Therapy of cirrhosis of the liver

The correct therapy for cirrhosis of the liver depends on the cause and condition of the patient.
Cirrhosis is a chronic and degenerative disease of the liver that leads to loss of organ function.


Diagnosis of cirrhosis of the liver

Cirrhosis is often diagnosed in its initial stages, when the patient has tests for another condition because there are no symptoms yet.

Someone who exhibits the following symptoms should seek immediate medical attention:

  • Fever and chills
  • Breathing difficulties
  • Vomiting of blood
  • Dark or tar stool
  • bouts of drowsiness or confusion

The family doctor examines the patient and palpates the area of the liver to see if it is enlarged.
The doctor asks the patient about his medical history and lifestyle habits (alcohol consumption, etc.).

The following examinations may be prescribed:

  • Blood tests – to determine liver functionality and see if there is any damage.
    If the levels of transaminases (GOT) are greatly increased, the patient may have acute hepatitis.
  • Imaging examinations – this includes echography, CT or magnetic resonance imaging of the liver.
    In addition to an enlarged liver (steatosis hepatis), the doctor can also detect possible scar tissue.
  • Biopsy – a small amount of liver cells is taken and examined under a microscope.
    The doctor inserts a fine needle between the ribs into the liver. This procedure is carried out under local anesthesia.
    The biopsy can confirm or rule out cirrhosis, and it can also say something about the possible cause (if it is cirrhosis).
  • Endoscopy – an endoscope is a long, thin tube with a light and a telephoto camera at the tip that is pushed through the patient’s esophagus to the stomach.
    The doctor looks at the inside of the stomach on a screen and looks for possible swollen blood vessels (varices), which are a clear sign of cirrhosis.

How is cirrhosis of the liver treated?

Cirrhosis tends to continue exacerbation if the cause persists and is not treated.
The cure of cirrhosis by medication is not possible.
Once fibrous tissue has formed in the liver, the organ is no longer able to regenerate.
Therefore, the goal of treatment is to prevent further fibrosis of the liver or slow down the progression of the formation of fibrous tissue.
Below are some medically recommended therapies.

Diet and lifestyle
All patients with cirrhosis may benefit from some lifestyle changes, such as:

Sodium (salt) can increase fluid retention in the body.
You should eat different foods every day. This can help limit the amount of salt consumed.
It is best to eat fresh fruits and vegetables. Processed foods should be avoided as much as possible.

a healthy diet 
People with cirrhosis are typically malnourished and need nutrients and lots of calories.
Excess proteins, however, can trigger hepatic encephalopathy.
Certain foods such as raw seafood or crustaceans should be avoided because there is a risk of poisoning and infection of the blood (septicemia). A dietitian can explain the dietary guidelines.

Patients with cirrhosis should ask the doctor what vaccinations are useful (for example, against hepatitis A, hepatitis B, flu, pneumococcal pneumonia).

Stop drinking
Whatever the cause of cirrhosis, one should completely stop drinking alcohol. Alcohol, regardless of the cause, increases the rate of progression of cirrhosis.

Caution when taking medication
You should always inform the doctor or pharmacist that you have cirrhosis if prescription or freely available medications are taken.
Some drugs that are broken down in the liver may only be taken in small doses or not at all in cirrhosis.

Therapy based on the cause
Some causes of cirrhosis can be treated. In this way, the progression of cirrhosis can be slowed or stopped. For example:

  • Stop drinking alcohol if the cause is alcohol.
  • Interferon and other medications may be used to treat viral hepatitis.
  • Cortisones or other immunosuppressants may be effective for treating autoimmune diseases that cause liver damage.
  • Regular sampling of half a liter of blood helps to remove excess iron that occurs with hemochromatosis.

Treatment to relieve symptoms and prevent complications

Different treatments may be recommended depending on the severity of cirrhosis and the symptoms that develop. For example:
Adequate nutrition (including calories and protein) and regular physical exercise are important for preventing weight loss and excessive muscle loss.
A low-salt diet and diuretics help against fluid retention in the body.

For hepatic encephalopathy, the doctor may prescribe a laxative such as lactulose (Tulotract), which is taken orally or administered via an enema.

Medications to reduce itching
Zinc deficiency is common in cirrhosis and you can use zinc-containing supplements.
Vaccinations against hepatitis A, influenza and pneumococcal infections.
Osteoporosis is a possible complication and therefore prevention and treatment are important.
Drugs to reduce portal hypertension.
Drainage of fluid that accumulates in the abdomen (ascites).

