Liver cirrhosis refers to the end stage of chronic liver disease where continuous damage to normal liver tissue has resulted in the formation of scar tissue. Often individuals with mild to moderate liver cirrhosis exhibit no symptoms. If the disease is not detected and is left untreated complications including jaundice, bleeding in the esophagus or stomach, fluid buildup in the legs and/or abdomen, or brain disease may develop. Asymptomatic patients who have been diagnosed with liver cirrhosis are closely monitored in order to detect the development of complications. They may also be treated for the underlying cause of liver cirrhosis. The U.S. Department of Veterans Affairs reports the two most common causes of liver cirrhosis in Americans are chronic alcohol consumption and hepatitis C infection.
Medications for Alcoholism
Liver scarring is irreversible; the goal of initial treatment in patients with liver cirrhosis is to prevent further liver damage. Alcohol is toxic to liver cells and patients with alcohol-caused liver cirrhosis must abstain from drinking to prevent further liver damage. An article in the Swedish Health Library states that the three drugs approved by the U.S. Food and Drug Administration to treat alcoholism are disulfiram, naltrexone and acamprosate. These drugs work either by exacerbating the symptoms of hangovers, by decreasing the craving for alcohol or by reducing the anxiety associated with quitting drinking alcohol.
Antiviral Medications
If the underlying cause of liver cirrhosis is hepatitis C infection patients may be treated with the antiviral drug ribavirin in combination with interferon. Although less common in the U.S., hepatitis B infection can also lead to liver cirrhosis and may be treated with one of the antiviral drugs lamivudine, adnovir, entecavir or telbivudine. Antiviral drugs work by blocking the replication of hepatitis viruses. Interferon stimulates the immune system to attack viruses and cells that are infected with viruses.
Portal Hypertension Treatment
The V.A. reports that some of the more serious complications of liver cirrhosis are caused by portal hypertension, which is an increase in blood pressure in the liver. Drugs that are used to decrease portal hypertension in patients with liver cirrhosis are diuretics and nonselective beta-blockers. Diuretics increase urine production and consequently reduce blood volume and blood pressure. Nonselective beta-blockers such as propranolol or nadolol reduce blood pressure by decreasing cardiac output. Blood vessel hemorrhaging may also be prevented by treatment with drugs that reduce blood flow to the liver or surgically with the procedures of endoscopic variceal ligation or intrahepatic shunting, also known as TIPS.
Liver Transplant
Hepatorenal syndrome is the rapid deterioration of kidney function and is a life-threatening condition that may develop in patients with severe liver cirrhosis; it usually requires liver transplantation. The V.A. reports that the vasoconstrictors octreotide, midodrine or terlipressin have shown some efficacy in treating hepatorenal syndrome during the waiting period for a liver transplantation. Liver transplant involves removing the patient's damaged liver and replacing it with part or all of a donor liver. Antirejection medications must be taken for the rest of the patient's life to prevent damage to the new liver.
Lactulose
A consequence of decreased hepatic function is hepatic encephalopathy, which refers to the development of neuropsychiatric symptoms, such as irritability, confusion and tremors. Normally functioning liver removes ammonia from the blood and converts it to urea, which is then excreted. In patients with advanced liver cirrhosis, ammonia, which is toxic the brain, accumulates in the blood. The V.A. recommends that patients who exhibit symptoms of hepatic encephalopathy be treated with lactulose, which is a sugar metabolized by bacteria in the colon. The bacterial metabolism of lactulose in the colon draws out ammonia from the blood and improves the symptoms of hepatic encephalopathy.
