Treating cirrhosis

Cirrhosis can't be cured, so t reatment aims to manage the symptoms and any complications,and stopthe condition getting worse.

It's usually not possible to reverseliver damage that's already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause can be successfully treated.

Treatment is likely to take place at a hospital with a specialist hepatology unit, which treats disorders of the liver, gallbladder and biliary ducts.

Stoppingcirrhosis getting worse

Taking medication to treatthe underlying cause of the liver damage and making healthy lifestyle changes can help stop cirrhosis getting worse and reduce your risk of developing further health problems.

Medication

The medication you need will depend on the specific cause of the damage to your liver.

For example, if you have viralhepatitis, you may be prescribed anti-viral medications.

If you have autoimmune hepatitis, you may be given steroid medication (corticosteroids) or medication to suppress your immune system (immunosuppressants).

Lifestyle changes

There are a number of things you can do to help yourself stay healthy and reduce your chances of developing further problems if you have cirrhosis.

Theseinclude:

• completely avoiding alcohol , regardless of the cause of your cirrhosis, asalcohol consumption increases the rate at which the condition progresses
• losing weight if you're overweight or obese
• regular exercise toreduce muscle wasting
• practising good hygiene to reduce your chances of developing infections
• speaking to your GP about vaccinations you may need, such as the annual flu vaccine or travel vaccines
• speaking to your GP or pharmacist ifyou're taking over-the-counter or prescription medications, as cirrhosis can affect the way your body processes some medicines

Malnutrition is common in people with cirrhosis, so it's important to ensure you have a balanced diet to help you get all the nutrients you need.

Avoiding salty foods andnot adding salt to foods you eat can help reduce your risk of developing swelling in yourlegs, feet and tummy (abdomen) caused by a build-up of fluid.

See tips for a lower salt diet for more information.

The damage to your liver can alsomean it'sunable to store glycogen,a carbohydrate that provides short-term energy.

When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. This means youmay need extra calories and protein in your diet.

Healthy snacking between meals can top up your calories and protein.It may also be helpful to eat three or four small meals a day, rather than one or two large meals.

Easing symptoms

A number of treatments can ease the symptoms of cirrhosis, including:

• a low-salt diet ortablets called diureticsto reduce the amount of fluid in your body
• tablets to reduce high blood pressure in your portal vein, the main vein that transports blood from the gut to the liver, and prevent or treat any infection
• creams to reduce itching

Managing complications

In cases of advanced cirrhosis, complications caused by the condition mayneed treatment.

Swollen varices

If you vomit blood or pass blood in your stools , you probably have swollen veins in your oesophagus, the long tube that carries food from the throat to the stomach. These are known as oesophageal varices.

Urgent medical attention is required in these cases. This means seeing your GP or going to the accident and emergency (A&E) department of your nearest hospital immediately.

Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as:

• banding a procedure where a thin, flexible tube is passed down your throat (endoscopy) is carried out, and a small band is placed around the base of the varices to help control the bleeding
• injection glue therapy after an endoscopy, a type of medical "super glue" is injected into the varices to make the blood clot, which helps stop the bleeding
• Sengstaken tube with a balloon on the end a specialtube is passed down your throat into your stomach and the balloon is inflated, whichputs pressure on the varices and helps stop the bleeding; you'll be heavily sedated during the procedure
• transjugular intrahepatic portosystemic stent shunt (TIPSS) a metal tube called a stent is passed across your liver to join two large veins called the portal vein and hepatic vein; this creates a new route for your blood to flow through, relieving the pressure that causes the varices

You may also be given a type of medication called a beta-blocker , such as propanolol, to reduce the risk of bleeding or the severity of any bleed thatdoes occur.

Fluid in thetummy and legs

A build-up of fluid around your stomach area (ascites) and fluid around your legs and ankles (peripheral oedema ) are common complications of advanced cirrhosis. They'll need to be addressed as soon as possible.

You may have 20 to 30 litres of free water in your stomach area, which can make it difficult for you to eat and breathe properly.

The main treatments for ascites and oedema are restrictingsalt in your diet and taking diuretic tablets, such as spironolactone or furosemide.

If thefluid around your stomach becomes infected, you may need to be treated with antibiotics . Alternatively, antibiotics may be used on a regular basisto prevent infection in people at high risk.

In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks.

Encephalopathy

People with cirrhosis can sometimes develop problems with their brain function (encephalopathy) . This occurs because the liver isn't clearing toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative to help clear the bowels, and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used.

Bleeding

Cirrhosis can affect the liver's ability to make the blood clot, leaving you at risk of severe bleeding if you cut yourself.

Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. You'll need to apply pressure to any cuts that bleed.

You should seek specialist advice before having medical procedures, including any dental work.

Liver transplant

Your liver may stop functioning if it's severely damaged by scarring. In this situation, a liver transplant is the only option.

This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver.

You will probably have to wait a long time for a liver transplant asthere are more people waiting for a transplant than there are donors.

The NHS Blood and Transplant Organ Donation website has more information about transplants and joining the Organ Donor Register .