What is cirrhosis of the liver?
Liver cirrhosis results from disease or chemical-induced injuries to the liver over a sustained period. As the injuries kill liver cells, your body attempts to rebuild the damage. In the process, the existing cells are inflamed and scar tissue results, compromising the structure of the liver and hampering its function. Your liver may become cirrhotic in response to a disease or toxins, such as alcohol. Sometimes cirrhosis results from a liver processing disorder or an autoimmune disorder that prompts the body’s defense mechanisms to attack the liver tissue. Treatment exists to slow the scarring and improve function, but in general, the scarring of liver cirrhosis is permanent.
What is the treatment for liver cirrhosis?
Treatment of cirrhosis is highly variable depending on the severity of the liver dysfunction and includes:
- Preventing further damage to the liver
- Treating the complications of cirrhosis
- Preventing liver cancer or detecting it early
- Liver transplant
- Consuming a balanced diet and a multivitamin daily. Patients with PBC with impaired absorption of fat-soluble vitamins may need additional vitamins D and K.
- Avoiding drugs (including alcohol) that cause liver damage.
- All people with cirrhosis should avoid alcohol. Most of those with alcohol-induced cirrhosis experience an improvement in liver function with abstinence from alcohol. Even people with chronic hepatitis B and C can substantially reduce liver damage and slow the progression towards cirrhosis with abstinence from alcohol.
- Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen). Patients with cirrhosis can experience worsening of liver and kidney function with NSAIDs.
- Eradicating hepatitis C virus by using anti-viral medications. Not all patients with cirrhosis due to chronic viral hepatitis are candidates for drug treatment. Some patients may experience serious deterioration in liver function and/or intolerable side effects during treatment. Decisions to treat viral hepatitis have to be individualized, after consulting with doctors experienced in treating liver diseases (hepatologists).
- Removing blood from patients with hemochromatosis to reduce the levels of iron and prevent further damage to the liver. In Wilson disease, medications can be used to increase the excretion of copper in the urine to reduce the levels of copper in the body and prevent further damage to the liver.
- Suppressing the immune system with drugs such as prednisone and azathioprine (Imuran) to decrease inflammation of the liver in autoimmune hepatitis.
- Treating patients with PBC with a bile acid preparation, ursodeoxycholic acid (UDCA), also called ursodiol (Actigall). Results of an analysis that combined the results from several clinical trials showed that UDCA increased survival among PBC patients during 4 years of therapy. The development of portal hypertension also was reduced by UDCA. Despite producing clear benefits, UDCA treatment primarily slows progression and does not cure PBC. Other medications such as colchicine (Colcrys) and methotrexate (Rheumatrex, Trexall) also may have benefit in subsets of patients with PBC.
- Immunizing people with cirrhosis against infection with hepatitis A and B to prevent a serious deterioration in liver function. There are currently no vaccines available for immunizing against hepatitis C.
What type of doctor treats liver cirrhosis?
Hepatology is the study of liver disease, and a liver specialist or hepatologist will likely be part of your medical team in treating liver cirrhosis. Hepatology is a subspecialty of gastroenterology (GI doctor). The liver is the body's largest internal organ, and the study of hepatology includes the study of acute and chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, liver transplantation, drug metabolism (which depends largely upon the liver), and immunology as it pertains to the liver.
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Bruha, R, et al. Alcoholic liver disease. World J Hepatol. 2012 Mar 27; 4(3): 81–90. Published online 2012 Mar 27. doi: 10.4254/wjh.v4.i3.81<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/>
Chopra, MD, et al. Patient education: Cirrhosis (Beyond the Basics). UpToDate. Updated: May 2018.
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Aspirin vs. NSAIDs (Side Effect and Use Differences)
Aspirin and nonsteroidal anti-inflammatory drugs, or NSAIDs, are both drugs used to treat pain, redness, swelling, and inflammation from a variety of medical conditions like menstrual cramps, arthritis, minor strains and sprains, and headaches. Aspirin also treats fever. Aspirin also is an NSAID, but it works in the body differently than other NSAIDs.
Some of the common side effects of aspirin and NSAIDS are nausea, vomiting, diarrhea, constipation, loss of appetite, peptic ulcers, and tinnitus. NSAIDs also can cause dizziness, headache, and drowsiness. Important and serious side effects of both drugs are kidney or liver failure, GI bleeding, and prolonged bleeding after surgery.
Aspirin and nonsteroidal anti-inflammatory drugs have other important side effects and drug interactions that should be reviewed prior to taking either drug.
REFERENCE: FDA. Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Cirrhosis (Liver)Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
Symptoms include yellowing of the skin (jaundice), itching, and fatigue.
