Wednesday, December 2, 2009

Cirrhosis - Diagnosis and Treatment

In my last update on Liver I am about to publish some valuable information on the diagnosis and treatment of Liver. Videos have been added for better understanding at the end of this article. I hope you find it useful.

How is cirrhosis diagnosed?

The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests, and imaging. The doctor will ask about the person’s medical history and symptoms and perform a thorough physical examination to observe for clinical signs of the disease. For example, on abdominal examination, the liver may feel hard or enlarged with signs of ascites. The doctor will order blood tests that may be helpful in evaluating the liver and increasing the suspicion of cirrhosis.

To view the liver for signs of enlargement, reduced blood flow, or ascites, the doctor may order a computerized tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or liver scan. The doctor may look at the liver directly by inserting a laparoscope into the abdomen. A laparoscope is an instrument with a camera that relays pictures to a computer screen.

A liver biopsy can confirm the diagnosis of cirrhosis but is not always necessary. A biopsy is usually done if the result might have an impact on treatment. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy.

How is the severity of cirrhosis measured?

The model for end-stage liver disease (MELD) score measures the severity of cirrhosis. The MELD score was developed to predict the 90-day survival of people with advanced cirrhosis. The MELD score is based on three blood tests:

  • international normalized ratio (INR)—tests the clotting tendency of blood
  • bilirubin—tests the amount of bile pigment in the blood
  • creatinine—tests kidney function

MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of 90-day survival.


How is cirrhosis treated?

Treatment for cirrhosis depends on the cause of the disease and whether complications are present. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for cirrhosis with complications.

Eating a nutritious diet:

Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If ascites develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement taken by mouth or through a nasogastric tube—a tiny tube inserted through the nose and throat that reaches into the stomach.

Avoiding alcohol and other substances:

People with cirrhosis are encouraged not to consume any alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medications—prescription and over-the-counter—can affect liver function, a doctor should be consulted before taking them.

Treatment for cirrhosis also addresses specific complications. For edema and ascites, the doctor will recommend diuretics—medications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites will require intravenous (IV) antibiotics.

The doctor may prescribe a beta-blocker or nitrate for portal hypertension. Beta-blockers can lower the pressure in the varices and reduce the risk of bleeding. Gastrointestinal bleeding requires an immediate upper endoscopy to look for esophageal varices. The doctor may perform a band-ligation using a special device to compress the varices and stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes.

Hepatic encephalopathy is treated by cleansing the bowel with lactulose—a laxative given orally or in enemas. Antibiotics are added to the treatment if necessary. Patients may be asked to reduce dietary protein intake. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled.

Some people with cirrhosis who develop hepatorenal failure must undergo regular hemodialysis treatment, which uses a machine to clean wastes from the blood. Medications are also given to improve blood flow through the kidneys.

Other treatments address the specific causes of cirrhosis. Treatment for cirrhosis caused by hepatitis depends on the specific type of hepatitis. For example, interferon and other antiviral drugs are prescribed for viral hepatitis, and autoimmune hepatitis requires corticosteroids and other drugs that suppress the immune system.

Medications are given to treat various symptoms of cirrhosis, such as itching and abdominal pain.

When is a liver transplant indicated for cirrhosis?

A liver transplant is considered when complications cannot be controlled by treatment. Liver transplantation is a major operation in which the diseased liver is removed and replaced with a healthy one from an organ donor. A team of health professionals determines the risks and benefits of the procedure for each patient. Survival rates have improved over the past several years because of drugs that suppress the immune system and keep it from attacking and damaging the new liver.

The number of people who need a liver transplant far exceeds the number of available organs. A person needing a transplant must go through a complicated evaluation process before being added to a long transplant waiting list. Generally, organs are given to people with the best chance of living the longest after a transplant. Survival after a transplant requires intensive follow-up and cooperation on the part of the patient and caregiver.

Related Video Links:

  1. http://www.indyarocks.com/videos/Understanding-the-Liver-372904
  2. http://www.indyarocks.com/videos/Cirrhosis-372906
  3. http://www.indyarocks.com/videos/Liver-Donation-Facts-374811
  4. http://www.indyarocks.com/videos/An-Introduction-to-Liver-Donor-Transplant-Evaluati-374814
  5. http://www.indyarocks.com/videos/The-informed-consent-process-for-Liver-Donation-374816
  6. http://www.indyarocks.com/videos/The-Liver-Donation-Evaluation-Process-374818
  7. http://www.indyarocks.com/videos/Liver-Transplant-Doctors-PerspectiveOverview-374823
  8. http://www.indyarocks.com/videos/Liver-Transplant-Recipients-PerspectiveOverview-374826
  9. http://www.indyarocks.com/videos/Potential-Benefits-and-Risks-to-both-the-Liver-Don-374830
  10. http://www.indyarocks.com/videos/Liver-Donation-Tests--Ultra-Sound-374835
  11. http://www.indyarocks.com/videos/Liver-Transplant-Tests--CT-Scan-374836
  12. http://www.indyarocks.com/videos/Liver-Donation-Tests--MRI-374837
  13. http://www.indyarocks.com/videos/Liver-Donation-Tests--ECG-374838
  14. http://www.indyarocks.com/videos/Liver-Donation-Tests--Biopsy-374839
  15. http://www.indyarocks.com/videos/Liver-Donation-Tests--Angiogram-374840
  16. http://www.indyarocks.com/videos/Mental-Health-Evaluation--Liver-Transplant-374842
  17. http://www.indyarocks.com/videos/Liver-Donor-Surgery-details-374845
  18. http://www.indyarocks.com/videos/Liver-Transplant-Recipients-Perspective--in-dept-374848
  19. http://www.indyarocks.com/videos/Minor-Donor-Liver-Transplant-Problems-374851
  20. http://www.indyarocks.com/videos/Major-Liver-Donor-Surgery-Problems-374860
  21. http://www.indyarocks.com/videos/Liver-Transplant-Issues-374865
  22. http://www.indyarocks.com/videos/Alternatives-to-Liver-Donation-374872
  23. http://www.indyarocks.com/videos/Your-Rights-as-a-Liver-Donor-374877
  24. http://www.indyarocks.com/videos/Liver-Donor-Transplant-Evaluation--Presentation-374884


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