Understanding Cirrhosis -- Treatment

How Do I Know If I Have It?

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A patient's history and symptoms, along with the results of a physical examination, are usually enough to determine a case of cirrhosis. Once the diagnosis has been made, the physician may order one or more liver function tests, which use blood samples to identify specific liver diseases and assess the organ's overall health. The doctor may also require a liver biopsy, or tissue sample, and blood tests to ascertain the cause of the cirrhosis. In a liver biopsy, a needle is inserted into the liver to draw out a fragment of tissue, which is then sent to a lab for analysis.

What Are the Treatments?

The best way to treat cirrhosis is to correct the underlying cause. This could involve giving up alcohol, seeking treatment for viral hepatitis or an inherited disorder, or eliminating certain substances from your diet or environment. Some conditions cannot be cured, but medications can put them into remission.

Specific remedies for cirrhosis depend on the underlying cause and its stage of development. Besides halting the progress of the disease, conventional treatment also aims at correcting any complications, such as internal bleeding, which in themselves can be disabling or life-threatening.

If your cirrhosis is caused by alcoholism, you simply must stop drinking — immediately and completely. If you continue to drink after you have been diagnosed with cirrhosis, you have less than a 40% chance of living longer than five more years. If you stop drinking, however, those chances increase to 60%-70%.

Corking the bottle is also the best way to remedy alcoholic hepatitis and alcohol-induced fatty liver. Both of these conditions usually clear up when the patient stops drinking long enough for the liver to heal. Conventional treatment of cirrhosis caused by chronic viral hepatitis emphasizes rest, proper nutrition, and possibly the use of the drug interferon. There are new medications, such as ribivarin or lamivudine, which if used in combination with interferon for some types of viral hepatitis can improve chances for a cure. Some types of hepatitis, however, cannot be cured.

For Wilson's disease, doctors generally prescribe medications that rid the body of accumulated copper. It may be necessary to continue these medications for life. In the case of hemochromatosis, the best way to dispose of excess iron is to draw blood from the patient once or twice a week. This may be kept up for as long as two years, or until the iron level reaches its normal range. Treatment then continues every two to four months.

Severe cirrhosis may require a liver transplant — a serious procedure usually regarded as a last resort. Transplants are not appropriate for everyone: Some patients are too old, too young, or too sick for the procedure. And people whose cirrhosis is due to alcohol abuse must demonstrate a prolonged period of abstinence before the operation. Doctors generally are hesitant to transplant a liver if the patient is just going to abuse it.

As with any form of major surgery, liver transplants can be risky. The new liver may not function properly, or the body may reject the transplanted organ. There's also the danger that infection will set in after surgery. Still, the procedure has a promising success rate overall. In the U.S., 60%-75% of adult patients and 90% of children survive the operation. Transplant patients live an average of five to 10 years after surgery.

Good nutrition often plays a vital role in the treatment of cirrhosis. Although parts of the liver that have given way to scar tissue can't be restored, a balanced diet — including plenty of fruits, vegetables, grains, milk, and protein — can help promote regeneration among cells in the intact portion. Adults with the disease need to monitor their intake of protein. Too little protein can slow cell regeneration, and too much can raise the amount of ammonia in your bloodstream, possibly leading to mental impairment. Check with a doctor or nutritionist for the amount of protein that's right for you.

Because the liver must filter and refine substances that are introduced into the body, patients with cirrhosis are often told to seek medical advice before taking large doses of vitamins or other dietary supplements. Cirrhosis patients should also avoid eating uncooked shellfish, which are sometimes harvested in polluted estuaries and may carry organisms that cause hepatitis or other diseases.

Reviewed by Gary D. Vogin, MD, August 2002.