Cirrhosis is the scarring of the liver that happens because of chronic liver disease. Scar tissue blocks blood and bile flow through the liver and keeps it from working as it should.
As the largest internal organ in the body, the liver performs many vital tasks. For example, it gets rid of or neutralizes toxins, such as poisons, germs, and bacteria, in the blood and controls infection. The liver makes proteins that regulate blood clotting. It also produces bile that helps your body absorb the fats and fat-soluble vitamins it needs to stay healthy.
You cannot undo the damage from cirrhosis, but it progresses slowly. So early treatment can help prevent more damage. As liver function gets worse, you may experience fatigue, weight loss, swelling in your legs and abdomen, and jaundice. If the disease is severe enough, it can be fatal.
The most common causes of cirrhosis in the United States are:
Signs and Symptoms
Symptoms of cirrhosis can range from no symptoms to outright liver failure. The most common symptoms include:
The most common cause of liver disease in the United States is alcohol abuse. Drinking too much alcohol on a regular basis almost always causes liver damage, although not always cirrhosis. Drinking 32 to 48 oz. of beer, 4 to 8 oz. of liquor, or 16 to 32 oz. of wine every day for 10 to 15 years or longer greatly increases your chances of developing cirrhosis. How much alcohol you drink, how often, and for how many years are more important than what kind of alcohol you drink.
Other causes of cirrhosis include:
Women can develop liver disease even though they may drink less than men. Being overweight may also raise your chances of developing alcoholic liver disease because of fatty deposits in the liver. Other risk factors include:
Your doctor will take a detailed history to determine the cause of your liver disease, and to see if your symptoms might be related to something else. Then your doctor will examine you closely for signs of liver disease, including yellowing (jaundice) of your eyes and skin, red spider-like blood vessels just under the surface of your skin, and redness of your palms.
Your doctor will press on your abdomen to feel the size of your liver. In the early stages of liver disease, the liver may be enlarged and firm, but it shrinks as scar tissue forms.
Your doctor may order other tests, such as blood tests to look for certain liver enzymes, a bilirubin test, an ultrasound, CT scan, MRI, or a liver biopsy.
Drink alcohol only in moderation.
Take precautions to avoid getting hepatitis B and C, such as being careful if you are exposed to blood or blood products, practicing safe sex, and getting the hepatitis B vaccine.
See your doctor regularly if you have chronic hepatitis.
Cirrhosis cannot be cured. But you can slow down the progression. Treatment depends on the underlying cause. Your doctor will also treat complications. In some cases a liver transplant may be needed.
If you have cirrhosis from any cause, it is vital to not drink any alcohol to prevent further damage to the liver. If your cirrhosis is caused by alcoholism, your doctor may suggest Alcoholics Anonymous (AA) as a good place to start your rehabilitation.
You will also need to stop taking medications that may cause liver damage. For example, acetaminophen (Tylenol) can cause liver damage if you take large doses or if you regularly drink alcohol and take acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or Aleve, and ibuprofen, Motrin, or Advil, can also damage the liver, as can some herbs and supplements. If you have liver disease, DO NOT take any over-the-counter medication, herbs, or supplements without checking with your doctor first.
You may need to make changes in your diet to treat complications of cirrhosis, such as lowering salt intake.
Medications can treat complications, such as bleeding from veins, infections in fluid accumulated in the abdomen, and damage to the brain (encephalopathy) caused by toxins circulating in the blood.
Surgery and Other Procedures
You may need a liver biopsy to determine the cause of cirrhosis, and to check how much liver damage has occurred. Generally a liver biopsy involves inserting a needle through the abdominal wall to the liver to get tissue samples.
Surgery may be required to stop and prevent certain complications of cirrhosis:
Nutrition and Dietary Supplements
Malnutrition is often a problem for people with cirrhosis. One of the liver's important functions is to help convert food into stored energy, as well as to rid the body of toxins. For these reasons, eating a healthy diet is an important part of treatment for cirrhosis. You should be eating a well-balanced diet with plenty of fruits, vegetables, and whole grains. Your doctor may also talk with you about proper protein balance, and limiting your fluid and salt intake.
