Brief Overview: According to Yale Medicine, “Cirrhosis is a blanket term that’s used to refer to the final, advanced stage of a number of diseases affecting the liver that cause scarring and permanent damage. A liver that’s affected by cirrhosis is unable to function properly, which causes serious health problems. A healthy liver helps to break down and eliminate toxic substances in the body. The liver also creates bile, which is necessary for digestion. A damaged liver leads to liver inflammation and scarring. Over time, these interfere with blood flow to the liver, its bile output levels, and its effectiveness in eliminating waste. These challenges eventually result in advanced disease and liver failure.”
Prevalence: According to NIDDK, “Researchers estimate that about 1 in 400 adults in the United States have cirrhosis.”
Etiology: According to Cleveland Clinic, “Cirrhosis is a gradual scarring process that’s triggered by chronic inflammation in your liver. Any chronic liver disease that causes chronic hepatitis can lead to cirrhosis. The most common causes include: alcohol-induced hepatitis, non-alcohol-related steatohepatitis, chronic Hep C, chronic Hep B. Some less common causes are: autoimmune biliary disease, genetic disorders, toxic hepatitis, cardiovascular disease.”
Risk Factors:
- Heavy alcohol use
- Overweight, obese
- Chronic viral hepatitis (B, C)
- Male
- Type 2 Diabetes
- Age > 40 years old
Commonly Associated Conditions:
- Alcohol-associated liver disease
- Metabolic dysfunction-associated steatotic liver disease
- Chronic viral hepatitis (Hep B, C virus infection)
- Ascites
- Portal hypertension
- Esophageal varices
Common Medications:
- There is no specific treatment, or cure, for cirrhosis at this time
- Medications to treat any underlying or associated conditions
- Medications for symptom management
Common Labs, Imaging, and Tests:
- CBC, CMP, hepatic panel, PT/INR
- Imaging – abdominal ultrasound, CT, MRI, liver elastography
- Upper endoscopy
- Liver biopsy
Common Symptoms:
- May be asymptomatic
- Fatigue
- Decreased appetite
- Abdominal pain (RUQ)
- Unintentional weight loss
- Nausea, vomiting
- Jaundice
- Muscle cramps
- Pruritus
- Falls
- Sleep disturbances
- Sexual dysfunction
- Symptoms of upper GI bleed (blood in stool or vomit, black tarry stools)
- Darkening of the urine
- Swelling of the abdomen – ascites
- Lower extremity edema
- Bruising, bruising easily
Common Treatments:
- Treatment of any underlying or associated condition
- Manage any complications, symptoms
- Abstinence from alcohol
- Eat a healthy, balanced diet to reduce stress on the liver
- Liver transplant may be indicated
Physical Findings:
- Jaundice
- Abdominal distention
- Confusion
- Lower extremity edema
- Weight loss
- Ascites – abdominal distention, fluid wave, flank dullness to percussion
- Gynecomastia
- Fetor hepaticus – a sweet, pungent smell to the breath
- Parotid gland enlargement
- Decreasing blood pressure
- Spider angiomas
- Palmar erythema
- Splenomegaly, hepatomegaly
- Testicular atrophy in males
Potential Complications and Contraindications:
- Portal hypertension
- Variceal hemorrhage
- Ascites
- Hepatic encephalopathy
- Hepatorenal syndrome
- Hepatopulmonary syndrome
- Spontaneous bacterial peritonitis
- Increased risk for infections like UTI and pneumonia
- Liver cancer
- Liver failure
- Bone disease like osteoporosis
- Malabsorption, malnutrition
- Falls
- Bruising, bruising easily
- Patients with cirrhosis are at increased risk of adverse events with many medications because of impaired hepatic metabolism or kidney excretion. Dose adjustments or avoidance of the medication may be needed.
General Health and Lifestyle Guidance:
- Stay up to date on age-appropriate vaccinations (Hep A, Hep B, flu vaccine, shingles vaccine, pneumonia vaccine, RSV vaccine, etc.). Discuss with your healthcare provider what vaccines are recommended for you.
- Avoid alcohol
- Weight loss may be recommended
- Smoking cessation
- Talk to your healthcare provider before taking any OTC medications or supplements
- Work with your healthcare provider and/or dietician to make sure you are following all dietary recommendations
- Talk with your healthcare provider to determine the best timing, frequency, and size of meals for you
- Avoid eating raw, or undercooked, shellfish, fish, and meat. Avoid unpasteurized milk and dairy products.
- Ask your healthcare provider how much sodium you should consume per day.
Suggested Questions to Ask Patients:
- Are you experiencing any swelling, confusion, or yellowing of the skin?
- Do you take any over-the-counter medications or supplements?
- Are you avoiding alcohol and following any recommended sodium restrictions?
- Have you had a liver ultrasound or endoscopy recently?
- Are you open to transplant evaluation if appropriate?
Suggested Talking Points:
- Make sure to report any new, worsening, or persistent symptoms to your healthcare provider
- Make sure to follow up with all healthcare providers as directed and complete any ordered lab tests, imaging studies, etc.
- Make sure to follow your treatment plan as directed by your healthcare provider. Report any side effects to your healthcare provider.
- It is important to have a support system – family, friends, religious/spiritual, support groups, etc.
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