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Can a liver recover from cirrhosis: Cirrhosis – Symptoms and causes

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How Quickly The Liver Can Repair Itself

Alcohol consumption and liver health is a fine balance – you don’t have to become a teetotaler to stay healthy, but you should be aware of how alcohol affects one of the most important organs of the body and what you can do to keep it healthy.

Alcohol affects men and women differently

The digestion of alcohol is different for men and women because men have a higher concentration of dehydrogenase, an enzyme that breaks down alcohol.

“When alcohol, or ethanol, reaches the liver, the cells of the liver have enzymes that help with the digestion and processing of alcohol,” explains Lance Stein, M.D., a transplant hepatologist at Piedmont Transplant. “When alcohol then reaches the blood, that’s when you feel the effects of alcohol.

How the body processes alcohol

There is no denying alcohol is a toxin to the liver, says Dr. Stein.

“As the liver is processing alcohol, it can damage the liver’s enzymes, which can lead to cell death,” he says. “As with any damage to any cell of any organ, there is always a process of healing.”

The liver’s healing process

One of the most incredible facts about the liver is that it is self-healing, just like your skin. For example, if you cut yourself, the wound eventually scabs over as it heals and possibly leaves you with a scar.

The same process happens in the liver. As cells die, scar tissue develops. This is known as liver cirrhosis. If excessive alcohol use and scarring continues over time, eventually the liver can become too scarred to function properly.

Some alcohol-related liver damage can be reversed if you stop drinking alcohol early enough in the disease process. Healing can begin as early as a few days to weeks after you stop drinking, but if the damage is severe, healing can take several months.

In some cases, “if the damage to the liver has been long-term, it may not be reversible,” warns Dr. Stein.

How much alcohol is too much?

“It’s important to know what you’re drinking because when people mix their own drinks, they’re often using more than the recommended amount,” says Dr. Stein. “They think they’re drinking one drink, but they’re actually having two or three.”

One serving of alcohol looks like:

The bottom line is that moderate alcohol use – no more than two to three drinks per day for men and one drink per day for women – should be acceptable and you should not expect any long-term damage.

“People who drink more heavily should be concerned and should seek medical counseling for assessment of whether they need assistance with stopping alcohol use or if they have any damage as a result of long-term alcohol use,” says Dr. Stein.

Learn more about liver health.

Need to make an appointment with a Piedmont physician? Save time, book online.

Alcohol-related liver disease – NHS

Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.

Symptoms of alcohol-related liver disease (ARLD)

ARLD does not usually cause any symptoms until the liver has been severely damaged.

When this happens, symptoms can include:

This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.

If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.

Information:

Coronavirus advice

Get advice about coronavirus and liver disease from the British Liver Trust

Alcohol and the liver

With the exception of the brain, the liver is the most complex organ in the body.  

Its functions include:

  • filtering toxins from the blood
  • aiding digestion of food
  • regulating blood sugar and cholesterol levels
  • helping fight infection and disease

The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die.

The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.

ARLD is very common in the UK. The number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse.

Read more about the causes of ARLD.

Stages of ARLD

There are 3 main stages of ARLD, although there’s often an overlap between each stage. These stages are explained below.

Alcoholic fatty liver disease

Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver.

This is called alcoholic fatty liver disease, and is the first stage of ARLD.

Fatty liver disease rarely causes any symptoms, but it’s an important warning sign that you’re drinking at a harmful level.

Fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your liver should return to normal.

Alcoholic hepatitis

Alcoholic hepatitis, which is unrelated to infectious hepatitis, is a potentially serious condition that can be caused by alcohol misuse over a longer period.

When this develops, it may be the first time a person is aware they’re damaging their liver through alcohol.

Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).

The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.

Severe alcoholic hepatitis, however, is a serious and life-threatening illness.

Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage.

Cirrhosis

Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms.

It’s generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.

A person who has alcohol-related cirrhosis and does not stop drinking has a less than 50% chance of living for at least 5 more years.

Treating alcohol-related liver disease (ARLD)

There’s currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life.

This reduces the risk of further damage to your liver and gives it the best chance of recovering.

