When this happens, a person may vomit blood or have stool that is black and tarry. The risk of bleeding from varices can be reduced by blood pressure medicines known as beta-blockers or by a surgical procedure in which tiny rubber bands are tied around the varices. Another problem caused by high pressure in the veins of the liver is ascites.
Fluid leaks out into the belly and it begins to fill it up. This can make the abdomen enlarge like a balloon filled with water. The legs can get swollen too. This can be very uncomfortable. Eating can be a problem because there is less room for food. Even breathing can be a problem, especially when the person is lying down.
But the most dangerous problem with ascites is infection, which can be life-threatening. Ascites may go away with a low salt diet, and with diuretics water pills ordered by your provider. But sometimes a provider must actually drain the fluid from the belly using a special kind of needle. A liver that is working poorly may not be able to get rid of toxic substances like ammonia which comes from the intestines , and it may allow these substances to go into the brain and cause confusion.
Besides confusion, toxins in the brain cause changes in sleep, mood, concentration, and memory. If extremely serious, it can even cause a coma. These are all symptoms of hepatic encephalopathy. With encephalopathy, a persons may have problems driving, writing, calculating, and performing other activities of daily living. Signs of encephalopathy are trembling and hand "flapping.
A liver that is working poorly cannot get rid of bilirubin, a substance that produces a yellowing of the eyes and skin called jaundice. Too much alcohol and some medicines can also lead to jaundice. The model for end-stage liver disease MELD score measures the severity of cirrhosis. The MELD score was developed to predict the day survival of people with advanced cirrhosis. The MELD score is based on three blood tests:.
MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of day survival. 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. Patient with cirrhosis may have an upper endoscopy pronounced "en-dahs-cup-ee" periodically see figure at right.
A thin tube with a camera can be inserted into the mouth to look for varices in the esophagus food tube and the stomach. The endoscopy is repeated every few years to monitor for varices. 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. 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. 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. 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.
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.
Fluid buildup may also cause nausea, loss of appetite, and abdominal and back pain. The person may also be at risk of developing an infection when this fluid is present. But the health care team can often drain the fluid. This will temporarily reduce abdominal and back discomfort, shortness of breath and nausea. The fluid may come back in a few weeks occasionally sooner. But the team can drain it again.
This is a medication that helps the body get rid of unwanted fluid. The doctor may also prescribe an opioid pain medication to help relieve discomfort and shortness of breath and an anti-nausea medication.
Another complication of end-stage liver failure is reduced brain function. This is because toxins such as ammonia build up in the blood, causing confusion. The person may be unable to tell night from day. He or she may also display irritability and personality changes, or have memory problems. As brain function continues to decline, he or she will become sleepy and increasingly confused. Doctors use several measurements to determine the outlook of someone with cirrhosis, but these only provide estimates.
If you have cirrhosis, your doctor can give you a better idea of your outlook and what you can do to improve it. Being diagnosed with a long-term health condition can be frightening and disorienting. However, you can take steps to maximize your quality of life…. Decompensated cirrhosis refers to advanced cirrhosis. Experts say the excessive drinking among younger adults can also damage their pancreas, heart, and brain. The Child-Pugh score is a system for assessing the prognosis of chronic liver disease and cirrhosis.
It can be used to determine the required…. Snuff is a dried form of tobacco that can raise your risk of health problems. Learn how to quit, starting today. Health Conditions Discover Plan Connect. It is common not to feel any discomfort during the inflammation stage and not to notice any other symptoms. However, without treatment, the inflammation may remain, and it can start to cause permanent damage to the liver. Without treatment, scarring may start to develop on the inflamed liver.
Excessive buildup of scar tissue on the liver is called liver fibrosis. Over time, excess scar tissue replaces the healthy liver tissue. As scar tissue begins to build up, the liver may not function as well as it previously did. Additionally, the scar tissue can stop blood from flowing through the liver. If a person seeks medical attention and treatment at this stage, there is still a possibility that the liver will be able to heal.
It is at this stage that people typically begin to notice symptoms. Cirrhosis can potentially lead to a few complications, including liver cancer. Without treatment, cirrhosis can worsen. As a result, the liver may stop working properly or at all.
Some doctors may also refer to ESLD as chronic liver failure. The average survival rate of people with ESLD depends on the symptoms and complications that the individual experiences. People who develop ascites , a buildup of fluid in the abdomen, have a median survival rate of 6 months if it does not respond to treatment. ESLD also leads to complications, such as hepatic encephalopathy , which affects brain function.
In cases where treatment proves ineffective for this condition, the average survival rate is 12 months. The causes of acute and chronic liver failure differ.
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