Cirrhosis is a chronic and progressive disease of the liver in which healthy tissue is replaced with scar tissue, leading to the loss of liver function. It is often caused by excessive alcohol consumption, viral hepatitis, or non-alcoholic fatty liver disease. If left untreated, cirrhosis can lead to liver failure and other life-threatening complications. Fortunately, advances in medical treatments have improved the management of cirrhosis and its related complications.

Nutritional Support and Lifestyle Changes

A balanced diet low in sodium is crucial to prevent fluid retention in patients with cirrhosis. Excessive sodium intake can exacerbate fluid buildup in the abdomen and legs, leading to conditions such as ascites and edema. Fresh fruits and vegetables, lean proteins, and whole grains should form the basis of the diet. A dietitian can provide personalized guidance to meet nutritional needs while adhering to sodium restrictions.

Regular physical activity is vital in maintaining overall health, particularly for patients with cirrhosis. Engaging in moderate exercise, such as walking, swimming, or yoga, can help improve cardiovascular health, reduce muscle wasting, and maintain a healthy weight. Physical activity also supports mental well-being by reducing stress and improving mood, which is especially important for individuals managing a chronic condition.

One of the most critical steps for patients with cirrhosis is to abstain from alcohol completely. Alcohol is a known toxin to the liver, and its consumption can significantly accelerate the progression of liver damage and exacerbate existing cirrhosis. Even small amounts of alcohol can trigger harmful inflammation and further scarring of liver tissue. Abstinence from alcohol not only halts the progression of liver damage but also provides the liver with the opportunity to regenerate and improve function to some extent.

Management of Portal Hypertension and Varices

Portal hypertension, a common complication of cirrhosis, refers to increased blood pressure within the portal vein system, which carries blood from digestive organs to the liver. This condition can lead to the development of varices, which are enlarged veins that can rupture and cause life-threatening bleeding.

Pharmacological Interventions - These medications decrease the heart rate and reduce blood flow into the portal vein. The goal is to lower the risk of bleeding from varices, which can be severe and life-threatening. Patients must take these medications as prescribed and attend regular follow-up appointments to monitor their effectiveness.

Endoscopic Procedures - These procedures are generally safe and are performed on an outpatient basis, though they require follow-up to manage new or recurrent varices.

Surgical and Radiological Approaches - This procedure can significantly lower the risk of variceal bleeding and improve symptoms of portal hypertension. However, it comes with risks, including hepatic encephalopathy, and thus requires careful patient selection and monitoring.

Management of portal hypertension and varices is a multi-faceted approach that combines medication, minimally invasive procedures, and surgical interventions. With comprehensive care and regular monitoring, patients with cirrhosis can achieve better control over their condition and reduce the risk of life-threatening complications.

Liver Transplant Consideration

For many patients with advanced cirrhosis or those who do not respond to other treatments, a liver transplant may be the best option to improve their quality of life and long-term prognosis. A liver transplant involves replacing the damaged liver with a healthy one from a deceased or living donor. The procedure is complex and requires a thorough evaluation process to determine a patient's suitability.

Evaluation Process

The evaluation for a liver transplant is comprehensive and involves multiple tests to assess the severity of liver disease, overall health, and potential contraindications. This includes blood tests, imaging studies, heart and lung function tests, and assessments by various specialists. The aim is to ensure that the patient is healthy enough to undergo surgery and that they do not have any conditions that would compromise the success of the transplant.

Eligibility Criteria

Eligibility for a liver transplant is determined by several factors, such as the Model for End-Stage Liver Disease (MELD) score, which quantifies the severity of liver disease. Patients with higher MELD scores are prioritized as they have a greater urgency for a transplant. Other factors include the absence of severe cardiovascular disease, controlled infections, and a commitment to abstain from alcohol and drug use.

Waiting List and Donor Matching

Once deemed eligible, patients are placed on the national transplant waiting list. The wait time can vary significantly based on factors like blood type, body size, and donor availability. Matching a donor liver involves compatibility testing to ensure the organ is suitable and will not be rejected by the recipient's immune system.

Post-Transplant Care

After the transplant, patients require lifelong immunosuppressive therapy to prevent organ rejection. Regular follow-up visits are essential for monitoring liver function, managing potential complications, and ensuring overall health. Lifestyle modifications, such as a healthy diet, regular exercise, and avoiding alcohol and tobacco, are crucial for maintaining the health of the new liver.

Liver transplantation offers hope and a new lease on life for patients with advanced cirrhosis. With careful evaluation, meticulous surgical care, and diligent post-transplant management, many patients go on to lead healthy, fulfilling lives. If you have more questions, contact Needham Gastroenterology Associates. Our experienced physicians are here to answer them or provide treatment if needed—schedule an appointment.