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Cirrhosis - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cirrhosis.

Highlights:

Causes of Cirrhosis

Causes of cirrhosis include:

Alcoholism
Chronic hepatitis B and C
Autoimmune hepatitis
Bile duct disorders such as primary biliary cirrhosis and primary sclerosing cholangitis
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
Metabolic disorders such as hemachromatosis, Wilson� ' s disease, and alpha-1 antitrypsin deficiency
Prolonged exposure to certain types of chemicals and medications

Complications

Cirrhosis can cause many serious complications including:

Ascites (fluid buildup in the abdomen)
Variceal hemorrhage, severe bleeding of varices (enlarged veins in the esophagus and upper stomach)
Spontaneous bacterial peritonitis, a severe infection of the abdominal fluid
Hepatic encephalopathy, damage to the brain caused by buildup in the body of toxins such as ammonia
Hepatocellular carcinoma, a type of liver cancer

Dietary and Lifestyle Changes

All patients with cirrhosis can benefit from certain types of lifestyle interventions. These include:

Stop drinking alcohol.
Restrict dietary salt.
Eat a nutritious diet.
Get vaccinations for influenza, hepatitis A and B, and pneumococcal pneumonia (if recommended by your doctor).
Inform your doctor of all prescription and nonprescription medications, and any herbs and supplements, you take or are considering taking.

Treatment

Cirrhosis is an irreversible condition. Treatment focuses on slowing the progression of liver damage and reducing the risk of further complications. Your doctor will treat any underlying medical conditions that are the cause of your cirrhosis. If liver damage progresses to liver failure, patients may be candidates for liver transplantation. Liver donations can come from a cadaver or from a living donor. Patients with cirrhosis who have a liver transplant have very good chances for survival.

Resources

www2.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
www.aasld.org -- American Association for the Study of Liver Diseases
www.liverfoundation.org -- American Liver Foundation
www.gastro.org -- American Gastrointestinal Association
www.cdc.gov/ncidod/diseases/hepatitis -- Centers for Disease Control and Prevention, Hepatitis
www.hepfi.org -- Hepatitis Foundation International
www.organdonor.org -- National Transplant Society
www.unos.org -- United Network for Organ Sharing
www.organdonor.gov -- US government organ donor site

References

Berg CL, Gillespie BW, Merion RM, Brown RS Jr, Abecassis MM, Trotter JF, et al Improvement in survival associated with adult-to-adult living donor liver transplantation. Gastroenterology. 2007 Dec;133(6):1806-13. Epub 2007 Sep 14.

Brown RS Jr. Live donors in liver transplantation. Gastroenterology. 2008 May;134(6):1802-13.

Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee ofAmerican Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007 Sep;102(9):2086-102.

Gonzalez R, Zamora J, Gomez-Camarero J, Molinero LM, Bañares R, Albillos A. Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann Intern Med. 2008 Jul 15;149(2):109-22.

Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006 Sep 1;74(5):756-62.

Heidelbaugh JJ, Sherbondy M. Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician. 2006 Sep 1;74(5):767-76.

Lindor K. Ursodeoxycholic acid for the treatment of primary biliary cirrhosis. N Engl J Med. 2007 Oct 11;357(15):1524-9.

Martín-Llahí M, Pépin MN, Guevara M, Díaz F, Torre A, Monescillo A, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008 May;134(5):1352-9. Epub 2008 Feb 14.

O'Leary JG, Lepe R, Davis GL. Indications for liver transplantation. Gastroenterology. 2008 May;134(6):1764-76.

Parikh S, Hyman D. Hepatocellular cancer: a guide for the internist. Am J Med. 2007 Mar;120(3):194-202.

Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life inpatients with cirrhosis who have minimal hepatic encephalopathy. Hepatology. 2007 Mar;45(3):549-59.

Said A, Lucey MR. Liver transplantation: an update 2008. Curr Opin Gastroenterol. 2008 May;24(3):339-45.

Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007 Sep;133(3):825-34. Epub 2007 Jun 20.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008 Mar 8;371(9615):838-51.

Torres DM, Harrison SA. Diagnosis and therapy of nonalcoholic steatohepatitis. Gastroenterology. 2008 May;134(6):1682-98.

Reviewed last on: 12/5/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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