If a person is dependent on alcohol, stopping drinking can be very difficult.

But support, advice and medical treatment may be available through local alcohol support services.

A liver transplant may be required in severe cases where the liver has stopped functioning and does not improve when you stop drinking alcohol.

You’ll only be considered for a liver transplant if you have developed complications of cirrhosis despite having stopped drinking.

All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life.

Complications

Death rates linked to ARLD have risen considerably over the last few decades.

Alcohol misuse is now one of the most common causes of death in the UK, along with smoking and high blood pressure.

Life-threatening complications of ARLD include:

  • internal (variceal) bleeding
  • build-up of toxins in the brain (encephalopathy)
  • fluid accumulation in the abdomen (ascites) with associated kidney failure
  • liver cancer
  • increased vulnerability to infection

Read more about the complications of ARLD.

Preventing alcohol-related liver disease (ARLD)

The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week

A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.

Even if you have been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health.

See our drinking and alcohol pages for more information and advice.

Video: liver disease

In this video, consultant hepatologist Mark Wright explains liver disease and how not drinking alcohol can help.

Media last reviewed: 1 July 2021
Media review due: 1 July 2024

Page last reviewed: 10 August 2018
Next review due: 10 August 2021

Things You Thought You Knew About Cirrhosis

You’ve probably heard of cirrhosis, a serious liver disease that leads some people to need liver transplants. But you may be surprised at what actually causes cirrhosis. Here, liver disease expert Helen Te, MD, explains the most common misconceptions about cirrhosis.

I don’t have any symptoms – there’s no way I could have cirrhosis.

False. It is possible to have cirrhosis of the liver and not know it. Many patients who have cirrhosis still have enough liver function to support their body’s daily operations and have no symptoms. Fatigue is a common symptom of cirrhosis, but feeling tired can be caused by many things. It’s only when liver dysfunction or failure sets in that you can experience symptoms like yellowing of the skin or eyes, confusion, fluid buildup in your belly, leg swelling and bleeding.

I don’t drink alcohol, so cirrhosis can’t affect me.

False. Cirrhosis is simply severe scarring of the liver caused by various ‘injuries’ over time. There can be several causes of those injuries, including hepatitis B or C, hereditary disorders of iron or copper overload, liver diseases caused by an overactive immune system, nonalcoholic fatty liver disease or drinking too much alcohol.

I might have cirrhosis, but the liver will heal itself naturally. The liver can regenerate after cirrhosis, right?

Partly false. The liver is indeed a highly regenerative organ, but only if it’s still healthy enough to do so and doesn’t have extensive scar tissue. Once cirrhosis is present, your liver’s regeneration becomes very limited. That’s why in most cases, cirrhosis can’t be reversed.

I have cirrhosis, but that doesn’t mean I have liver cancer. 

True. Liver cancer is one possible complication of cirrhosis, though. Early detection of liver cancer is critical, so if you do have cirrhosis, your doctor will want you to undergo periodic testing using blood and radiologic tests. Early-stage liver cancer can be cured with surgery or transplantation, depending on your health and the location and size of the tumor.

It’s good news that I’m gaining weight, despite having cirrhosis.

It depends. If your weight gain is from eating too many calories, this can lead to fat deposits on your liver, which can cause further injury. If your weight gain is due to fluid retention, it may be a sign that your liver is deteriorating. With cirrhosis, it’s important to eat a well-balanced diet to provide your body with all of the nutrients it needs and to avoid losing muscle mass.

Now that I’ve been diagnosed with cirrhosis, I’m going to need a liver transplant.

Not necessarily true. Your liver may still be able to perform all of its routine functions on a daily basis for a long time. However, having cirrhosis means you may experience the previously mentioned symptoms and have a risk for developing liver cancer. If your symptoms aren’t adequately controlled with medical therapy or you have early liver cancer that can’t be removed with surgery, you may need a liver transplant.

I have cirrhosis with some complications; a liver transplant will fix my health problems.

