Treatment depends on the cause and stage of the cirrhosis. The aim of treatment is to stop the cirrhosis getting worse, to reverse any damage (if this is possible) and to treat any disabling or
life-threatening complications.
Stopping the progression
Making lifestyle changes and cutting alcohol out of your diet may help delay progression.
Many causes of liver disease can now be treated much more successfully than before to stop or at least slow down any decline in the condition of your liver.
This includes treating infections such as hepatitis B or C with new anti-viral medications and
autoimmune diseases such as autoimmune hepatitis (AIH) with steroid-based drugs. Genetic
haemochromatosis (GH), an inherited liver disease, can be managed successfully with phlebotomy or venesection, a procedure similar to blood donation in which a quantity of blood is
regularly taken from a vein in your arm.
Reversing the problem
Until recently, it was thought that a liver with cirrhosis could not be healed. This is usually the case because most diseases that cause scarring of your liver (fibrosis) are long-term and difficult to ‘cure’.
However, recent research has shown that it may be possible to heal scarring and even cirrhosis
where the liver disease causing this damage is able to be successfully treated.
The treatment of hepatitis B and C, as already mentioned, gives hope for the development of new drugs to combat scarring of the liver. More research, however, needs to be done before any
new treatments become widely available.
Treating and managing the effects of cirrhosis
Another aspect of treatment is to deal with the complications of cirrhosis as early as possible. For this reason your doctor may suggest you have regular tests to identify problems even before you notice any symptoms. You may also be given other drugs to reduce blood pressure, to prevent and treat infections and to help support your body’s functions.
Portal hypertension and variceal bleeding
Medicines including beta blockers such as propanolol can reduce the risk of bleeding and reduce the severity of any bleed, should it occur. If there is a serious bleed, initial treatment is to replace the fluid and then to identify and correct the cause of bleeding. There are several techniques aimed at stemming the bleeding which involve endoscopy.
One of these is called banding, where a single vein (called an oesophageal varix) is sucked into a ring at the end of the endoscope. A small band is then placed around the base of the varix which will control the bleeding.
Injection sclerotherapy is also used and involves injecting a substance into the veins of the gullet to induce clotting and scar tissue that will help stop the veins from bleeding.
If bleeding can not be stopped by endoscopy, a Sengstaken tube is passed down the throat into the stomach. This device has a balloon on the end. Once this balloon is infl ated, it puts pressure on the varices and helps control the bleeding. People are heavily sedated for this procedure.
If bleeding still cannot be controlled a procedure to lower pressure in the portal vein called a transjugular intrahepatic portosystemic stent shunt (TIPSS) may be needed. In this procedure a metal tube (stent) is passed across your liver to join two large veins (the portal vein and hepatic vein). This creates a bypass (shunt) so the blood flows straight into the hepatic vein relieving the pressure which causes the varices.
Ascites and peripheral oedema
Ascites (fluid building in your abdominal cavity, appearing like a bulge across your tummy area) and peripheral oedema (swelling in your ankles and legs) are very common in people with advanced cirrhosis. Ascites can be uncomfortable and make it hard for people to breathe and eat normally. In addition, there is a risk of infection in the fl uid, called spontaneous bacterial peritonitis (SBP), which can be life threatening and is treated with antibiotics.
The main treatments for ascites and oedema are sodium restriction (low salt diet and diuretics, such as spironolactone and Furosemide). It can be helpful to see a dietitian about how to manage on such a strict diet. Some patients benefit from having the fluid drained off the abdomen with a needle and tube. This usually needs to be repeated every few weeks. Patients considered at higher risk of infection may be offered prophylactic (preventative) antibiotics to take every day.
Hepatic encephalopathy
Many people with cirrhosis experience episodes of hepatic encephalopathy, most at a level where it is not very noticeable. In overt stages (where it is noticeable), it can show up as sleep disturbance, mild confusion, subtle personality changes and slightly poorer performances in tests such as drawing a star and connecting dots. It can also feature problems in movement (called ataxia) and speech, slurring of words, tremor and a particular symptom of fl apping hands when you extend your arms (called asterixis). In some people the sleepiness can progress to a loss of consciousness and even to a coma, where it can be life-threatening.
The main treatment for encephalopathy is lactulose (a sweet syrupy medicine). This not only acts as a laxative but also helps the body remove the toxins that build up in the body when the liver is failing. People are given enough lactulose so that they have one or two loose bowel movements each day. They may also be given other laxatives and/ or an enema. Most periods of encephalopathy are triggered by problems such as an infection, constipation, dehydration, a medicine or a bleed. It is important that patients seek medical advice so the cause of an episode can be identified and treated.
Bleeding
The liver makes products to help blood clot (including clotting factors and platelets) and when the liver stops working effectively, patients can be at risk of severe bleeding. Treatments include administering vitamin K and plasma in medical emergencies. People should seek specialist advice before having medical procedures, including any dental work, and ensure that they treat any cuts that bleed with pressure and bandages and seek medical help.
Kidney problems
People with decompensated cirrhosis who are already very ill with problems such as encephalopathy, jaundice and bleeding problems, are at risk of a serious complication called hepatorenal syndrome, which is kidney failure in liver disease. For most patients, a liver transplant is needed, for some urgently.
Liver cancer
Some people with cirrhosis develop liver cancer, most commonly hepatocellular carcinoma (HCC). The aim is to detect and treat liver cancer as early as possible.
Treatment can involve cutting out the part of the liver affected by cancer. There are a variety of other treatments aimed at controlling the cancer, including injections of chemotherapy, radio frequency ablation and oral medicines. A liver transplant may be an option for some patients.
Liver transplantation If your liver is very badly damaged, a liver transplant may be needed. This is a procedure where a diseased liver is removed during a lengthy operation and replaced with a healthy donor liver.
A liver transplant is usually only recommended if other treatments are no longer helpful and your life is threatened by end stage liver disease. It is a major operation and you will need to plan it carefully with your medical team, family and friends.
Liver transplantation is usually very successful although in some cases it is possible for liver diseases to return and affect your new liver.
Discuss any worries you have about your suitability for treatment with your specialist nurse or doctor and those nearest to you.