Cirrhosis (cont.)

Medical Author:

Jeffrey A Gunter, MD

Coauthor:

Erik D Barton, MD, MS

Medical Editor:

Scott H Plantz, MD, FAAEM

Medical Editor:

Francisco Talavera, PharmD, PhD

Medical Editor:

Steven L Bernstein, MD

Surgery

The only surgery that has been proven to improve the chances of long-term survival is liver transplantation.

• In this operation, the diseased liver is removed and replaced with a healthy liver from an organ donor.
• About 80-90 percent of people who undergo liver transplantation survive.
• As in all transplantation procedures, supportive care before and after the procedure is very important in determining the success of the operation.

Portal hypertension

Various surgeries can be performed to redirect liver blood flow into the circulatory system, reducing liver blood pressures. However, surgery may worsen hepatic encephalopathy or ascites.

Bleeding varices

If you have bleeding from varices in the esophagus or stomach, you are at high risk of bleeding to death.

• You will have to stay in the hospital until the bleeding is under control.
• You have a 1 in 2 chance of dying during that hospital stay if you suffer from bleeding varicose veins in your esophagus.

If you have significant blood loss, treatment will focus on restoring lost fluids.

• You will be monitored carefully until bleeding is controlled and your blood circulation is stabilized.
• Two large IV lines will be placed to replace lost fluids.
• You will need supplemental oxygen until you begin to replace some of the lost blood.
• You may need blood transfusions.

Ongoing bleeding from the esophagus is detected by inserting a tube down your nose into your stomach to suck out any pooled blood. Once bleeding is recognized, various methods are used to control it.

• Balloon inflation to compress the vein
• Medications that decrease blood flow into the liver
• Tying off the bleeding vein

Hepatorenal syndrome

For unknown reasons, liver failure sometimes leads to kidney failure.

• Kidney failure often causes other organs throughout the body to fail. This can be fatal.
• Liver transplant is the only treatment that works in this advanced disease.

Liver cancer

People with ongoing liver damage often develop liver cancer before they develop cirrhosis.

• People with liver cancer may die within 3-6 months after diagnosis if the cancer remains untreated.
• Even with treatment, people rarely survive beyond 5 years.
• Surgery is the only chance for a cure, but usually the cancer has progressed too far by the time surgery is performed.
• Liver transplantation may also be considered.