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Cirrhosis

What is it?

  • Cirrhosis (sir-o-sis) is a long-term liver disease. The liver lies in the upper right side of your abdomen (belly) and mostly under the lower ribs. The liver makes bile that helps digest (break down) food to turn it into energy. The liver also helps store energy to be used later as fuel (energy) for your muscles. And, the liver helps keep your blood sugar levels normal. The liver also finds and fights foreign (for-un) things in the body, such as drugs, alcohol, and other chemicals.
  • With cirrhosis, liver cells die and are replaced by scar tissue instead of normal liver cells. This death of liver cells continues until there are not enough liver cells to do their job. Cirrhosis starts slowly. It may be years before you know that you have cirrhosis. Liver damage cannot be changed but symptoms can be decreased and controlled. The liver can repair itself but only a little bit. Your health may improve with treatment.

Causes:

Several things can cause cirrhosis. Cirrhosis is most often caused by long-term alcohol abuse. How much alcohol is too much is different for every person. Cirrhosis can also be caused by another liver disease called hepatitis (hep-uh-ti-tis). Or, you can get cirrhosis if you are exposed to toxic chemicals. Some people are born with diseases that can lead to cirrhosis.

Signs and Symptoms:

At first, you may not know you have cirrhosis and may not have any signs or symptoms. Cirrhosis is sometimes only found by blood tests or a health exam. Signs and symptoms of cirrhosis are divided into early cirrhosis and late cirrhosis.

Early cirrhosis:

  • Fatigue (tired) and weak.
  • Liver begins to grow larger.
  • Loss of appetite or not wanting to eat.
  • Nausea (upset stomach) and vomiting (throwing up).
  • Weight loss.

Later cirrhosis:

  • Ascites (uh-si-tees) or abdomen (belly) swelling with fluid.
  • Bruise and bleed easily.
  • Dark yellow or brown urine.
  • Diarrhea or black or bloody BMs.
  • Edema (swollen feet and legs).
  • Increased sensitivity to drugs.
  • Jaundice (jon-dis) or yellow skin and eyes.
  • Spider veins (small blood vessels under your skin start to look like a spider web).
  • Uncontrollable itching.
  • Vomiting blood.
  • Confusion and not thinking clearly.
  • Coma.
  • Death.

Wellness Recommendations:

Do not drink alcohol. Alcohol can damage your brain, heart, and liver. Almost every part of your body can be harmed by alcohol. Drinking alcohol can also make your cirrhosis worse.

Medical Care:

You may have some or all of the following tests. The tests will help caregivers find out what stage your cirrhosis is in.

  • Blood and urine tests.
  • Doppler ultrasound. This is a painless test using sound waves to look at your liver and blood vessels.
  • Esophagoscopy (e-saw-fuh-gaw-skuh-p). A tube is put through your mouth into your stomach to look for places that may bleed.
  • Liver biopsy (bi-op-c). This is when a small piece of liver tissue is removed and sent to a lab for tests.
  • X-rays of your liver, stomach, and esophagus (e-sof-uh-gus). The esophagus is the tube that connects your throat to your stomach.

Talk with your caregivers to decide which of the following treatments are best for you:

  • Medicine to treat the side effects of cirrhosis, such as edema (retaining water).
  • Diet that controls the amount of protein and/or sodium you eat and drink.
  • Vitamins.
  • Paracentesis (draining fluid built up in the abdomen through a needle).
  • Esophageal balloon tamponade (compressing veins in the esophagus with an inflatable device).
  • Gastric lavage.
  • Surgical shunt.
  • Tips (a non-surgical shunt).
  • Liver transplant.

Dietary Measures:

  • Do not eat grapefruit as it can affect liver function.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Green tea (Camellia sinensis) has been used for many years, but has not been studied in people with cirrhosis.
  • Licorice (Glycyrrhiza glabra) has been used for many years, but has not been studied in people with cirrhosis.
  • Milk thistle (Silybum marianum) may be helpful for cirrhosis and has been studied in people with liver disease. Before buying, read the label on the bottle carefully. Be sure the label says each pill contains 70% silymarin, the active ingredient.
  • Picrorhiza (Picrorhiza kurroa) has been used for many years, but has not been studied in people with cirrhosis.
  • Schisandra (Schizandra chinensis) has been used for many years, but has not been studied in people with cirrhosis.

Supplements:

  • B-complex vitamins (including (B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B12 (cyanocobalamin), biotin, and folic acid) are needed in people who have cirrhosis.
  • Branched chain amino acids are helpful for cirrhosis and have been studied in people.
  • L-carnitine has been used, but has not been studied in people with cirrhosis.
  • N-acetylcysteine (NAC) has been used, but has not been studied in people with cirrhosis.
  • S-adenosyl methionine (SAMe) may be helpful in cirrhosis and has been studied in people with liver disease.

Complementary Therapies:

  • TCM (Traditional Chinese Medicine), which includes acupuncture and herbs, has been used for liver problems.

Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat cirrhosis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • Your vomit (throw up) looks like coffee grounds or blood.
  • Your BM looks red or black.
  • You have pain in your abdomen (belly).
  • You have trouble thinking clearly.
  • You have a fast heart rate and fast breathing, feel confused, or are dizzy or lightheaded. These are signs of shock. THIS IS AN EMERGENCY . Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Dakovic-Svajcer K, Samojlik I, Raskovic A et al: The activity of liver oxidative enzymes after single and multiple grapefruit juice ingestion. Exp Toxicol Pathol 1999; 51(4-5):304-308.

2. Freund H, Yoshimura N & Fischer JE: Chronic hepatic encephalopathy. Long-term therapy with a branched-chain amino-acid-enriched elemental diet. JAMA 1979; 242(4):347-349.

3. Rafique S, Guardascione M, Osman E et al: Reversal of extrahepatic membrane cholesterol deposition in patients with chronic liver diseases by S-adenosyl-L-methionine. Clin Sci (Colch) 1992; 83(3):353-356.

4. Tangkijvanich P, Mahachai V, Wittayalertpanya S et al: Short-term effects of branched-chain amino acids on liver function tests in cirrhotic patients. Southeast Asian J Trop Med Public Health 2000; 31(1):152-157.


Last Updated: 4/4/2014

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