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Cirrhosis
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Cirrhosis

Diseases & Conditions A-Z

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DIGESTIVE SYSTEM
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From MayoClinic.com

Treatment

Although liver damage from cirrhosis is irreversible, treatment can often help prevent further damage and reduce complications. The best treatment for you depends on the underlying cause of your cirrhosis.

Treating alcoholic cirrhosis

Abstaining from alcohol is the main treatment for alcoholic cirrhosis. Fortunately, a number of treatments are available to help people with alcohol problems. Treatment is tailored to the individual and may involve an evaluation, a brief intervention, an outpatient program or counseling, or a residential inpatient stay.

In addition, because people with cirrhosis, and especially alcoholic cirrhosis, are frequently malnourished, nutrition is often a key part of therapy. A doctor or dietitian can recommend a good dietary plan, which may include 2,000 to 3,000 calories a day to help liver cells regenerate.

Researchers are also studying certain substances that may prove useful in treating alcoholic cirrhosis. These include drugs that block factors that contribute to liver inflammation and a soybean extract that may stop the progression of liver scarring.

In addition to treating the cause of cirrhosis, your doctor will focus on preventing or improving any complications:

  • Portal hypertension. Your doctor may prescribe blood pressure medications such as beta blockers — usually propranolol (Inderal) or nadolol (Corgard) — to help lower portal vein pressure and prevent bleeding from enlarged blood vessels.

  • Bleeding blood vessels. To help stop actively bleeding blood vessels, you may be given drugs such as octreotide (Sandostatin) or vapreotide (Octastatin) — derivatives of a natural hormone. You may take medications alone or in combination with certain surgical procedures. One of these, endoscopic variceal band ligation, treats bleeding in the esophagus. In this procedure, latex bands are used to pinch off the blood supply to bleeding blood vessels. If this isn't successful, your doctor may use a catheter with a balloon on the end to compress the veins and stop the bleeding. When bleeding is severe or recurs often, you may need a surgical procedure to create a bypass (shunt) between the venous system in your liver and your general venous system. Although this lowers the pressure in the portal vein and stops internal bleeding, shunt operations pose serious risks, including encephalopathy.

  • Fluid retention. Sometimes avoiding alcohol and salt are all you need to reduce fluid buildup in your legs or abdomen. If not, your doctor may prescribe diuretics such as spironolactone (Aldactone) or furosemide (Lasix). Severe cases may require paracentesis — a procedure in which large amounts of fluid are removed through a thin tube inserted in the abdomen.

  • Itching. Doctors often prescribe antihistamines such as cholestyramine (Questran) and rifampin (Rifadin, Rimactane) to reduce itching caused by metabolites in the blood.

  • Treatments for hepatic encephalopathy. The medication lactulose (Cholac, Duphalac), a synthetic sugar, can help lower blood ammonia levels by changing the type of bacteria in the intestine and decreasing the absorption of ammonia. Your doctor may also recommend the antibiotic neomycin to reduce the level of bacteria in your intestine that produce ammonia.

  • Liver failure. When complications can't be controlled or liver function is severely impaired, a liver transplant may be the only option for some people. The encouraging news is that the success rate of liver transplantation continues to improve, and more than 90 percent of people who receive transplants are still alive 1 year later. Unfortunately, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive the organs they desperately need.

  • These developments include the donation of liver segments from living relatives, splitting one donated liver between two recipients, new organ allocation policies and, especially, new approaches to liver transplants for people with hepatitis C. Until recently, hepatitis C-infected livers were routinely discarded. But studies show that people already infected with hepatitis C who receive livers from hepatitis C-positive donors do as well as if they had received a liver not infected with the virus. This may mean that many more livers will become available for people with hepatitis C. Nevertheless, hepatitis C may recur in the new liver.

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