Author: Dr. Thomas Couri
Overview
The liver is an important organ in the body that serves many functions, including detoxifying substances, making proteins, and regulating blood sugar. Cirrhosis is the medical condition in which the liver becomes scarred and stops working as it should. Cirrhosis is one of the top ten leading causes of death in America1. The most common causes of cirrhosis are alcohol, fat causing inflammation within the liver (“fatty liver”), hepatitis C, and hepatitis B1. Some risk factors for cirrhosis are excess alcohol use, obesity, diabetes, and intravenous drug use. Symptoms of cirrhosis include abdomen and leg swelling, yellowing of the eyes and skin, confusion, and vomiting blood.
How is it diagnosed?
When cirrhosis is suspected, patient need blood tests and imaging tests, such as ultrasounds, CT scans, or MRI scans. In some cases, a liver biopsy may be necessary. Some patients do not have any symptoms when they are diagnosed with cirrhosis, and the only indication that something is wrong is abnormal blood or imaging tests. The blood tests often indicate abnormal liver function tests and low platelet levels. The imaging tests show that the liver is misshapen, and a liver biopsy shows scarring in the liver. When cirrhosis develops, increased pressure develops around the liver because of the liver scarring. This increased pressure can cause fluid to build up in the abdomen and in the legs, and can cause esophageal varices to develop2. Esophageal varices are veins located in the esophagus that can rupture and cause life threatening bleeding. If a patient is diagnosed with cirrhosis, an upper endoscopy is typically performed to see if varices are present in the esophagus3, 4.
How is it treated?
Lifestyle changes, regular monitoring, and medications are recommended for patients with cirrhosis. Eating less than two grams of salt a day is recommended to prevent fluid overload. No alcohol use is recommended. Blood work is typically done every three to six months to monitor the liver, and an imaging test of the liver is done every 6 months to screen for liver cancer, which is increased in cirrhosis patients5. Patients with fluid overload need diuretic medications to treat the excess fluid. Patients with esophageal varices need beta blocker medicines to reduce the size of the varices, or in some cases, rubber bands are placed around the varices during an upper endoscopy to reduce their size. If confusion develops from cirrhosis, the medications Lactulose and Rifaximin can be given to prevent this as well1. If a patient’s health continues to worsen from liver cirrhosis despite these efforts, liver transplant evaluation is recommended1.
References
1. Ge, P., & Runyon, B. (2016). Treatment of Patients with Cirrhosis. The New England Journal of Medicine, 375(8) 767-777.
2. Garca-Tsao, G. et al (2017). Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis, and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 65(1) 310-335.
3. Garcia-Tsao, G. et al (2007). Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. Hepatology 46(3) 922-938.
4. Garcia-Tsao, G., & Bosch, J. (2010). Management of Varices and Variceal Hemorrhage in Cirrhosis. The New England Journal of Medicine 362(9) 823-832.5. Marrero, J et al (2018). Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Associations for the Study of Liver Diseases. Hepatology 68(2) 723-750
