MANAGEMENT OF LIVER CIRRHOSIS

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1 MANAGEMENT OF LIVER CIRRHOSIS Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What is cirrhosis? Cirrhosis is a result of long-term, continuous damage to the liver and may be due to many different causes. The damage leads to scarring, known as fibrosis. Irregular bumps (nodules) replace the smooth liver tissue and the liver becomes harder. Together, the scarring and the nodules are called cirrhosis. The build-up of scar tissue can interfere with the flow of blood to your liver and stop it from functioning properly. Cirrhosis can lead to liver failure. Who is at risk of cirrhosis? Cirrhosis can affect anyone, however you are most at risk if you: drink too much alcohol have a long-term (chronic) liver infection, such as hepatitis B or hepatitis C have an inherited liver disease, such as genetic haemochromatosis have an immune system problem that leads to liver disease What are the different stages of cirrhosis? Cirrhosis is sometimes referred to as the end stage liver disease. This simply means it comes after the other stages of liver damage which can include inflammation (hepatitis), fatty deposits (steatosis) and increased stiffness and mild-scarring of your liver (fibrosis). Many people with cirrhosis can feel quite well and live for many years without needing a liver transplant as the liver can function relatively well even when it is quite severely damaged. Cirrhosis is classified as compensated or decompensated. Compensated cirrhosis is where the liver is coping with the damage and maintaining its important functions. In decompensated cirrhosis, the liver is not able to perform all its functions adequately and serious symptoms and complications arise such as portal hypertension, bleeding varices, ascites and encephalopathy.

3 Page 3 of 6 Treatment 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. Treating the cause of the liver disease, such as using anti-viral medications in hepatitis B or C, can stop or at least slow down the decline in the liver condition. Making lifestyle changes and cutting alcohol out of your diet may help delay progression. If you have cirrhosis whether it s caused by alcohol or not you should not drink alcohol at all. Another aspect of treatment is to deal with the complications of cirrhosis as early as possible. For this reason patients with liver cirrhosis are asked to attend the nurse-led cirrhosis clinic to have regular tests to identify problems even before you notice any symptoms. Portal hypertension and varices Patients with liver cirrhosis will be given a gastroscopy procedure either annually or 3 yearly (depending on compensated or decompensated cirrhosis) to check for evidence of portal hypertension and varices. Varices are swollen veins in the oesophagus and stomach which are at high risk of bleeding. Treatment of varices and portal hypertension can include the use of beta blockers, either Carvedilol or Propranolol. In bleeding varices these are sometimes treated during endoscopy using banding. This is where a small band is placed around the base of the bleeding varix. Ascites 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 fluid, called spontaneous bacterial peritonitis (SBP). SBP can be life threatening and requires treatment with antibiotics. The main treatments for ascites and oedema are sodium restriction, using a low salt diet and diuretics. Some patients benefit from having the fluid drained off the abdomen with a needle and tube, called paracentesis. This procedure often needs to be repeated if sodium restriction is not able to clear the ascitic fluid. Patients with ascites will be given a weight monitoring booklet to monitor the effect of their current treatment in-between clinic visits. Hepatic encephalopathy Many people with cirrhosis experience episodes of hepatic encephalopathy, often at a level where it is not very noticeable. Symptoms can include sleep disturbances, mild confusion, subtle personality changes, problems in movement (called ataxia), slurring of words and a particular symptom of flapping hands when you extend your wrists (called asterixis). A poor performance in tests such as drawing a star and connecting dots (known as psychometric testing) can also indicate the presence of hepatic encephalopathy. The main treatment for hepatic encephalopathy is Lactulose, however other medications such as Rifaxamin may also be used alongside Lactulose therapy. Treatment is designed to help remove the toxins that build up in the body when the liver is failing. The aim of Lactulose therapy is to pass 2-3 soft motions a day, and doses often need to be adjusted to achieve this.

4 Page 4 of 6 Bleeding The liver makes products to help blood clot and so in liver cirrhosis patients can be at risk of severe bleeding. Specialist advice should be sought before having medical procedures, including any dental work. 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. Most patients in hepatorenal syndrome require consideration for a liver transplant. Liver cancer People with liver cirrhosis are more at risk of developing liver cancer, most commonly hepatocellular carcinoma (HCC). The aim is to detect and treat liver cancer as early as possible and so patients with liver cirrhosis are given an abdominal ultrasound scan 6-12 monthly for early detection of HCC. 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 requires various assessments before being accepted on the transplant list. If the specialist nurse and medical team feel you are a candidate for liver transplantation this will be discussed with you and a referral made to Leeds Hospital for consideration. Diet It is important to eat well and to include a good balance of foods in your diet including vitamins, minerals and calcium. It is recommended to have a high protein, high calorie diet. If you have ascites and peripheral oedema you may also be advised to have a no added salt diet and to avoid foods such as ready meals which are high in salt. Cirrhosis affects your ability to store glycogen, a carbohydrate that gives you short-term energy. This means that your body has to use its own muscle tissue to provide energy between meals and this can lead to muscle wasting and weakness. Due to this, snacking between meals is advised as well as having a late evening snack before bed. If you are unable to manage an adequate diet you may be prescribed supplement drinks as it is an important part of your treatment to have a good nutritional intake. Further advise, support and help For more information regarding liver cirrhosis and how to access local support groups visit: or contact the British Liver Trust on:

5 Page 5 of 6 Contact Us Gastroenterology Department Cedar House Stepping Hill Hospital Poplar Grove Stockport SK2 7JE Tel: / 5641 Fax: Melody Fazackerley Cirrhosis Clinical Nurse Specialist Melody.fazackerley@stockport.nhs.uk Phone number:

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MED123 Publication date January 2016 Review date January 2017 Department Gastroenterology Location Stepping Hill Hospital