Liver transplants are complex surgeries and are usually a patient’s last option to get better. Despite your transplant team’s best intentions and efforts, however, complications from the surgery can occur. You’ll also have to take medications for life to prevent liver rejection. These medications may have side effects such as diabetes, high blood pressure, high cholesterol, kidney dysfunction or neurologic problems. Also, certain liver diseases can reoccur in the new liver after time, like cancer, autoimmune hepatitis, primary sclerosing cholangitis or primary biliary cholangitis. While a liver transplant is your best chance to return to a functional life if you have significant complications from cirrhosis, keeping your liver healthy enough to avoid a liver transplant in the first place is the best approach. You can do this by getting medical care for your liver condition early, taking medications prescribed by your doctor faithfully, maintaining a healthy weight and avoiding additional injury to the liver from alcohol.

Liver disease: Frequently asked questions

What are some of the symptoms of liver disease?

The most important thing to recognize about liver disease is that up to 50 percent of individuals with underlying liver disease have no symptoms. The most common symptoms are very non-specific and they include fatigue or excessive tiredness, lack of drive, and sometimes itching. Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool, bleeding from the GI tract, mental confusion, and retention of fluids in the abdomen or belly.

What quantity of alcohol usage should be seen as being a risk to the liver?

Any amount of alcohol can produce damage to the liver. In an otherwise healthy person with no underlying liver problems, the general rule of thumb is different for men and women:

  • Men metabolize and are able to clear alcohol more efficiently than women due to body size, body fat, and certain enzymes, so they should limit to three to four drinks in a day.
  • Women, because of the same reasons, should limit to one to two drinks in a day.

Beer and wine are not “safer” than whiskey or spirits. One drink is defined as one shot (1 and 1/4 ounces) of whiskey or spirits, one four-ounce glass of wine, or one 12-ounce beer. If an individual has an underlying liver condition such as hepatitis B or C, or prior damage from alcohol or other diseases, the liver is very sensitive to any amount of alcohol. In those conditions, the only safe dose of alcohol is zero.

I know alcoholism damages the liver, what other toxic substances are there that will do damage?

The most common agent is probably acetaminophen (Tylenol, although it is contained in many OTC medications). It remains the safest medication for fevers, aches, and pains, but only taken in small recommended amounts. Amounts greater than those recommended can result in liver damage or failure. Acetaminophen overdose is a common reason for considering a liver transplant.

A more serious problem occurs in patients who drink alcohol on a daily basis, particularly more than two drinks. In those situations, normal doses of Tylenol three to four times a day can produce severe liver damage. The same problem can occur in patients with the other liver diseases such as viral hepatitis. Additionally, more common toxins tend to be those that are inhaled, such as cleaning solvents, aerosolized paints, thinners, etc., which are more dangerous with an underlying condition.

Can liver damage be reversed?

The liver is a unique organ. It is the only organ in the body that is able to regenerate. With most organs, such as the heart, the damaged tissue is replaced with scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells. If up to 50 to 60 percent of the liver cells may be killed within three to four days in an extreme case like a Tylenol overdose, the liver will repair completely after 30 days if no complications arise.

Complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is the condition known as cirrhosis. The development of cirrhosis indicates late stage liver disease and is usually followed by the onset of complications.

How long can I go on drinking every day before it affects my liver?

The largest risk factor for liver disease from alcohol is the amount and the length of time the individual has been drinking. Males often develop complications that appear to be on a gender basis as well. Each individual is entirely different. Complication can develop after 5 to 10 years, though it more commonly it takes 20 to 30 years. Many individuals appear to never develop end stage liver disease from alcohol. This is impossible to predict ahead of time. And many other factors such as other diseases, hepatitis C, exposure to other toxins, as well as the individual’s own genetic make-up play a role.

What causes hepatitis?

Hepatitis is a generic term. It indicates inflammation and damage to liver cells. This damage can be caused by drugs, toxins, alcohol, inherited diseases, certain metabolic diseases, and viruses. Commonly, hepatitis refers to viral hepatitis. There are a wide variety of viruses that can cause hepatitis, but again most commonly the term refers to the viruses designated A, B, C, D, E, and G. In the United States, the most common causes are hepatitis A, B, and C.

How necessary is it to inform employers about HCV status?

