Cirrhosis Treatment
Liver Cirrhosis Treatment
What is liver cirrhosis and what causes it?
Cirrhosis implies irreversible scarring of the liver which can be a potentially life-threatening. In an advanced stage, 80-90% liver may be damaged and replaced with scar (dead) tissue. Cirrhosis is caused by sustained liver damage over several years either by alcohol, viral infection (Hepatitis B, C), a toxic substance (for eg. drugs, excess copper or iron in the liver), or by blockage of biliary system such that the liver undergoes progressive scarring that slowly replaces all of normal liver cells.
In most instances, the above causes initially result in Hepatitis which can usually be treated. However, if the offending factor is not removed or treated on time, cirrhosis develops and then it is usually too late to change the course of the disease.
Symptoms of liver cirrhosis
Initially, there may general symptoms such as tiredness, lethargy, yellowness of eyes and urine (mild jaundice), swollen feet, excessive itching and anemia (low hemoglobin). In more advanced stages, the patient may have several life threatening complications such as blood vomiting, bloated stomach due to water (ascites) in the abdomen which may develop serious infection, mental deterioration and coma, deep jaundice and kidney impairment.
In addition, the patient may have bleeding tendency due to low levels of a liver protein prothrombin, and low platelet count both of which are vital for normal clotting of blood.
How Does Liver Cirrhosis Affect the Body and Liver?
Liver cirrhosis occurs when scar tissue replaces healthy liver tissue, disrupting normal liver function. This scarring hinders blood flow through the liver, slowing its ability to process nutrients, detoxify the body, and produce essential proteins and bile. Over time, scar tissue can also constrict key blood vessels, such as those in the portal vein system, leading to portal hypertension—a condition that increases pressure in the veins supplying the liver.
Management and Treatment of Liver Cirrhosis
Cirrhosis represents permanent liver damage. Although the liver is a resilient organ capable of self-repair, advanced scarring from cirrhosis limits its regenerative capacity. However, timely intervention can often slow or halt its progression, depending on the underlying cause and your response to treatment.
How Do Medical Professionals Treat Liver Cirrhosis?
- Addressing the underlying cause to minimize further liver damage.
- Adopting lifestyle changes and nutritional strategies to reduce stress on the liver.
- Managing complications arising from cirrhosis.
- Liver transplantation as a last resort.
Addressing the Cause
- Hepatitis B and C: Antiviral medications can manage chronic hepatitis B and cure hepatitis C in most cases.
- Autoimmune diseases: Corticosteroids and immunosuppressants may help, although effectiveness varies.
- Toxic or alcohol-related damage: Eliminating alcohol or harmful substances is essential. In severe cases, rehabilitation programs might be needed.
- Non-alcoholic fatty liver disease (NAFLD): Managing metabolic factors like obesity, diabetes, and high cholesterol can slow progression. Medications or lifestyle changes may be recommended.
Lifestyle and Nutrition
- Avoiding alcohol and liver-toxic substances is crucial regardless of the cause.
- Eating a balanced diet and maintaining a healthy weight are recommended for all liver disease patients.
- Nutritional deficiencies may require dietary supplements under a doctor’s guidance.
Managing Complications
Doctors monitor for common complications such as portal hypertension, which can lead to issues like:
- Bleeding varices: Treated with procedures to seal veins or prevent further bleeding.
- Ascites (fluid buildup): Managed with antibiotics, diuretics, or paracentesis (fluid drainage).
- Encephalopathy: Laxatives like lactulose help eliminate toxins that affect brain function.
Other interventions might include blood transfusions, oxygen therapy, or kidney dialysis if needed.
Liver Cancer
Primary liver cancer (hepatocellular carcinoma) is a potential complication of cirrhosis. While not all cirrhosis patients develop liver cancer, the risk increases with advanced scarring. Treatment options include surgery, chemotherapy, radiation, or a liver transplant in eligible cases.
Liver Transplantation
A liver transplant may be considered if:
- Liver failure becomes life-threatening.
- Complications such as cancer or decompensated cirrhosis occur.
Patients are evaluated and placed on a transplant waiting list based on disease severity and other factors.
Can Liver Cirrhosis Be Prevented?
Early action can prevent liver disease from progressing to cirrhosis. Regular check-ups and liver function tests can detect problems before symptoms appear. Timely intervention, such as lifestyle changes, managing chronic conditions, and addressing viral hepatitis, can significantly reduce risks.
Is Recovery from Liver Cirrhosis Possible?
While liver cirrhosis is irreversible, its progression can often be managed. Many individuals with compensated cirrhosis (early stage) experience few symptoms and can maintain a good quality of life with proper care. Preventing inflammation and further damage is key to avoiding decompensated cirrhosis (advanced stage). Ongoing monitoring and lifestyle adjustments are essential to managing this chronic condition.
Living with cirrhosis (do's and don'ts)
Although cirrhosis implies irreversible damage to the liver, a person with early cirrhosis (stage Child’s A or early Child’s B) can have several years of fairly active life provided appropriate treatment is given by liver specialists. Advanced or Child’s C Cirrhosis on the other hand, clearly dictates the need for a liver transplant for which expert opinion should be sought.
Some do's
- Intial detailed evaluation with a liver specialist is essential to grade the disease and chalk out appropriate therapy.
- Regular liver function tests and follow up with your specialist is necessary every 1-3 months in early cirrhosis and 1-4 weeks in advanced cirrhosis. The exact interval between check ups will be decided by your liver physician depending upon your symptoms and severity of disease.
- Nutritious diet is essential for optimal liver function in presence of chronic liver disease. Contrary to popular belief, the digestion remains normal until very late stages of liver disease except in the presence of severe jaundice. Hence, the need for complete avoidance of fatty food and proteins in all forms of liver disease is a myth. This is not only unnecessary in most cases, but also harmful since it results in malnutrition, weight loss and faster deterioration in health.
- In Hepatitis B induced cirrhosis, Lamivudine treatment may be considered in consultation with the liver specialist if HBV DNA test is positive
- In early cirrhosis due to Hepatitis C, treatment with Interferon-alpha and ribavirin may be useful in consultation with your liver physician.
Some don'ts
- Alcohol must avoided at all costs in alcohol-induced cirrhosis and restricted in all other forms of cirrhosis, especially Hepatitis C.
- Excessive physical activity should be avoided especially in virus related cirrhosis.
- At the same time, forced bed rest should be avoided and reasonable degree of mobility and activity should be maintained.
- Contact sports should be avoided in advanced stages of cirrhosis due to poor clotting and a bleeding tendency.
- Self-medication is dangerous since the liver is suboptimal and drugs will have much more prolonged effects and may harm the already damaged liver.
