Cirrhosis and Chronic Liver Failure

What is cirrhosis?

 

The word cirrhosis is used when the liver is damaged by scarring.  The scarring can come from many things. 

 

What causes cirrhosis?

 

The most common causes are

• Alcohol.
• Hepatitis B or C
• Biliary problems.
• Hemochromatosis (the body absorbs and stores too much iron).
• Nonalcoholic fatty liver disease.
• Certain drugs, genetic diseases, infections, and blood vessel problems.

 

Ask your doctor what caused your cirrhosis.

 

What are the symptoms of cirrhosis?

 

The liver is a complex organ and has many jobs.  It helps you process food, get rid of waste and toxins, and clot blood.  When the liver is damaged, it is not able to do its job, and the body changes.  At first, you may have no symptoms.  Most people do not have symptoms until 80 to 90% of the liver has been damaged.  At that point, the liver cannot do its job as well.  When the liver is not able to process food as it should, you become tired and weak.  You may not feel hungry.  You lose weight and your bones become weaker.  The body’s sex hormones change.  Men may develop breasts, lose body hair, and have smaller testicles.  Sex drive may decrease.  Premenopausal women may stop having periods.

 

When the damaged liver cannot get rid of waste, chemicals build up in the body.  One of these chemicals is bilirubin.  The liver gets rid of bilirubin when it is emptied into the intestines.  In cirrhosis, the liver does not excrete bilirubin and it builds up in the blood.  This makes your skin and eyes become yellow.  This is called jaundice.  Your skin may be itchy, and your urine becomes tea colored.  Your breath may become sweet and sharp.  Ammonia is a byproduct from proteins being broken down during digestion.  When the liver cannot remove it, it can build up and can make you tired and confused.  

 

The liver also makes chemicals that help blood form clots.  When the liver cannot do that as it should, you are more prone to bruising.  When you have cuts, it takes longer to form a scab.  Your doctors will order blood tests called an INR or protime to measure how long it takes blood to clot.

 

Your blood should flow through your liver, but the scarring from cirrhosis prevents normal blood flow.  The blood backs up into your abdomen and blood vessels.  Your abdomen becomes bigger because of fluid build up.  This is called ascites.  Blood vessels become bigger and can be seen on your skin.  These are called spider angiomas.  Blood vessels in the esophagus (the tube from your mouth to stomach) become bigger and are more likely to bleed.  These are called esophageal varices. 

 

What are the treatments for cirrhosis?

 

• Avoid medicines that may further damage the liver.  Ask your doctor before taking any herbal or over-the-counter medicine.  Medicine like Tylenol^® (acetaminophen) can further damage your liver.

 

• Extra nutrition is vital.  Your doctor may prescribe vitamins or a special diet to reduce ammonia levels and ascites.

 

• Your doctor will try to control waste build up in your body.  Your doctor may prescribe medicine to decrease ammonia.  Lactulose (syrup or enema) binds with ammonia and causes you to have a bowel movement.  Antibiotics decrease the bacteria in the gut that make ammonia.

 

• The way your blood clots will be watched.  Your doctor may prescribe medicine and vitamins to help your blood clot.  You may receive a blood product called platelets through an IV.

 

• Your doctor will try to reduce the build up of ascites in your body.  You may take medicines to reduce ascites.  Or, you may need a treatment called paracentesis which removes fluid from your abdomen with a needle.  The TIPS procedure (transjugular intrahepatic portosystemic shunts) creates a channel for blood to flow through the liver.

 

• Esophageal varices may be treated with TIPS to prevent blood from pooling in veins or the varices are banded together to prevent them from getting bigger.

 

• A liver transplant is the only cure for cirrhosis.

 

Treatment plans vary.  The doctor bases treatment on your symptoms.  Ask your doctor or nurse if you have questions.

 

When should I call my doctor?

 

Call your doctor when any of these symptoms are present.

• You become confused.
• You become forgetful.
• You have problems sleeping at night or sleeping during the day.
• You have problems waking up.
• You are short of breath.
• You have bleeding that does not stop after pressure has been applied.
• You find blood in vomit or stool.
• You see an increase in weight gain with ascites or swelling of the ankles.
• You have a fever greater than 100°F for more than 24 hours.
• You have an increase in pain.

 

References

1. Goldberg E., Chopra, S. (2007) Diagnostic approach to patient with cirrhosis. Up-To-Date. Retrieved December 19, 2007, from http://www.utdol.com/utd/store/index.do.
2. Heidelbaugh, J.J., Bruderly, M. (2006) Cirrhosis and chronic liver failure: part I diagnosis and evaluation. American Family Physician Volume 74 Number 5.
3. Heidelbaugh, J.J. & Sherbondy M. (2006) Cirrhosis and chronic liver failure: part II. Complications and treatment. American Family Physician, Volume 74 (5).

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 12/19/2008

Copyright © 12/19/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6761

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