Cirrhosis

WHAT YOU SHOULD KNOW:

• Cirrhosis (si-RO-sis) is a condition where liver cells die and are replaced by scar tissue instead of normal liver cells. It is a chronic (long term) condition where the liver shrinks and becomes hard. Cirrhosis often starts slowly and it may be years before you know that you have cirrhosis. Alcohol abuse and infections of the liver are the common causes of cirrhosis. Certain medicines for treating tuberculosis (TB) for a long period or exposure to toxic (harmful) substances may also cause cirrhosis. Imaging tests like abdominal (stomach) ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scan can help diagnose cirrhosis. Blood tests and a liver biopsy may also be used in the diagnosis.
  
  
• Signs and symptoms include abdominal enlargement, yellowish coloring of the skin and eyes, weight loss, and weakness. You may also have changes in your bowel movements, or swelling of your arms and legs. Your caregiver may tell you to stop drinking alcohol as you are treated for cirrhosis and its complications. Treatment may include the use of medicines, such as diuretics and antibiotics. Avoiding or limiting the use of salt, or limiting the amount of liquids that you drink will also help you. Paracentesis (removing fluid in the abdomen), hemodialysis, or a blood transfusion may also be used. Surgery to direct blood away from the liver, or a liver transplant may be done if other treatments fail. Diagnosing and treating cirrhosis as soon as possible may relieve your symptoms and improve quality of life.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Treatment of cirrhosis and its complications have several risks. Blood transfusion may cause unwanted reactions like decreased blood pressure and shock (very low blood pressure). Surgery may lead to bleeding problems or you may get an infection in your abdomen. A liver transplant may result in organ rejection and cause further problems. If left untreated, the complications of cirrhosis could get worse. You could go into a coma, or bleed more than expected. You could have severe (very bad) liver and kidney problems and you may die. Call your caregiver if you are worried or have questions about your medicine, surgery, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Activity:

• You may breathe easier and sleep better by sleeping on 2 to 3 pillows. Putting pillows on each side to support your abdomen will also make you feel more comfortable. You may need to exercise to help get rid of extra fluid in your legs and feet. Exercise your legs by lifting one leg off the bed and drawing big circles with your toes. Then do it with the other leg. Another good exercise is to lie on your side and pretend to pedal a bike. These exercises make your legs stronger and stop blood clots from forming. If you ever feel weak or dizzy, sit or lie down right away then call your caregiver.
  
  

Medicines:

You may be given the following medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Anti-itching medicine: Caregivers may give you medicine to help keep your skin from itching. This medicine may be given in an IV, as a shot, by mouth, or as a skin lotion. Sometimes this medicine can make you sleepy.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.

Monitoring:

• Abdominal measuring: Caregivers use a measuring tape to measure around your abdomen. Your abdomen may be measured as often as every four to eight hours to see if it is getting smaller or larger.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

Tests:

You may need any of the following:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Liver biopsy: A liver biopsy is when a small piece of your liver is removed and sent to a lab for tests. Caregivers will clean your skin, and you may be given medicine to numb (lose feeling) in the area. A needle is put through the wall of your abdomen or between your ribs. The needle is put into the liver and a small piece is taken out. A bandage will be placed over the area.
  
  
• Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.
  
  
• Computed tomography (CT) scan: A special x-ray machine uses a computer to take pictures of your liver. Your caregivers look at the pictures to see the size and shape of your liver. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the liver show up better in the pictures. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Esophagoscopy: This test looks at the inside of your throat and esophagus. A scope with a magnifying glass and a light on the end is gently put into your mouth and throat. Your caregiver will look for varices in your esophagus and stomach. Varices are blood vessels that have become swollen and twisted. Varices can burst and cause bad bleeding if not treated.
  
  
• Magnetic resonance imaging (MRI): During the MRI, pictures are taken of your liver or blood vessels. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.

Treatment options:

You may need one or more of the following treatments for cirrhosis and its complications:

• Blood transfusion: You will get whole or parts of blood through an IV during a transfusion. Blood is tested for diseases, such as hepatitis and HIV, to be sure it is safe.
  
  
• Dialysis: Dialysis cleans your blood when your kidneys cannot. Extra water, chemicals, and waste products are removed from your blood by a dialyzer or dialysis machine. The dialysis machine does this by passing your blood through a special filter, then returning it back to you. You may need dialysis for a short time, or for the rest of your life. Caregivers will check your vital signs often during dialysis. You may also be given medicines or have blood taken for lab tests during dialysis.
  
  
• Limiting salt and water intake: Your caregiver may tell you to avoid eating salty foods and drinking liquids more than the usual. This is to prevent too much fluid from staying in your body. Ask your caregiver how much liquid you should drink.
  
  
• Liver transplant: A liver transplant is surgery to put a new liver into your body. This liver is called a graft or a donor liver. You may need a liver transplant because your liver does not work anymore. The donor liver may come from a family relative or from an organ donor. You will have many tests before surgery to make sure that you are healthy and ready for the surgery. It also checks if the donor liver will match your body.
  
  
• Paracentesis: This procedure is also called an abdominal or peritoneal tap. During a paracentesis, caregivers use a needle to remove extra fluid or put special medicine in your abdomen. Removing extra fluid may help you breathe easier and feel more comfortable. The fluid may be sent to a lab and checked for signs of infection or other problems.
  
  
• Shunts: This is surgery to direct blood away from the liver and decrease pressure on your liver. The shunt also decreases the risk of bleeding in your esophagus and stomach. There are many different kinds of shunts. Caregivers will help you decide on the type of shunt you may need.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Cirrhosis (Inpatient Care)