Hepatitis C virus-positive patients face a number of difficulties due to the unfortunate stigma that is attached to this carrier status. Transmission or passing of this virus to others requires that they be exposed to the HCV-positive individual’s blood or bodily fluid. In most occupations this is not a risk and can be avoided by common sense. In situations where there is a risk of exposure due to trauma, due to use of needles or knives or other situations of this sort, it is probably best and most appropriate to let the employer know. In most situations, including the health care field, this is not a reason to not employ the individuals. Local laws may vary and this needs to be checked locally. If one does inadvertently expose one to blood or bodily fluid, there would be a moral obligation to let the other individual know.

How important are hepatitis vaccines?

There are vaccines to prevent hepatitis A and B. Hepatitis B is a disease that could be completely eradicated with universal vaccination. It is now one part of the newborn vaccination series. Attempts are ongoing to vaccinate all children by the time they reach junior high age. Adults who are in high-risk occupations such as the health care field or carry out high-risk activities, such as IV drug use and multiple sexual partners, should also be vaccinated. Hepatitis A vaccine is recommended in a number of child-care settings and should be discussed with your pediatrician. Adults or children traveling to areas of the world where hepatitis A is very common, including all underdeveloped or poorly developed countries, should be vaccinated before they go. Any individual with underlying chronic liver disease that is not due to hepatitis B, particularly those with hepatitis C or cirrhosis, should be vaccinated against both hepatitis A and hepatitis B, unless they are already immune.

Is hepatitis C caused only by an exchange of bodily fluid?

The majority of patients with hepatitis C are found to have a risk factor such as needle exposure, blood exposure, tattooing, body piercing, or sexual exposure that would allow for an exchange of blood or bodily fluids. Depending on the study, a small percentage of patients, ranging from 5 to 30 percent, have no identifiable risk factor. Presumably, they acquired the disease through inadvertent exposure. Up to 50 percent of patients with hepatitis C have no symptoms. A larger percentage do not know they are carrying the virus. There are many opportunities for inadvertent exposure such as sharing a razor, sharing a toothbrush, sharing scissors for cutting hair, or manicure tools, etc.

Leveraging the liver’s ability to heal scarred tissue

In medical school, Cliff Brass was interested in the brain. He and a friend, who favored the liver, used to argue about which organ was smarter. They are both hepatologists now. 

“I guess that answers that question,” says Brass, Senior Global Program Medical Director at Novartis Pharmaceuticals. “The liver is an amazing organ.” 

For instance, it is possible to take a hunk of one person’s liver and transplant it into another person. The partial organ will grow to fit the space available, suggesting that the liver has unusual regenerative capabilities.  

It is one thing for a healthy liver to have such powers, but can a scarred liver heal itself? For a long time, the answer was quick and clear: No.  

“Despite the fact that evidence of the reversibility of liver scarring started accumulating in the 1960s, the prevailing wisdom was that once you get scar tissue in the liver, it’s permanent,” says Chinwe Ukomadu, a hepatologist and Senior Translational Medicine Specialist at the Novartis Institutes for BioMedical Research. 

Only recently have scientists and liver specialists begun to change their answer to a qualified yes. Yes, it’s reversible, but it isn’t clear how. This shift in thinking has opened the door to the idea that medicine may be able to speed up the process. Scarring occurs in many liver diseases and is ultimately the cause of liver failure in late stages of disease, so healing scarred liver tissue would benefit most liver disease patients. For instance, Novartis has recently begun clinical testing of a new investigational compound that might have anti-scarring effects.  

One of the first clues suggesting that liver scarring might be reversible came out of a hospital in Miami, FL, in 1962. Doctors there were working with a handful of patients with hemochromatosis, a disorder that causes iron to accumulate in the liver and cause scarring. They took biopsies of patients’ livers before and after performing procedures to remove the iron. After the procedure, they found that the amount of scarring had decreased. 

Over time, similar hints appeared in other small-scale studies, says Ukomadu. For instance, the life expectancies of recovering alcoholics—who are thought to have extensive liver scarring—are longer than the life expectancies of people who continue to drink. And patients with autoimmune hepatitis who are treated with steroids to reduce liver damaging inflammation have similar life expectancies whether they begin treatment with advanced liver scarring, called cirrhosis, or without. 

