View source for Cirrhosis (patient information)

'''For the WikiDoc page for this topic, click [[Cirrhosis|here]]'''
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{{Cirrhosis (patient infomration)}}

{{CMG}};  {{AOEIC}} {{JW}}

==Overview==
The [[liver]] is a large organ that locates in the upper abdomen, carrying out several essential functions, such as detoxifying harmful substances in the body, purifying blood and manufacturing vital nutrients. Cirrhosis occurs in response to chronic damage to your liver for several years. A number of diseases and conditions can cause the chronic liver damage that leads to cirrhosis. Chronic [[alcohol abuse]] is the most common cause of cirrhosis in the United States and other western countries. And chronic [[hepatitis]] B and C viruses are the most common cause in some Asian countries. Early cirrhosis does not have any symptoms. With the disease developing, the patient may experience symptoms such as [[fatigue]] and [[weakness]], [[loss of appetite]], [[nausea]] and [[vomiting]], [[weight loss]], [[abdominal pain]] and [[abdominal bloating]], [[itching]], [[jaundice]], even [[gastrointestinal bleeding]]. Blood tests, imaging procedures and liver [[biopsy]] may help diagnose. The goals of treatment of cirrhosis are to slow the progression of scar tissue in the liver and prevent or treat the [[complication]]s of the disease. Treatment options depend on the underling cause and whether complications are present. Usual treatments include medications and liver transplant surgery. The prognosis of cirrhosis depends on whether [[complication]]s are present and liver function.
==What causes Cirrhosis?==
Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. Common causes of chronic liver disease in the United States include:

* [[Hepatitis C ]]infection (long-term infection)
* Long-term [[alcohol abuse]] 

Other causes of cirrhosis include:

* Autoimmune inflammation of the liver
* Disorders of the drainage system of the liver (the biliary system), such as [[primary biliary cirrhosis]] and [[primary sclerosing cholangitis]]
* [[Hepatitis B ]]
* Medications
* Metabolic disorders of iron and copper ([[hemochromatosis]] and [[Wilson's disease]])
* [[Nonalcoholic fatty liver disease]] (NAFLD) and [[nonalcoholic steatohepatitis]] (NASH)

==What are the symptoms of Cirrhosis?==
Early cirrhosis does not have any symptoms. However, as the disease progresses, a person may experience the following symptoms:

:*[[Fatigue]] and [[weakness]]
:*[[Loss of appetite]]
:*[[Nausea]] and [[vomiting]]
:*[[Weight loss]]
:*[[Abdominal pain]] and bloating when fluid accumulates in the abdomen
:*[[Itching]]
:*[[Bleeding]] easily, even [[gastrointestinal bleeding]]
:*[[Jaundice]]
:*[[Spider angiomata]]
:*[[Confusion]]

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

==Who is at highest risk?==
Cirrhosis can be caused by many things, some known and others unknown:

:*Chronic alcohol abuse: This is the most common cause of cirrhosis in the United States and other western countries. 
:*Chronic Hepatitis B and C viruses and perhaps other viruses, can damage the liver over a prolonged time and eventually cause cirrhosis. This is the most common cause of cirrhosis in some Asian countries. 
:*[[Autoimmune hepatitis]]: The body's protective antibodies injure the liver cells  because  they fail to recognize the liver as its own tissue.
:*Chronic bile duct blockage
:*[[Wilson's Disease]] or [[hemochromatosis]]: Tetals are present in all body cells. When abnormal amounts of them accumulate in the liver, scarring and cirrhosis may develop.
:*[[Cystic fibrosis]] and [[Alpha l-antitrypsin deficiency]]
:*Nonalcoholic fatty liver disease
:*Drugs and toxins: Studies demonstrate that prolonged exposure to certain chemicals or drugs can damage the liver.

==Diagnosis==
:*Blood tests: Blood tests such as a [[complete blood count]], [[bilirubin]] test, [[coagulation study]] and [[liver function]] tests to determine the cause of cirrhosis, and assess liver function and coagulation function.
:*Imaging procedures and liver [[biopsy]]: Images studies such as ultrasound, computerized tomography ([[CT]]), and magnetic resonance imaging ([[MRI]]) can show the constructure of liver and organs nearby. These images tests can also be used to guide biopsy and a biopsy sample is usually removed and looked at under a microscope by a pathologist. Liver biopsy can tell valuable information about the disease.

