Cirrhosis: Diagnosis and Treatment

Diagnosis

• History and physical examination should include a special focus on alcohol use, exposure to toxins, intravenous drug abuse, blood transfusions, history of viral infections, the presence of tattoos, and the characteristic symptoms of cirrhosis.
• Blood tests can reveal abnormal liver function early in the course of disease. As the disease progresses, blood tests become more abnormal.
• Abdominal CT scan and ultrasound are usually the first tests to evaluate the liver. They can demonstrate the abnormal liver architecture that occurs in cirrhosis and can identify complications of the disease, such as ascites (abnormal abdominal fluid collection) and liver cancer.
• Ultimately, liver biopsy provides a definitive diagnosis. It is not always necessary, especially when cirrhosis is strongly suspected by history and testing.
• Further tests, such as endoscopy, may be required to diagnose the complications of cirrhosis as they arise. During endoscopy, a thin tube with a camera on its end is slowly advanced through the mouth and into the throat and stomach. This procedure is able to identify bleeding and other disorders.

Treatment

Cirrhosis is irreversible. Treatment is aimed at slowing the progression of the disease, preventing and treating complications, and, if possible, providing a cure through liver transplantation.

• The cause of cirrhosis should be identified and treated. Strict alcohol avoidance is necessary in alcoholics. Avoid medications or drugs that are toxic to the liver, such as acetaminophen (Tylenol). Patients with viral hepatitis should be treated with appropriate antiviral therapies.
• It is also critical to prevent and treat cirrhosis complications. Bleeding in the esophagus is a medical emergency that requires immediate treatment with endoscopy or intravenous medications. Patients with hepatic encephalopathy may benefit from lactulose. Patients with ascites can manage their condition with sodium restriction, diuretics, and antibiotics. In advanced cases of ascites, paracentesis, a procedure to remove abnormal fluid from the abdomen, may be necessary.
• All patients with cirrhosis require regular screening for the development of liver cancer. This can be done by blood tests and ultrasound.
• Ultimately, liver transplantation is the only potential cure. Transplantation is an option for appropriate patients with advanced disease. However, transplantation is contraindicated in patients who continue to use alcohol or drugs. It is also contraindicated in patients who are unsuitable for surgery due to heart or lung disease.