“In these cases, something is getting better,” says Ukomadu. “But is it the liver? Researchers have argued that it could be anything.” 

The real turning point in thinking came with the advent of treatments for viral liver disease. In the 1990s, drugs became available to treat hepatitis C and hepatitis B. When patients took these drugs, they effectively removed the root cause of the organ damage. Later, liver biopsies revealed that many patients, even those with late-stage cirrhosis had recovered. 

“In some cases, you couldn’t tell that the patients had been sick,” says Ukomadu. “Their cirrhosis had completely disappeared.” 

Today, researchers at Novartis see two possible ways to repair scarred livers. One is to stop the disease process that is causing the damage and wait for tissue to heal.  

This approach has merit, but during the time it takes for the liver to repair itself, patients are left in a vulnerable condition. If they experience another illness or hospitalization while living with an incapacitated liver, they may not fare well. In some cases, this vulnerability may be hidden because patients with liver scarring don’t always show symptoms.  

“The liver is a biochemical factory for the body, but it’s a factory with a vast overcapacity,” says Brass. “It may not be until someone’s liver is very close to the edge of keeping up that they suddenly see a dramatic downturn in health.” 

Currently the only option for patients with end-stage liver disease is a liver transplant. This procedure is only offered in certain parts of the world, and donor tissue is in short supply.  
So Novartis favors a more proactive strategy to find ways to directly reverse scarring to give liver disease patients a fighting chance. 

“Many patients who are waiting for transplants become miserably sick,” says Ukomadu. “The ability to stall or reverse liver scarring would have enormous impact.” 

Main image: This liver tissue from a patient with non-alcoholic fatty liver disease (NASH) shows mild fibrosis (green), which can lead to advanced liver scarring called cirrhosis. Image: Nephron/Wikimedia

Is it Possible to Reverse Liver Damage from Alcoholism?

Alcohol dependence can have profound effects on an individual’s life. It does more than affect a person’s career and relationships, and on a practical level, it can seriously impact overall health and longevity. Long periods of heavy alcohol use are linked to brain and nervous system disease, nutrient deficiencies, and more. Perhaps the most well-established complication of long-term alcohol use is liver disease. An individual who completes a recovery program may go on to receive evidence-based interventions that address nutrition and the importance of self-care in recovery. However, the lingering question remains: can liver damage from alcoholism be reversed?

Common Liver Diseases

The body is an incredible machine that continually focuses on self-regulation. When exposed to alcohol, a toxin, the liver will step in to flush out the excess in an attempt to protect the body from damage. Over time, this process proves taxing for the liver and can lead to damage, from minor disease to permanent scarring. Liver diseases are common in people struggling with alcoholism, and the issue may persist even after a person stops drinking. Here are some of the most common liver diseases.

Jaundice

Jaundice, or the yellowing of the skin or eyes, is the result of excess bilirubin in the body. During the course of normal blood production, the body produces bilirubin excreted by the liver. When the liver sustains damage from alcohol use, it is unable to excrete bilirubin, causing the pigmented substance to build up in the body. People with jaundice may also experience abdominal pain, flu-like symptoms, and fatigue. The presence of jaundice itself is non-life-threatening, but it often signals an underlying issue with the liver itself.

Hepatitis

Chronic alcohol use is also associated with Hepatitis, or inflammation of the liver. Alcoholic hepatitis can lead to nausea, vomiting, and abdominal pain. Left untreated, it can progress to cirrhosis of the liver. Alcoholic Steatohepatitis is a severe form of hepatitis that can affect up to 20% of heavy drinkers and can lead to permanent damage and scarring.

Alcoholic Fatty Liver

One of the most common conditions affecting heavy drinkers is Alcoholic Fatty Liver, affecting some 20% of chronic users. It often has no discernable symptoms, but the damage is still occurring within the liver tissues.

Alcoholic Cirrhosis

The most serious form of alcoholic liver disease is the formation of scar tissue, or cirrhosis. This scar tissue makes it difficult for the liver to perform its functions properly. People with cirrhosis may experience inflammation of the liver leading to abdominal pain, fat buildup in the liver cells, redness of the palms, shortening and thickening of the fingers, and more.

