Diagnosis

Cirrhosis FAQs

Transplant hepatologist Sumera Ilyas, M.B.B.S. answers the most frequently asked questions about cirrhosis.

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Ask Mayo Clinic: Cirrhosis

Sumera I. Ilyas, M.B.B.S., Transplant Hepatologist, Mayo Clinic Hi, I'm Dr. Sumera Ilyas, a transplant hepatologist at Mayo Clinic, and I'm here to answer some of the important questions you may have about cirrhosis.

Can I still drink alcohol with liver disease?

No amount of alcohol is considered safe in patients with cirrhosis. They should avoid all alcohol use.

Are pain medications safe to take with liver disease?

Well, some pain medications are safe to take in certain doses, and some are not. For instance, nonsteroidal, anti-inflammatory drugs such as ibuprofen and naproxen, they should be avoided in patients with cirrhosis, because when the liver is scarred, there's a greater chance of hurting the kidneys with these types of medications. Narcotics such as oxycodone are not a good idea either as they can be quite problematic with certain complications of cirrhosis. Acetaminophen, on the other hand, is safe to take, but at smaller doses. For pain relief in cirrhosis, we recommend taking acetaminophen up to two grams a day. So that's four extra strength tablets within a 24-hour period.

How can diet help manage my cirrhosis?

So it's important to eat an overall healthy diet that is balanced and full of fruits and vegetables. It's important to have protein intake, and that can be from lean sources of protein such as beans or lentils, and salt restriction is also very important. Limit the amount of salt in your diet to less than two grams of total intake a day.

Will taking supplements help my cirrhosis?

Although certain herbal supplements such as milk thistle have been tried in liver disease, there's no evidence to suggest that herbal supplements or any other alternative therapies can effectively treat cirrhosis. However, there is a chance of herbal supplements causing harm to the liver, sometimes to the point of liver failure requiring a liver transplant. So we recommend avoiding any and all herbal supplements.

Why are vaccines important with cirrhosis?

Well, vaccinations are an important preventive measure in patients with cirrhosis because when the liver is scarred, patients are at higher risk of complications from certain infections. For patients with cirrhosis, we recommend vaccination against hepatitis A and B. We also recommend the pneumococcal vaccine, which is commonly referred to as the pneumonia vaccine, for all adult patients with cirrhosis. And patients with cirrhosis should also get the annual flu shot.

How can I slow or reverse cirrhosis?

There are instances when damage to the liver can be slowed although complete reversal generally does not happen. For example, if a patient has cirrhosis due to alcohol use, we know that completely abstaining from alcohol can improve the function of the liver. Similarly, weight loss can help improve fatty liver disease. And cirrhosis from hepatitis C was a major reason patients required liver transplants, but we now have medications, antiviral drugs, that are very effective at curing it. There's evidence to suggest that getting rid of the hepatitis C can slow or maybe even help reverse some of the damage done. But there are instances when the liver disease is too advanced and medical interventions cannot reverse the process and that's when we consider liver transplantation.

How can I be the best partner to my medical team?

We know that this is tough for our patients and their loved ones and we want to do everything we can to make the process seamless for our patients. It's helpful for us if we have as much information about your condition as possible--any prior medical therapies, any new symptoms or signs, any medications, herbal supplements or any other medical conditions that you may have. Collect all of this information and share it with your liver team. Be open and transparent with your team. Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time, and we wish you well.

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People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first found through a routine blood test or checkup. To help confirm a diagnosis, a combination of laboratory and imaging tests is usually done.

Tests

Your health care provider may order one or more tests to check your liver, including:

  • Laboratory tests. Your provider may order blood tests to check for signs of liver malfunction, such as high bilirubin levels or certain enzymes. To evaluate kidney function, your blood is checked for creatinine. Your blood count would be measured. You'll be screened for the hepatitis viruses. Your international normalized ratio (INR) is also checked for your blood's ability to clot.

    Based on history and blood test results, your provider may be able to diagnose the underlying cause of cirrhosis. Blood tests also can help identify how serious your cirrhosis is.

  • Imaging tests. Certain imaging tests, including transient or magnetic resonance elastography (MRE), may be recommended. These noninvasive imaging tests look for hardening or stiffening of the liver. Other imaging tests, such as MRI, CT and ultrasound, also may be done.
  • Biopsy. A tissue sample, called a biopsy, is not necessarily needed for diagnosis. However, your provider may use it to find out how severe liver damage is and what's causing it.

If you have cirrhosis, your health care provider is likely to recommend regular tests to see if liver disease has progressed or check for signs of complications, especially esophageal varices and liver cancer. Noninvasive tests are becoming more widely available for monitoring liver disease.

Treatment

Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.

