Nov 15, 2001 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

Information from Your Family Doctor

Cirrhosis - A Liver Problem

Am Fam Physician. 2001 Nov 15;64(10).

What is cirrhosis?

If the liver is damaged, scars can form. When the liver has a lot of scar tissue, blood will not easily flow through it. Cirrhosis is the name for a scarred liver. (Say this: sir-oh-sis.) Cirrhosis keeps the liver from working the way it should. A liver with cirrhosis can't make enough of some proteins your body needs. It can't remove enough harmful toxins (poisons) from your blood. It can't help your blood to clot normally.

What causes cirrhosis?

Cirrhosis is most often caused by heavy use of alcohol or by an infection (usually with the hepatitis B or hepatitis C virus). Some medicines and chemicals can hurt the liver. Diseases that weaken the immune system and some inherited diseases can damage the liver.

What problems can cirrhosis cause?

  • People with cirrhosis bruise easily because their blood does not clot the right way. When these people have a cut, it may bleed for a long time.

  • Blood vessels around the esophagus (in the throat) and the intestines can stretch and become thin. If these blood vessels burst open, the result is a dangerous amount of bleeding.

  • Because the liver is not working right, toxins build up in the blood. They can hurt your brain. People with cirrhosis are also more likely to get liver cancer.

  • If the cirrhosis is so bad that the liver stops working, the only treatment is a liver transplant.

  • Cirrhosis can cause death. According to the American Liver Foundation, cirrhosis is the 8th leading cause of death in the United States.

Some Medicines, Vitamins and Herbal Remedies That May Be Harmful to Patients with Cirrhosis*

* - Not all of the dangerous medicines and herbal remedies are included in this list. Ask your doctor for more information about every medicine and herbal product you use.

† -Acetaminophen in a dosage of 500 mg four times daily (2,000 mg per day) is safe; higher doses can harm the liver.

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Some Medicines, Vitamins and Herbal Remedies That May Be Harmful to Patients with Cirrhosis*

Over-the-counter medicines

Ibuprofen (brand names: Advil, Motrin), ketoprofen (brand name: Orudis KT), naproxen (brand name: Aleve)

Acetaminophen (brand name: Tylenol)†

Prescription medicines

Some antidepressants

Diabetes medicines like rosiglitazone (brand name: Avandia), pioglitazone (brand name: Actos), and troglitazone (brand name: Rezulin)

Estrogens

Cholesterol-lowering medicines like atorvastatin (brand name: Lipitor) and simvastatin (brand name: Zocor)

Some muscle relaxants

Rofecoxib (brand name: Vioxx) and celecoxib (brand name: Celebrex)

Oral medicines for fungus infections, like fluconazole (brand name: Diflucan), itraconazole (brand name: Sporanox), and ketoconazole (brand name: Nizoral)

Prescription ketoprofen (brand name: Orudis), naproxen (brand name: Anaprox), ibuprofen (brand names: Advil, Motrin), rofecoxib (brand name: Vioxx), and celecoxib (brand name: Celebrex)

Vitamins

Niacin (also called nicotinic acid; brand name: Nicolar)

Vitamin A (in doses higher than 25,000 IU per day)

Herbal products

Amanita mushrooms

Chaparral

Comfrey

Germander

Pennyroyal oil

Senna fruit extracts


* - Not all of the dangerous medicines and herbal remedies are included in this list. Ask your doctor for more information about every medicine and herbal product you use.

† -Acetaminophen in a dosage of 500 mg four times daily (2,000 mg per day) is safe; higher doses can harm the liver.

Some Medicines, Vitamins and Herbal Remedies That May Be Harmful to Patients with Cirrhosis*

Over-the-counter medicines

Ibuprofen (brand names: Advil, Motrin), ketoprofen (brand name: Orudis KT), naproxen (brand name: Aleve)

Acetaminophen (brand name: Tylenol)†

Prescription medicines

Some antidepressants

Diabetes medicines like rosiglitazone (brand name: Avandia), pioglitazone (brand name: Actos), and troglitazone (brand name: Rezulin)

Estrogens

Cholesterol-lowering medicines like atorvastatin (brand name: Lipitor) and simvastatin (brand name: Zocor)

Some muscle relaxants

Rofecoxib (brand name: Vioxx) and celecoxib (brand name: Celebrex)

Oral medicines for fungus infections, like fluconazole (brand name: Diflucan), itraconazole (brand name: Sporanox), and ketoconazole (brand name: Nizoral)

Prescription ketoprofen (brand name: Orudis), naproxen (brand name: Anaprox), ibuprofen (brand names: Advil, Motrin), rofecoxib (brand name: Vioxx), and celecoxib (brand name: Celebrex)

Vitamins

Niacin (also called nicotinic acid; brand name: Nicolar)

Vitamin A (in doses higher than 25,000 IU per day)

Herbal products

Amanita mushrooms

Chaparral

Comfrey

Germander

Pennyroyal oil

Senna fruit extracts


* - Not all of the dangerous medicines and herbal remedies are included in this list. Ask your doctor for more information about every medicine and herbal product you use.

† -Acetaminophen in a dosage of 500 mg four times daily (2,000 mg per day) is safe; higher doses can harm the liver.

Can any of these problems be prevented?

If you have cirrhosis, it may be possible to avoid, or at least slow down, many of the problems caused by cirrhosis. Here are some things you can do to feel better for a longer time:

  • Don't drink any amount of alcohol of any kind.

  • Ask your doctor about getting important vaccines, like hepatitis A vaccine, hepatitis B vaccine, pneumococcal vaccine (to help prevent pneumonia) and influenza vaccine (to help prevent the flu). Hepatitis A infection is very dangerous for people with liver damage.

  • Tell your doctor about every medicine, vitamin and herbal remedy you are taking. Many medicines and herbal remedies are dangerous to people with cirrhosis (see the list in the box on the next page).

  • Follow a low-fat, "heart-smart" diet. Foods that are low in fat, oil, and salt are good for your liver and your heart.

  • Work with your doctor to set up a health care routine. In addition to your regular doctor visits, you will need tests at least once a year to check your liver and your risk for bleeding problems.

Where can I get more information about chronic liver disease and cirrhosis?

For more information, you can contact the following groups:

Hepatitis Information Network

Web address: http://www.hepnet.com

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

Telephone: 1-800-891-5389

Web address: http://www.niddk.nih.gov/health/digest/nddic.htm

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038

Telephone: 1-800-465-4837

Web address: http://www.liverfoundation.org

United Network for Organ Sharing

1100 Boulders Parkway, Suite 500

P.O. Box 13770

Richmond, VA 23225-8770

Telephone: 1-888-TXINFO1 (1-888-894-6361)

Web address: http://www.unos.org


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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