Can You Reverse Liver Damage from Alcoholism?

The human body has an amazing capacity to heal itself. At the same time, a limit exists for what it can do. The human body can reverse damage from several types of minor liver damage; however, in some cases, the damage might be permanent. If you can reverse liver damage from alcoholism, it will occur in the earliest stage of dependency. In the case of cirrhosis, for example, you cannot undo the damage that has already occurred. Scarring is permanent, and the liver has lost its previous ability to function normally. However, a healthy lifestyle can help mitigate the risk of further damage.

In other cases, such as fatty liver disease, you can reverse the damage from alcohol. The liver has the benefit of being the body’s only regenerative organ. In fact, if you lost 75% of your liver, it would regenerate to its previous size. When the Alcohol Liver Disease (ALD) is in its early stages, it is possible to heal the liver and restore its functioning completely. Improving liver health will require adherence to a healthy lifestyle and a dedication to feeling your best.

The Pillars of Good Liver Health

If you’re interested in promoting good liver health and reversing any damage from chronic drug and alcohol use, there are a few steps you can take to boost your efforts.

Stop Drinking

Firstly, and most importantly, stop drinking alcohol. If it is difficult for you to stop drinking, seek help. Evidence-based interventions can help you on the road to recovery. By cutting out alcohol use altogether, you have made the most vital step in helping your liver cells heal and regenerate.

Assess Your Other Unhealthy Behaviors

Drinking is not the only unhealthy behavior that can damage your liver. Other common causes of liver disease include smoking, excess consumption of saturated fats, and obesity. A healthy diet is essential to protecting the health of your liver. If your diet is high in processed fats or sugars, you are putting more stress on the organ as it works to filter out substances your body doesn’t need. A diet rich in fruits, vegetables, lean sources of protein, and whole grains will help your body heal your liver.

Exercise More

Regular, moderate intensity exercise has documented benefits for your liver and other organs. Excess cholesterol is a known risk factor for liver disease, and exercise has the unique benefit of increasing your HDL (“good”) cholesterol while simultaneously lowering your LDL (“bad”) cholesterol, which boosts your liver health. Additionally, exercise is good for your immune system, which aids in the healing of your liver overall.

Talk to Your Doctor about Your Medications

Certain medications, such as acetaminophen (Tylenol), can be harmful for your liver when taken in excess or for long periods. Talk to your primary care provider about the medications you take and how they can affect your liver health.

Be Aware of Your Risk

Exposure to toxins in common household and industrial items such as aerosols, insecticides, and chemicals can also increase your risk of liver damage. If you are in a profession that regularly handles these substances, take precautions such as wearing a mask and gloves. Limit exposure to household toxins and choose safer alternatives when feasible.

Drink Plenty of Water

Chronic dehydration is a common problem in those who suffer from alcohol dependence. The body needs water to effectively flush toxins from the body, and alcohol inhibits the production of an anti-diuretic hormone the body needs to reabsorb water. Dehydration also makes the blood thicker, which makes it more difficult for the liver to perform its functions, in turn making it work harder.

Drinking plenty of water seems to have the opposite effect. Water helps keep your blood thin and helps your body absorb nutrients. Drinking at least 64 ounces of water each day can help improve your body’s ability to filter toxins and heal itself.

Vitamins for Liver Health

You might be wondering how to reverse liver damage from alcohol naturally and more effectively. Lifestyle changes are the most important, but some evidence suggests that certain vitamins can improve your liver health.

Vitamin A and Vitamin B-12

Vitamin A is an antioxidant, but it also has a synergistic effect with iron. When Vitamin A levels are low, it can affect the body’s iron levels, which in turn can lead to anemia. An anemic person may have trouble healing because of the lack of nutrients in the bloodstream. However, people with a history of liver disease should discuss supplementation with a health provider, as too much can have a toxic effect on the liver that leads to scarring.