Treatment for the underlying cause of cirrhosis

In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:

  • Treatment for alcohol dependency. People with cirrhosis caused by excessive alcohol use should try to stop drinking. If stopping alcohol use is difficult, your health care provider may recommend a treatment program for alcohol addiction. If you have cirrhosis, it is very important to stop drinking since any amount of alcohol is toxic to the liver.
  • Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels.
  • Medicines to control hepatitis. Medicines may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.
  • Medicines to control other causes and symptoms of cirrhosis. Medicines may slow the progression of certain types of liver cirrhosis. For example, for people with primary biliary cholangitis that is diagnosed early, medicine may significantly delay progression to cirrhosis.

Other medicines can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis. Supplements also can help prevent weak bones, known as osteoporosis.

Treatment for complications of cirrhosis

Your health care provider will work to treat any complications of cirrhosis, including:

  • A buildup of fluid in your body. A low-sodium diet and medicine to prevent fluid buildup in the body may help control ascites and swelling. More-severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure.
  • Portal hypertension. Certain blood pressure medicines may control increased pressure in the veins that supply the liver, called portal hypertension, and prevent severe bleeding. Your provider will regularly perform an upper endoscopy to look for enlarged veins in the esophagus or stomach that may bleed. These veins are known as varices.

    If you develop varices, you likely will need medicine to lower the risk of bleeding. If you have signs that the varices are bleeding or are likely to bleed, you may need a procedure known as band ligation. Band ligation can stop the bleeding or reduce the risk of further bleeding. In severe cases, you may need a small tube — a transjugular intrahepatic portosystemic shunt — placed in your vein to reduce blood pressure in your liver.

  • Infections. You may receive antibiotics or other treatments for infections. Your provider also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.
  • Increased liver cancer risk. Your provider will likely recommend regular blood tests and ultrasound exams to look for signs of liver cancer.
  • Hepatic encephalopathy. You may be prescribed medicines to help reduce the buildup of toxins in your blood caused by poor liver function.

Liver transplant surgery

In advanced cases of cirrhosis, when the liver stops working properly, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is one of the most common reasons for a liver transplant. Candidates for liver transplant have extensive testing to determine whether they are healthy enough to have a good outcome following surgery.

Historically, those with alcoholic cirrhosis have not been liver transplant candidates because of the risk that they will return to harmful drinking after transplant. Recent studies, however, suggest that carefully selected people with severe alcoholic cirrhosis have post-transplant survival rates similar to those of liver transplant recipients with other types of liver disease.

For transplant to be an option if you have alcoholic cirrhosis, you would need to:

  • Find a program that works with people who have alcoholic cirrhosis.
  • Meet the requirements of the program. These would include lifelong commitment to alcohol abstinence as well as other requirements of the specific transplant center.

Potential future treatments

Scientists are working to expand current treatments for cirrhosis, but success has been limited. Because cirrhosis has a variety of causes and complications, there are many potential avenues of approach. A combination of increased screening, lifestyle changes and new medicines may improve outcomes for people with liver damage, if started early.

Researchers are working on therapies that will specifically target liver cells, helping to slow or even reverse the fibrosis that leads to cirrhosis. However, no targeted therapy is quite ready.

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Lifestyle and home remedies

If you have cirrhosis, be careful to limit additional liver damage:

  • Don't drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, don't drink alcohol. Drinking alcohol may cause further liver damage.
  • Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
  • Eat a healthy diet. People with cirrhosis can experience malnutrition. Combat this with a healthy diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Don't eat raw seafood.
  • Protect yourself from infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
  • Use over-the-counter medicines carefully. Cirrhosis makes it more difficult for your liver to process medicines. For this reason, ask your provider before taking any medicines, including nonprescription ones. Don't take aspirin and ibuprofen (Advil, Motrin IB, others). If you have liver damage, your provider may recommend that you not take acetaminophen (Tylenol, others) or take it in low doses for pain relief.

Preparing for your appointment

If you have cirrhosis, you may be referred to a health care provider who specializes in the digestive system, called a gastroenterologist, or the liver, called a hepatologist.

Here's some information to help you get ready for your appointment and what to expect from your provider.

What you can do

  • Be aware of any pre-appointment restrictions, such as diet restrictions on the day before your appointment.
  • Write down your symptoms, including when they started and how they may have changed or worsened over time.
  • Take a list of all your medicines, as well as any vitamins or supplements.
  • Write down your key medical information, including other diagnosed conditions.
  • Bring results of medical tests done so far, including digital copies of CT, MRI or ultrasound images and biopsy slides if a liver biopsy has been done.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Take a family member or friend along to help you remember things.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Preparing a list of questions can help you make the most of your time. Some basic questions to ask include:

  • What is most likely causing my cirrhosis?
  • Is there a way to slow or stop my liver damage?
  • What are my treatment options?
  • Are there medicines or supplements that can hurt my liver?
  • What signs and symptoms of complications should I watch for?
  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be prepared to answer questions, including:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How often do you drink alcohol?
  • Have you been exposed to or taken toxic drugs?
  • Do you have a family history of liver disease, hemochromatosis or obesity?
  • Have you ever had viral hepatitis?
  • Have you ever had jaundice?
  • Have you ever had a blood transfusion or used injection drugs?
  • Do you have any tattoos?

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Feb. 11, 2023

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