alcohol. Alcohol can cause additional liver damage, even if you have cirrhosis that isn’t related to drinking alcohol.
• Eat a low-sodium diet. Cirrhosis can cause your body to retain fluids, leading to swelling in your abdomen and legs. Foods that are high in salt can make swelling worse.
• Protect yourself against infections. Try to stay away from people who are sick and wash your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
• Discuss over-the-counter medications with your doctor. With cirrhosis, it’s more difficult for you liver to process any medications, including over-the-counter drugs. Talk with your doctor before you take prescription or nonprescription medication, such as aspirin or ibuprofen.