==When to seek urgent medical care?==
Call your health care provider if symptoms of cirrhosis develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible: 
:*[[Jaundice]]
:*[[Gastrointestinal bleeding]]
:*[[Abdominal pain]]
:*[[Confusion]]

==Treatment options==
The goals of treatment of cirrhosis are to slow the progression of scar tissue in the liver and prevent or treat the [[complication]]s of the disease. Treatment options depend on the underling cause and whether complications are present. Hospitalization may be necessary for cirrhosis with complications.

:*Diet: Eating a nutritious diet is very important in all stages of cirrhosis. To improve nutrition, sometimes the doctor may add a liquid supplement taken by mouth or through a nasogastric tube. If ascites develops, a sodium-restricted diet is recommended. 
:*Treatments on the specific causes of cirrhosis: [[Interferon]] and other antiviral drugs may be prescribed for [[viral hepatitis]], and [[autoimmune hepatitis]] requires [[corticosteroid]]s and other drugs that suppress the immune system.
:*Avoiding alcohol: The alcoholic patient must permanently stop consuming alcohol. 
:*[[Edema]] and [[ascites]]: For edema and ascites, [[diuretics]] will be recommended to remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. 
:*[[Infection]]s: Oral [[antibiotic]]s may be prescribed to prevent infection. Severe infection with ascites will require intravenous antibiotics.
:*Portal hypertension: The doctor may prescribe a [[beta-blocker]] or [[nitrate]] to control portal hypertension and reduce the risk of [[bleeding]].
:*[[Gastrointestinal bleeding]]: This severe complication requires an immediate upper [[endoscopy]] to look for esophageal varices and to compress the varices to stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes.
:*[[Hepatic encephalopathy]]: At first, the patient may be asked to reduce dietary protein intake. Then, [[lactulose]] may be prescribed by oral or in enemas to cleanse the bowel. If necessary, antibiotics are added to the treatment. 
:*Hepatorenal failure: These patients must undergo regular hemodialysis treatment to improve blood flow through the kidneys.
:*Symptomatic treatment: Medications are given to treat various symptoms of cirrhosis, such as [[itching]] and [[constipation]].
:*[[Liver transplant surgery]]: Patients with advanced cirrhosis may require liver transplants if they have liver failure. Liver transplant is a procedure to remove your liver and replace it with a whole liver from a deceased donor or with part of a liver from a living donor.

===Medications to avoid===
{{MedCondContrPI

|MedCond =cirrhosis|Acetazolamide|Ranolazine|Ticagrelor|Triamterene}}

==Diseases with similar symptoms==
:*[[Hepatitis]]
:*[[Hepatocellular carcinoma]]
:*[[Chronic cholecystitis]]
:*[[Chronic pancreatitis]]
:*[[Peptic ulcer]]

==Where to find medical care for Cirrhosis?==
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|cirrhosis}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating cirrhosis]

==Prevention of Cirrhosis==
:*Avoidance of alcohol abuse
:*[[Vaccine]] for [[hepatitis B virus]]
:*Eat a healthy diet and maintain a healthy weight

==What to expect (Outlook/Prognosis)?==
The prognosis of cirrhosis depends on: 
:*Whether [[complication]]s, such as [[ascites]] and [[gastrointestinal bleeding]],  are present. 
:*Liver function
==Possible complications==
* [[Bleeding disorders ]](coagulopathy)
* Buildup of fluid in the abdomen ([[ascites]]) and infection of the fluid ([[bacterial peritonitis]])
* Enlarged veins in the esophagus, stomach, or intestines that bleed easily 
* Increased pressure in the blood vessels of the liver
* [[Kidney failure]] 
* [[Liver cancer]] 
* Mental[[ confusion]], change in the level of consciousness, or [[coma ]]

==Sources==
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/index.htm

http://www.hepatitis.va.gov/vahep?page=cirrh-00-00



[[Category:Patient information]]
[[Category:Gastroenterology patient information]]
[[Category:Hepatology patient information]]

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