Cirrhosis

GENERAL INFORMATION:

What is cirrhosis?

• Cirrhosis (si-RO-sis) is a chronic (long term) condition where normal, healthy liver cells are damaged. The liver cells harden and die causing the liver to shrink and scar, not work well. Cirrhosis often starts slowly and you may not even know that you have the condition. You may end up with the liver totally failing if cirrhosis is not diagnosed and treated early. This may lead to coma and even death.
  
  
• The liver lies in the upper right side of your abdomen (stomach) and mostly under the lower ribs. It makes bile that helps digest (break down) food to turn it into energy. It also helps keep your blood sugar levels normal. The liver also removes harmful substances from the body, such as drugs, alcohol, and other chemicals. It may repair itself from little injuries but not to damages present in cirrhosis.

What causes cirrhosis? Cirrhosis may be caused by any of the following:

• Alcohol: Drinking too much alcohol. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks.
  
  
• Diseases: Heart disease and infections caused by a virus, such as hepatitis B or C, and parasites like schistosomiasis may cause cirrhosis. Diseases that you were born with, such as hemochromatosis and metabolic diseases may also cause cirrhosis. Hemochromatosis is a condition where you have a problem with dietary iron that gets deposited in the liver.
  
  
• Medicines: Taking certain medicines for treating tuberculosis (TB), and being around toxic chemicals a lot may also cause cirrhosis. Ask your caregiver for information on the medicines or chemicals which may cause cirrhosis.
  
  
• Obstruction: Problems in the biliary tract (passageway of bile) may block bile and cause cirrhosis.

What are the signs and symptoms of cirrhosis? You may not know you have cirrhosis at first and may not have any signs or symptoms. Later as the disease progresses, signs and symptoms may include:

• Generalized:
  
  
  • Having abdominal enlargement and edema (swollen feet and legs).
    
    
  • Having a loss of appetite for food, not wanting to eat, and losing weight.
    
    
  • Not thinking clearly, feeling tired and weak most of the time, or having a sleep disturbance.
  
  
• Skin:
  
  
  • Bleed and bruise easily.
    
    
  • Having frequent itchy skin.
    
    
  • Having the appearance of spider veins (spider web-like blood vessels under your skin).
    
    
  • Having jaundice (yellowish discoloration of the skin).
  
  
• Gastrointestinal:
  
  
  • Having diarrhea (loose bowel movement), or black or bloody bowel movements.
    
    
  • Having nausea (upset stomach) and vomiting (throwing up) which may have blood in it.
  
  
• Others: You may have itching and yellowish coloring of the eyes. You may also have trouble breathing. Your urine may be dark yellow or brown colored. In males, you may notice your breast to be enlarged or your testicles shrink.

How is cirrhosis diagnosed? Cirrhosis may be diagnosed with any of the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• 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: An abdominal ultrasound is a test that is done to see inside your abdomen. Sound waves are used to show pictures of your abdomen on 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.
  
  
• Magnetic resonance imaging (MRI): During the MRI, pictures are taken of your liver and 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.

What are the complications of cirrhosis? You may have any of the following:

• Ascites (presence of large amounts of fluid in the abdomen).
  
  
• Bacterial infections.
  
  
• Enlarged blood vessels in the esophagus or stomach.
  
  
• Liver and kidney failure.
  
  
• Liver cancer (tumor).

How is cirrhosis treated? Your caregiver may tell you to stop drinking alcohol. You may also have any of the following treatment for cirrhosis and its complications:

• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Surgery:
  
  
  • 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.
    
    
  • 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.
  
  
• Other treatment options:
  
  
  • Blood transfusion: During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
    
    
  • 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 fluids from staying in 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.

Where can I get support and more information? Cirrhosis is a life-changing disease for you and your family. Accepting that you have cirrhosis is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Contact the following for more information:

• American Liver Foundation
  75 Maiden Lane Suite 603
  New York, New York 10038
  Phone: 1-212-668-1000
  Phone: 1-800-465-4837
  Web Address: http://www.liverfoundation.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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