Medical care for patients with cirrhosis has several aims: (1) treating the underlying cause of liver disease when possible, (2) preventing cirrhosis-related complications, and (3) treating the symptoms of cirrhosis. Cirrhosis is a chronic disease, and patients with cirrhosis require ongoing medical care with a physician specializing in the care of patients with liver disease (a gastroenterologist or hepatologist).
Whenever possible, the underlying cause of cirrhosis should be treated. Some conditions improve with medial therapy and treatment can improve or delay worsening of liver function. In some circumstances, patients may not tolerate treatments for their underlying liver disease because their cirrhosis is too advanced.
Patients with cirrhosis should not drink alcohol. In patients who consume alcohol regularly, liver function may improve significantly with total avoidance of alcohol.
Your doctor may recommend various treatments aimed at preventing complications of cirrhosis from developing. Infection is an important cause of illness in patients with cirrhosis and your doctor may recommend updating your vaccinations. Typically, patients with cirrhosis should receive a yearly flu (influenza) vaccine and the pneumonia (pneumococcal) vaccine. Your doctor may test you for hepatitis A and hepatitis B and vaccinate you if you are not immune.
Patients with cirrhosis are at increased risk of developing primary liver cancer, known as hepatocellular carcinoma. The risk for liver cancer varies according to the underlying liver disease, but in patients with hepatitis C infection (one of the most common causes of liver disease in the United States) it is approximately 3-4% each year. Successful treatment for liver cancer depends on early detection. Liver cancers frequently do not cause any symptoms when they are small and treatment options may be limited by the time symptoms develop. Your doctor may recommend an ultrasound, CT scan or MRI of your liver at a regular interval, typically every 6 months, to detect liver tumors. A blood test called alpha-fetoprotein (AFP) may also be used to help detect tumors, however, it is not reliable enough by itself to replace the need for periodic imaging testing.
Your doctor may prescribe various treatments to help control symptoms from complications of cirrhosis. These may include:
- Dietary salt restriction and diuretic medications (commonly known as “water pills”) are prescribed for the control of ascites and edema. In some cases, a small needle may be inserted into the abdominal cavity under local anesthesia to drain ascites fluid, a procedure known as a paracentesis.
- Patients with ascites who have experienced prior episodes of infection in the fluid (spontaneous bacterial peritonitis) or who have a high risk of infection (based on laboratory analysis of the fluid) are given long-term oral antibiotic medication to prevent future episodes of infection.
- Various medications may be prescribed for patients with hepatic encephalopathy. These include lactulose and/or certain types of oral antibiotics.
- Patients with esophageal varices may be treated with blood-pressure reducing medications or treatment may be applied directly to the varices during an endoscopy.
In some cases your doctor may recommend the insertion of a TIPS shunt. The placement of a TIPS shunt is an invasive procedure. A TIPS shunt is a metal tube (also called a stent) placed within the liver under x-ray guidance through an incision in the jugular vein in the neck. A TIPS shunt works by decreasing the pressure against which blood must flow within the liver (that is to reduce portal hypertension). TIPS shunts are used to treat patients with severe difficulty with ascites or bleeding from varices that is not able to be controlled with medication or endoscopy. Not all patients should receive a TIPS shunt. TIPS shunt insertion has associated risks and the placement of TIPS shunt can lead to new or worsening hepatic encephalopathy.
For some patients with severe liver disease, liver transplantation may be considered as a treatment option. During liver transplantation surgery the diseased liver is removed and a new healthy liver from a deceased-donor or a part of a liver from a living-donor is put in its place. Liver transplantation surgery is a major undertaking and requires life-long anti-rejection medications afterwards. Extensive testing is required before a liver transplant to ensure that a candidate is in good enough health to proceed with a transplant operation. Additionally, transplant centers typically require some period of abstinence from alcohol (often at least 6 months) and/or formal alcohol and drug treatment for patients with alcohol-related liver disease before transplantation. Not all patients with cirrhosis need a liver transplant and transplantation is not the best choice for all patients. Although cirrhosis due to chronic hepatitis C is the leading cause for liver transplantation in the U.S., transplantation due to cirrhosis from fatty liver disease is increasing across the country. Because liver transplantation is so complex it is only performed at large specialty centers and your doctor may need to refer you elsewhere in order to be evaluated for a liver transplant.