Cirrhosis

When liver disease progresses to an advanced stage, an excess amount of scar tissue replaces the normal liver tissue. This condition is termed cirrhosis. At this stage, the damage is considered irreversible, and eventually may lead to liver failure, liver cancer, liver transplantation or death.

Signs and symptoms

There are several typical symptoms and signs of cirrhosis, including:

• Abdominal swelling
• Lower extremity swelling (edema)
• Impaired mental abilities (memory, attention, concentration)
• Yellowing of the skin and eyes (jaundice)
• Dark urine
• Itching (pruritus)

Causes

Many liver diseases can progress to cirrhosis over time. The three most common are:

• Alcoholic liver disease
• Nonalcoholic fatty liver disease (NAFLD)
• Viral hepatitis (B or C)

Treatment

• Alcohol abstinence
  Avoid all alcohol use.
• Optimize nutritional status
  Many cirrhotic patients are malnourished and may have some vitamin and mineral deficiencies. Sodium (salt) restriction is often recommended.
• Medications
  Based on presenting symptoms, signs and complications, medications may be prescribed, including diuretics for ascites and edema; a beta blocker drug to decrease the pressure in the portal vein (vein that drains blood to the liver) and thus decrease the risk of variceal hemorrhage (bleeding from the esophagus); lactulose and rifaximin for management of hepatic encephalopathy (altered mental status).
• Procedures
  An esophagogastroduodenoscopy (scope test) is recommended, usually every one to two years, to check for esophageal varices; a paracentesis (tap) may be done to drain abdominal fluid; an ultrasound of the liver is recommended every six months for liver cancer screening.
• Vaccinations
  If not immune, vaccinations against hepatitis A and B are recommended.