Please note: This information was as current as we could make it on the date given above. But medical information is always changing, and some information given here may be out of date.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.
An article on this topic is available in this issue of AFP.
Cirrhosis--A Liver Problem
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.
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.
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)ÝPrescription 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.
Ý -- Acetaminophen in a dosage of 500 mg four times daily (2,000 mg per day) is safe; higher doses can harm the liver.
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.comNational 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.htmAmerican Liver Foundation
75 Maiden Lane, Suite 603
New York, NY 10038
Telephone: 1-800-465-4837
Web address: http://www.liverfoundation.orgUnited 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 provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.
Visit familydoctor.org for information on this and many other health-related topics.
Copyright © 2001 by the American Academy of Family Physicians.
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.
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