Treatment of bleeding varicose veins (varicose veins)
A varicose vein hemorrhage is a medical emergency.
A cirrhosis patient should immediately consult a doctor for:

  • vomiting blood,
  • blood in the stool,
  • black chair.

Various surgical techniques can help stop bleeding and reduce further bleeding.

Liver transplant for cirrhosis

If cirrhosis progresses, the patient may be a candidate for liver transplantation in the final stages of liver disease.
Patients with liver cancer that does not spread beyond the organ are other candidates for liver transplantation.
The current 5-year survival rate after liver transplantation is about 75%.
Patients report improvements in quality of life and mental performance after transplantation.
Patients should visit medical centers that perform more than 50 transplants a year, as they have better results than average.

A scoring system called the “end-stage liver disease model” (or MELD score) is used to determine which patients are the best candidates to transplant a donor liver.
A MELD score provides for 3 months survival time and is based on laboratory tests of creatinine, bilirubin and blood clotting time.
Priority is given to patients who have a higher probability of dying without liver transplantation.
Unfortunately, many more patients are waiting for a liver transplant than organs are available.

Patients can also receive a liver transplant through living donors.
When transplanted by a living donor, the surgeon replaces the diseased liver with part of the liver taken from the living donor.
The donor’s liver fully regenerates within a few weeks of surgery, and the recipient’s liver also grows back.
This procedure shows excellent results for patients, but there are some risks for the donor.
The transplant takes 4-12 hours and the patient remains hospitalized for up to 3 weeks after surgery.
Most patients resume their normal activities in about 6-12 months after transplantation.
For the rest of their lives, they need to take immunosuppressants to prevent rejection.

Liver transplantation in patients with viral hepatitis One of the main problems with hepatitis
is viral recurrence after transplantation.
In general, recurrence occurs with viral hepatitis C, but can also occur with hepatitis B.

Liver transplantation in patients with primary biliary cirrhosis
Patients who require transplantation for primary biliary cirrhosis are those who develop more complications of portal hypertension and hepatic insufficiency, or who have poor quality of life and low life expectancy without the procedure.
Survival rates after transplantation are excellent.

Liver transplantation in patients with autoimmune hepatitis
Expectations for patients with autoimmune hepatitis who need a transplant are good.
The survival rate is about 90% after one year and about 70-80% after 5 years.
Rejection usually occurs in patients whose immune system is severely impaired.

Liver transplantation for alcohol-dependent patients
In general, liver transplantation is not recommended for people addicted to alcohol or drugs.

The future
Until recently, the course of scarring in cirrhosis was considered irreversible.
However, recent research has led to a better understanding of the process of fibrosis. Some research shows that medications may be able to reverse the progression of fibrosis.
Transplantation of liver cells or stem cells for the final restoration of liver function is being studied.

Prevention of cirrhosis of the liver

Do not drink too much alcohol. Talk to the doctor if there are alcohol problems.

Pregnant women. The Health Minister’s recommendations are that “women in pregnancy or those who want to become pregnant should not drink alcohol.
If, on the other hand, they decide to do so, in order to minimise the risk to the child, they should not drink a glass of wine more than once or twice a week and should not get drunk.”

Take steps to avoid transmission of hepatitis B or C.

Use a condom during sexual intercourse.
Do not use the same hypodermic needle when using drugs.
People at risk for hepatitis B, such as medical staff, social workers and police officers, can be vaccinated (there is currently no vaccination against hepatitis C).

The best natural precaution against cirrhosis is a healthy diet and avoiding certain foods, such as fried foods.

What is the life expectancy and prognosis for patients with cirrhosis of the liver?

If drinking is not stopped, life expectancy is not good if the fibrosis of the liver is strongly developed, especially in alcoholic cirrhosis.

Cirrhosis can lead to death or coma due to hepatic insufficiency due to bleeding in esophageal varices.
People with cirrhosis have an increased risk of developing serious infections.

With cirrhosis, there is an increased risk of developing liver cancer (hepatocellular carcinoma).
The risk varies depending on the cause of cirrhosis.
The greatest risk is cirrhosis caused by hepatitis C or hereditary hemochromatosis.
The risk of developing a liver tumor is lower in patients with alcohol-induced cirrhosis.
The disease is not curable, but you can alleviate the symptoms to improve the quality of life.

How long do you live?

The prognosis depends on the underlying cause and timely treatment.
Many people with not too severe cirrhosis lead a normal life for several years. In some cases, the progression of cirrhosis can be interrupted or slowed down by therapy.