High-quality dietary protein may be particularly important for you if you have buildup of fluid in the abdomen or swelling of the feet, legs, or back. Protein also helps repair muscle mass. But too much protein can raise ammonia levels and trigger hepatic encephalopathy. In general, your doctor needs to determine how much protein is right for you. Your doctor may recommend eating vegetable protein such as soy, instead of animal protein.
If you have fluid retention, you may need to eat less sodium since salt encourages the body to retain water. In addition to passing up the salt shaker, avoid foods high in salt, including processed and prepared foods, such as canned meats, soups, and vegetables, crackers, and cold cuts. Eat good amounts of fresh foods because they contain very little sodium. Instead of adding salt to your food, try lemon juice or black pepper for flavor.
Avoid raw shellfish, which may carry a bacteria called Vibrio vulnificus that can be dangerous to people with cirrhosis. If you are not sure how well shellfish is cooked, do not eat it.
It is very important that you talk to your doctor before taking any supplement if you have liver disease, including the following:
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. Pregnant and breastfeeding women should never take herbs or supplements unless expressly approved by their physicians.
People with liver disease must be particularly careful because the liver processes almost everything you take. For these reasons, you should take herbs with extreme care, and only under the supervision of your doctor.
Bupleurum (Bupleurum chinense). The Chinese herb Bupleurum has anti-inflammatory properties and has been used historically to treat liver disorders. In one study, a formulation that contained Bupleurum appeared to reduce the risk of liver cancer in people with cirrhosis. Bupleurum is not appropriate for pregnant women, people who have bleeding disorders, autoimmune disease, diabetes, or people who will be undergoing surgery.
Licorice root (Glycyrrhiza glabra) Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses, including liver disease. Some preliminary data from Japanese researchers suggests that taking glycyrrhizin (an active component of licorice root) along with cysteine and glycerine might help reduce the risk of cirrhosis if you have hepatitis C. However, the formula was delivered intravenously (IV). It is not known whether taking these substances by mouth would have any effect. More studies are needed. People with high blood pressure or those who take steroids, hormonal medications, digoxin (Lanoxin), diuretics (water pills), or blood thinners, such as warfarin (Coumadin), should not take licorice. Pregnant women and people with a history of hormone-related cancer should avoid licorice. Men with a history of libido problems or erectile dysfunction should use caution when taking licorice, as should anyone who has issues with their potassium levels. Speak with your doctor.
Milk thistle (Silybum marianum, standardized to 70 to 80% silymarin). Milk thistle contains components that may have estrogen-like effects in the body. So people with a history of hormone-sensitive conditions should use milk thistle with caution. People with ragweed allergies may be more likely than others to be allergic to milk thistle. The herb has been used since Greco-Roman times to treat liver problems. Several scientific studies lend support to this traditional use. They suggest that a substance in milk thistle (silymarin) can protect the liver from damage caused by viruses, toxins, alcohol, and certain drugs such as acetaminophen (Tylenol). However, the evidence is stronger for some conditions than others:
Cordyceps (Cordyceps sinensis). A type of mushroom used in traditional Chinese medicine to support the liver. Preliminary studies suggest it may help improve liver and immune system function in people with hepatitis B.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies based on their knowledge and experience for reducing the physical addiction to alcohol and to help treat hepatitis. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Remedies that may be recommended for alcoholism include:
Remedies that may be recommended for hepatitis include:
If you have cirrhosis, your doctor will use caution when prescribing medications because many medicines cause complications in people with liver disease.
Talk to your doctor before taking any herb or supplement if you have liver disease. Certain herbs and supplements are known to harm the liver or cause complications that affect people with liver disease, including.
Pregnant or breastfeeding women should not use milk thistle or licorice.
Prognosis and Complications
Complications from cirrhosis include:
Cirrhosis can be serious and life threatening, especially if you continue to drink alcohol. The outcome of cirrhosis depends on the stage. The good news is that with proper diet, medical management, and avoidance of alcohol, you can drastically slow down the rate of progression of liver damage.
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Review Date: 8/22/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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