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The aim of the liver cirrhosis treatment is to halt further liver damage, control symptoms, and to manage complications. In this article, you will know about step by step guide of Liver Cirrhosis treatment that you can follow.
It has been recently found that some level of reversal of cirrhosis can be achieved in certain cases. These cases could be:
• People with alcoholic cirrhosis who completely stop drinking alcohol
• People with NASH undergoing bariatric surgery and achieving successful weight loss
• Alcohol abstinence: The person should completely avoid alcohol. Amongst the people who completely stop drinking alcohol 65% of them are found alive after 3 years as compared to 0% of people who don’t stop drinking.
• Weight loss: Obese people with NASH should lose weight.
• Avoid viral hepatitis risk factors: People should avoid doing things that can lead to increased risk of viral hepatitis such as unprotected sex, sharing a needle, etc.
• Drug precautions: cirrhotics should avoid using NSAIDs. They can take paracetamol for pain up to 2 g/day (if abstinent from alcohol). Herbal supplements should be avoided.
• A person should take about 1.2 to 1.5 gm of protein per kg of dry body weight every day.
• People should avoid overnight fasting. It is recommended to take late evening meals.
• In case of ascites a person should restrict sodium in food to a value not more than of 2000 mg/day in Liver cirrhosis treatment.
• The fluid intake is kept normal and restricted only when serum sodium concentration becomes less than 120 to 125 mmol/L.
• Prevention of bleeding of varices: a person has to undergo endoscopy to check for the presence of dilated veins in the food pipe. If the endoscopy shows significantly large varices or varices with a high chance of rupture then preventive measures are to be taken to avoid rupture and bleeding. This type of Liver Cirrhosis Treatment can be done through the following methods:
– Medicines: oral tablets of propranolol can be taken in the initial stage.
– Endoscopic procedure: ligation of the dilated blood vessels with the help of endoscopy has been found to be more effective than medicines without increasing the risk of death. The procedure has to be repeated every 1 to 8 weeks until the dilated vessels become completely obliterated.
• Management of malnutrition: A significant number of people (20 to 60%) with compensated cirrhosis have a tendency to develop malnutrition during the course of the disease. This can be prevented by high consumption of protein every day of 1 to 1.5 g/kg of dry body weight.
• Evaluation for liver transplant referral: These people are also evaluated by the doctors and a score is given to assess the requirement for a liver transplant. A person is referred to a liver transplant doctor for evaluation if the Model for End-stage liver disease score comes out to be 15 or more).
A person should seek evaluation for transplant at the first episode of decompensation.
He or she should avoid undergoing any surgery other than transplant during this period.
Another important goal in people with decompensated cirrhosis is to manage complications and prevent further worsening.
– If the fluid inside the abdomen makes your abdomen tense, then the doctor would take out the fluid using a needle or catheter to reduce tension and relieve symptoms. A small amount of fluid is sent for the examination. The rest of the liver cirrhosis treatment is followed after this.
– The doctor would ask you to restrict the amount of sodium intake in the food up to 2000 mg/day. He would also give diuretics. Spironolactone is generally given with or without furosemide.
– In the case of ascites that doesn’t respond to medicines, repeated removal of fluid is done serially.
– Some procedures in liver cirrhosis treatment such as TIPS or peritoneovenous shunt could also be done to manage such ascites.
– If you develop abdominal pain and fever with ascites it may suggest abdominal infection, spontaneous bacterial peritonitis (SBP). This is a serious complication that needs urgent medical attention. To manage this the doctor would take out a small amount of fluid to investigate it and start the antibiotic treatment for liver cirrhosis after that.
– Antibiotics such as cefotaxime, piperacillin-tazobactam, or ceftriaxone, meropenem plus daptomycin are given.
– The people who survive the infection (SBP) should take long-term preventive treatment with trimethoprim-sulfamethoxazole, norfloxacin, or ciprofloxacin daily.
– To prevent the bleeding of varices the same measures are taken as in patients of compensated cirrhosis.
– If you develop bloody vomiting, black-colored stools, or low blood pressure, it might indicate bleeding varices. This needs immediate medical attention which would aim to stabilize your vitals, stop bleeding, and reduce the risk of re-bleeding.
– If vitals are stable, bleeding is stopped by endoscopy and sclerotherapy/banding.
– If vitals remain unstable with ongoing bleeding, portal decompression with TIPS can be used to control bleeding
– You would also be given antibiotics such as quinolone or ceftriaxone for 7 days to prevent bacterial infections during this period.
– The doctor would first try to identify and treat conditions that are precipitating the hepatic encephalopathy. These conditions could be gastrointestinal bleeding, infection, etc.
– Medicines are also given to decrease the production and absorption of ammonia which leads to hepatic encephalopathy. Generally, lactulose is given for this which induces soft stools. A dose that leads to the production of soft stools 3 times a day is recommended. A dose that causes diarrhea has to be avoided. In a person with severe or refractory hepatic encephalopathy, the doctor would give rifaximin along with lactulose.
A person with end-stage liver disease/chronic liver disease needs a liver transplant for survival.
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