Cirrhosis - Treating cirrhosis

Cirrhosis can't be cured.  Treatment aims to manage the symptoms and any complications, as well as stopping the condition from getting worse.

It's usually not possible to reverse liver damage that's already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause of the liver damage can be successfully treated.

Treatment is likely to take place at a hospital with a specialist hepatology unit (which treats disorders of the liver, gall bladder and biliary ducts).

Stopping cirrhosis getting worse

Taking medication to treat the underlying cause of the liver damage and making healthy lifestyle changes can help stop your cirrhosis getting worse and reduce your risk of further health problems.

Medication

The medication you need depends on the specific cause of the damage to your liver.

For example, if you have viral hepatitis you may be prescribed anti-viral medications. If you have autoimmune hepatitis you may be given steroid medication (corticosteroids) or a medication to suppress your immune system (immunosuppressants).

Lifestyle changes

There are a number of things you can do to help yourself stay healthy and reduce your chances of developing further problems if you have cirrhosis, including:

• completely avoid alcohol, regardless of the cause of your cirrhosis, as alcohol consumption increases the rate at which the condition progresses
• lose weight if you are overweight or obese
• regularly exercise to reduce muscle wasting
• practise good hygiene to reduce your chances of developing infections
• speak to your GP about vaccinations you may need, such as the annual flu vaccine or travel vaccines
• speak to your GP or pharmacist if you're taking over-the-counter or prescription medications, as cirrhosis can affect the way your body processes some medicines

Malnutrition is common in people with cirrhosis, so it's important to eat a balanced diet to help ensure you get all the nutrients you need.

Avoiding salty foods and not adding salt to foods you eat can help reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build up of fluid. See tips for a lower salt diet for more information.

The damage to your liver can also mean it is unable to store glycogen, a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet.

Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat three or four small meals a day, rather than one or two large meals.

Easing symptoms

A number of treatments can ease the symptoms of cirrhosis. They include:

• a low-sodium (salt) diet or tablets called diuretics to reduce the amount of fluid in your body
• tablets to reduce high blood pressure in your portal vein (the main vein transporting blood from the gut to the liver) and prevent or treat any infection
• creams to reduce itching

Managing complications of advanced cirrhosis

With advanced cirrhosis, complications caused by the condition may need treatment.

Swollen varices

If you vomit blood or pass blood in your stools, you probably have swollen veins in your oesophagus (the long tube that carries food from the throat to the stomach). These are known as oesophageal varices.

In these cases, urgent medical attention is required. This means seeing your GP or going to the accident and emergency (A&E) department of your nearest hospital immediately.

Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as:

• Banding – an endoscopy is carried out (a thin, flexible tube is passed down your throat) and a small band is placed around the base of the varices to help control the bleeding.
• Injection glue therapy – following an endoscopy, a type of medical “super glue” is injected into the varices to make the blood clot, which helps to stop the bleeding.
• A Sengstaken tube with a balloon on the end – a special tube is passed down your throat into your stomach and the balloon is inflated. This puts pressure on the varices and helps stop the bleeding. You'll be heavily sedated during the procedure.
• A transjugular intrahepatic portosystemic stent shunt (TIPSS) – a metal tube called a stent is passed across your liver to join two large veins (the portal vein and hepatic vein). This creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices.

You may also be given a type of medication called a beta blocker, such as propanolol, to reduce the risk of bleeding or reduce the severity of any bleed that does occur.

Fluid in the tummy and legs

Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. They'll need to be addressed as soon as possible.

You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The main treatments for ascites and oedema are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide.

If the fluid around your stomach becomes infected, you may need to be treated with antibiotics. Alternatively, antibiotics may be used on a regular basis to prevent infection in people at high risk.

In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks.

Encephalopathy

People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isn't clearing toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used.

Bleeding

Cirrhosis can affect the liver's ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. You'll need to apply pressure to any cuts that bleed.

Therefore, you should seek specialist advice before having medical procedures, including any dental work.

Liver transplant

Your liver may stop functioning if it's severely damaged by scarring. In this situation, a liver transplant is the only option. This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver.

However, you will probably have to wait a long time for a liver transplant as there are more people waiting for a transplant than there are donors.