The prognosis is good for some people with cirrhosis of the liver, and the survival can be up to 12 years; however the life expectancy is about 6 months to 2 years for people with severe cirrhosis with major complications.
colchicine (Colcrys)Colchicine (Colcrys) is a drug prescribed for the treatment of acute gout and familial Mediterranean fever (FMF). Off-label treatment uses include pseudogout, amyloidosis, and scleroderma. Side effects, drug interactions, warnings and precautions should be reviewed prior to taking any medication.
How Do I Make My Liver Healthy Again?Your doctor may suggest lifestyle changes to improve your liver function such as, weight loss, healthy diet, lowering cholesterol, alcohol reduction, exercising regularly, and diabetes management.
How Is a Transjugular Liver Biopsy Done?A transjugular liver biopsy is an intravenous technique to obtain liver tissue sample for a biopsy. The doctor inserts the biopsy needle, covered in a thin, flexible sheath, through the jugular vein in the neck down into the liver’s primary vein (hepatic vein) to access the liver.
Lasix Side Effects, Warnings, and Drug InteractionsLasix (furosemide) is a potent diuretic (water pill) used to treat excess fluid or swelling of the body (edema) caused by cirrhosis, chronic kidney failure, heart failure, and kidney disease. Furosemide is also used in conjunction with other blood pressure medications to treat high blood pressure (hypertension). Common side effects of furosemide include low blood pressure, dehydration, electrolyte depletion, yellowing of skin and eyes (jaundice), ringing in the ears (tinnitus), sensitivity to light, rash, pancreatitis, nausea, diarrhea, abdominal pain, dizziness, increased blood sugar, and increased uric acid levels. Serious side effects of furosemide include severe anaphylactic shock, necrotizing angiitis, interstitial nephritis, hearing loss, anemia, low white blood cells, low blood platelets, among others.
Liver Disease QuizWhat is liver disease? Take the Liver Disease Quiz and test your knowledge about this organ and its function.
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of drugs are used to treat inflammation, mild to moderate pain, and fever. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol), oxaprozin (Daypro), celecoxib (Celebrex).
Primary Biliary Cirrhosis (PBC)
Primary Biliary Cirrhosis (PBS) is a liver disease in which bile building up in the organ damages bile ducts. Ultimately, this can cause liver failure. A number of drugs are available to treat this disease of unknown cause, but the only ultimate cure is a liver transplant.
Primary Biliary Cirrhosis (PBC) TreatmentPrimary biliary cirrhosis (PBC) is thought to be an autoimmune disorder that involves the deterioration of the liver's small bile ducts. These ducts are crucial to transport bile to the small intestine, digesting fats and removing wastes. Symptoms of PBC are edema, itching, elevated cholesterol, malabsorption of fat, liver cancer, gallstones, urinary tract infections (UTIs), and hypothyroidism. Treatments include ursodeoxycholic acid (UDCA); colchicine (Colcrys); and immunosuppressive medications, such as corticosteroids; obeticholic acid (Ocaliva); and medications that treat PBC symptoms. For PBC that is associated with cirrhosis of the liver, liver transplantation may be indicated in extreme cases.
How Does a Transjugular Intrahepatic Portosystemic Shunt (TIPS) Work?A transjugular intrahepatic portosystemic shunt (TIPS) is an artificial connection that is created by a radiologist between two veins (hepatic vein and portal vein) in the liver. These veins are connected by a small tube known as a stent. The TIPS procedure is performed in patients who have increased pressure in their portal vein (portal hypertension), which is usually due to scarring and hardening of the liver (liver cirrhosis).
What Are Signs That Your Liver Is Not Functioning Properly?Liver pain can be a sign that you have a serious health problem like cirrhosis or liver cancer. Find out more about what could be causing your liver pain and how to treat it.
What Can a Liver Biopsy Diagnose?A liver biopsy is a procedure that involves inserting a small needle into the liver to collect a tissue sample. The tissue is then analyzed in a lab to help the doctors diagnose a variety of disorders and diseases of the liver. A liver biopsy is usually performed to help identify the cause of liver ailments, and estimate the degree of liver damage, grade and stage of hepatitis B and C. Complications include internal bleeding, pain, infections, leak of bile from the liver or gallbladder, and pneumothorax.
What Is a Hepaticojejunostomy?The hepatic duct is the tubular channel that carries bile from the liver to the small intestine to aid digestion. A hepaticojejunostomy is a surgical procedure to make a connection (anastomosis) between the hepatic duct and the jejunum, which is the middle portion of the small intestine. This technique is called the Roux-en-Y hepaticojejunostomy.
What Is the Main Cause of Esophageal Varices?Esophageal varices are enlarged veins in the food pipe (esophagus). This condition develops in people with liver disease.
What Is the Pringle Maneuver Procedure?The Pringle maneuver is a procedure to stop the liver’s blood supply during a liver surgery. The surgeon clamps off the blood vessels leading to the liver to prevent bleeding during other liver procedures, whether for injury repair, transplant or gallbladder surgery.