Cirrhosis of the liver

Reviewed by Dr Alan Ogilvie, gastroenterologist

Activity
Try to lead an active life. This may be difficult because of the tiredness and weakness but it is worth persevering.

If your legs are swollen, it may be helpful to raise them while you are resting.

Food

Avoid all alcohol intake.

Eat a well-balanced, high-protein diet (only in consultation with your doctor).

Avoid adding salt to meals. Salt may be used in small amounts in cooking.

In the later stages, the amount of protein you eat may be reduced from time to time (on the advice of your doctor).

Vitamin and mineral supplements may be necessary.

Possible complications

Impotence in men. This is a combination of the effects of alcohol and cirrhosis.

Severe internal bleeding from ruptured varicose veins in the stomach or oesophagus. This is serious and requires hospital treatment.

Liver cancer, which occurs at a late stage in a number of patients with cirrhosis.

Blood poisoning, due to infection of the excess fluid in the abdomen (ascites).

Future prospects
The gradual destruction of the liver can be stopped by removing the cause. This underlies the advice on alcohol. Treatment is available for chronic hepatitis B virus infection and also for chronic hepatitis C virus infection. Iron overload can be treated by removing blood on a regular basis. Autoimmune chronic active hepatitis can be treated with steroids to suppress the immune system and prevent it attacking the liver cells.

Although the damage may not be repaired, the symptoms can be relieved and controlled. If treatment is started early, the sufferer may be able to lead an almost normal life. If the cause is not removed, however, the formation of scar tissue and destruction of the liver structure will continue, ultimately resulting in liver failure and death.

How is cirrhosis of the liver treated?
Apart from removing the cause, cirrhosis of the liver cannot be treated. The emphasis is therefore on dealing with and reducing the complications of the disease.

The following approaches are used:

water tablets (diuretics) for the treatment of fluid retention in the legs (oedema) or abdomen (ascites).

vitamins and mineral supplements.

calorie supplements (usually sugar-based drinks) to maintain nutrition.

laxatives (usually a syrupy solution called lactulose) to prevent constipation and to reduce the chances of the poisonous substances from the bowel bypassing the liver and reaching the brain, causing drowsiness, confusion and coma (hepatic encephalopathy).

some patients who have had bleeding from ruptured varicose veins in the lower oesophagus may be put onto a drug called propranolol, which reduces the pressure in those veins and lowers the chances of them bleeding again.

finally, liver transplantation may be considered in patients with end-stage cirrhosis.

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