— There have been major advances in the treatment of cirrhosis in the past few decades. In particular, it has become easier to recognize, prevent, and treat complications of cirrhosis.
People with cirrhosis should see their health care provider regularly for monitoring and treatment of cirrhosis complications. Although cirrhosis cannot be cured, several treatments are available to minimize cirrhosis-related complications. Other treatments are recommended to help prevent complications.
Avoid substances that can injury the liver — People with cirrhosis should avoid consuming substances that can further damage the liver. The most common of these is alcohol. You should talk to your health care provider before taking any new medication (including prescription and non-prescription drugs, herbs, vitamins, or dietary supplements).
Acetaminophen (Tylenol®) is a nonprescription medication that can further injure the liver in people with cirrhosis. The exact amount of acetaminophen that is safe in cirrhosis is uncertain; some experts recommend that patients not use more than 650 mg per dose every 4 to 6 hours, with no more than 2000 mg per day. However, even low doses may not be safe for those who drink alcohol. Use of acetaminophen should be discussed with a health care provider.
Screen for and treat varices — People with cirrhosis should undergo an upper endoscopy to determine if varices (expanded blood vessels) are present in the esophagus, the tube that connects the mouth and stomach . Varices develop when blood cannot flow easily through the liver; thus, the blood backs up in the vessels, causing them to stretch. The vessel walls become thin and could break under pressure. If you have bloody or black, tarry stools or are vomiting bright red blood or a black substance that looks like coffee grounds, you are experiencing a bleed and need help immediately. Go to your local ER or call 911. Treatment: routine EGD (endoscopy) and banding (rubber bands are used to “tie off” any varices). You will be screened for potential bleeds and you might be banded periodically to prevent them. Medicines: Inderal (Propranolol) or Nadolol to lower the pressure in swollen veins. Sometimes nitrates are added to these medicines to help relieve pressure; if you are on nitrates, you cannot take Viagra, Cialis, or Levitra.
Vaccination — People with cirrhosis should be vaccinated against hepatitis A and B. Pneumococcal vaccine and yearly influenza vaccine are also recommended.
Treat ascites and edema — Ascites and edema can lead to complications, particularly infection. Ascites can also cause a person to feel short of breath or full. Thus, treatment is usually recommended to reduce the amount of fluid that collects in the lower legs and abdomen. Treatment usually involves taking one or more diuretic pills (fluid pills) and following a low sodium (salt) diet and when that fails Paracentesis is done.
Paracentesis — Some people do not get adequate relief of edema and ascites with fluid pills alone. In this case, periodic drainage of the fluid (paracentesis) may be required. This is done by inserting a needle into the abdomen and withdrawing a large amount of fluid from the space around the abdominal organs. The procedure can usually be performed in a doctor's office.
Following paracentesis, it is important to continue taking your diuretic medication and to limit the amount of sodium you consume
TIPS — A TIPS (transjugular intrahepatic portosystemic shunts) procedure may be recommended to treat ascites if diuretics, paracentesis, and changes in diet are not completely successful in relieving ascites.
During the procedure, a radiologist places a device within the liver to reduce the blood pressure in the portal vein (in the liver, ) The procedure is usually performed with local anesthesia and sedation, and takes between one and three hours. Most patients remain in the hospital for one to three nights after the procedure.
Screen for hepatocellular carcinoma — People with cirrhosis should have tests to detect hepatocellular carcinoma (cancer of the liver). Testing usually requires an ultrasound examination of the liver and a blood test every 6 to 12 months.
Consider liver transplantation — Not all patients with cirrhosis will require a liver transplantation, and many are not eligible for one. However, because the waiting list for liver transplantation is lengthy (up to two years in some regions), it is important to know if liver transplantation is a reasonable option while you are still relatively healthy.
Screen for encephalopathy — People with cirrhosis can develop confusion, which is sometimes subtle. Detecting confusion is important since treatment is available and the confusion itself can lead to serious problems (eg, an automobile accident). A change in the sleep pattern (insomnia or sleeping too much) may be an early sign. The most common treatment is Lactulose (A laxative used to help clean the toxins from the intestinal tract.) Such as ammonia.Many people with encephalopathy have a elevated ammonia level. Ammonia .Ammonia can be problematic for some and does not always help Xifaximin is a antibiotic that works in the intestinal tract It works well for some with our the same side effect as lactulose .However there are many causes of encephalopathy. Infection, Gastrointestinal bleeds , renal failure and narcotic pain meds are only a few.
Dietary advice — People with advanced cirrhosis may require a specialized diet that includes lower amounts of salt. Salt restriction is usually recommended for people with early cirrhosis who tend to accumulate fluid. Many people with liver disease also have diabetes , controlling your intake of carbohydrates is very important and can be harder with liver disease. A low protein diet use to be used to help control Encephalopathy , with the use of Lactulose to remove toxins from the body However with the real concern of malnutrition in cirrhosis patients this is no longer recommended . A health care provider or dietitian can help to determine if dietary changes are needed.
The benefit of vitamins, antioxidants and other supplements on the underlying liver disease has not been established. Several herbal therapies have been reported as having a benefit in patients with cirrhosis. None have clearly been proven to be effective, although some continue to be studied. Most experts do not recommend vitamins, herbs, or other supplements for people with cirrhosis.
Exercise — Exercise is generally safe for people without advanced stage cirrhosis. Exercise may increase the risk of variceal bleeding in patients with advanced disease (such as those who have ascites or varices). Thus, check with your health care provider regarding the risks and benefits of exercise.