It’s common for those with alcohol use disorders to suffer from nutrient deficiencies, particularly since those with alcohol use disorder likely use alcoholic drinks as their main source of calories. Vitamin B12 is commonly found in meats, eggs, and other sources of protein such as nuts. B12 deficiency- anemia can affect your body’s ability to transport oxygenated blood throughout the body, leading to decreased immune system functioning and slowed regeneration. Since B12 is a water-soluble vitamin, it is safe to take as a supplement, but it should be under the guidance of a health care provider.

How Long Does It Take the Liver to Regenerate?

The liver is a vital organ that has the ability to heal itself, even after years of heavy drinking. In the event that 50-60% of the liver cells die, then it should be able to regenerate within 30 days. However, it’s important to recognize that good liver health is an ongoing effort that requires adherence to a healthy lifestyle.

In some cases, the liver cannot regenerate on its own. When Alcohol Liver Disease progresses to cirrhosis, it leads to scarring and the tissue becomes permanently damaged. Cirrhotic liver tissue cannot regenerate. However, following a healthy lifestyle can help minimize symptoms and improve overall life quality.

The single most important thing you can do to protect your liver is to cut out all forms of alcohol. If you or a loved one suffer from alcohol dependency, Family First offers evidence-based alcohol abuse intervention.

Department of Surgery – End-stage Liver Disease (ESLD)

Chronic liver failure, also called end-stage liver disease, progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which scar tissue replaces healthy liver tissue until the liver cannot function adequately. Patients with abnormal liver function who develop ascites, variceal hemorrhage, hepatic encephalopathy, or renal impairment are considered to have end-stage liver disease (ESLD).

While liver transplantation is a viable treatment option for ESLD, with increasing waiting times for organ transplantation, nearly 17% of patients on the transplant wait list die annually; others are not candidates for a liver transplant. Patients with ESLD have a constellation of symptoms and disease-related complications that affect survival and health-related quality of life.

What causes cirrhosis?

When a substance or disease attacks and damages the liver, liver cells are killed and scar tissue is formed. This scarring process is called fibrosis (pronounced “fi-bro-sis”), and it happens little by little over many years. When the whole liver is scarred, it shrinks and gets hard. This is called cirrhosis, and usually this damage cannot be undone.

Any illness that affects the liver over a long period of time may lead to fibrosis and, eventually cirrhosis. Some common causes are heavy drinking, viruses, a buildup of fat in the liver, inherited diseases, toxic effects from drugs and autoimmune diseases. These are more fully explored in the next section.

Cirrhosis has numerous causes. In the United States, heavy alcohol consumption and chronic hepatitis C have been the most common causes of cirrhosis. Obesity is becoming a common cause of cirrhosis, either as the sole cause or in combination with alcohol, hepatitis C, or both. Many people with cirrhosis have more than one cause of liver damage. 

Cirrhosis is not caused by trauma to the liver or other acute, or short-term, causes of damage. Usually years of chronic injury are required to cause cirrhosis. 

By BruceBlaus (Own work) [CC BY-SA 4.0], via Wikimedia Commons

Common Causes of Cirrhosis









Alcohol-related liver disease. Most people who consume alcohol do not suffer damage to the liver. But heavy alcohol use over several years can cause chronic injury to the liver. The amount of alcohol it takes to damage the liver varies greatly from person to person. For women, consuming two to three drinks-including beer and wine-per day and for men, three to four drinks per day, can lead to liver damage and cirrhosis. In the past, alcohol-related cirrhosis led to more deaths than cirrhosis due to any other cause. Deaths caused by obesity-related cirrhosis are increasing.
Chronic hepatitis C The hepatitis C virus is a liver infection that is spread by contact with an infected person’s blood. Chronic hepatitis C causes inflammation and damage to the liver over time that can lead to cirrhosis.
Chronic hepatitis B and D The hepatitis B virus is a liver infection that is spread by contact with an infected person’s blood, semen, or other body fluid. Hepatitis B, like hepatitis C, causes liver inflammation and injury that can lead to cirrhosis. The hepatitis B vaccine is given to all infants and many adults to prevent the virus. Hepatitis D is another virus that infects the liver and can lead to cirrhosis, but it occurs only in people who already have hepatitis B.
Nonalcoholic fatty liver disease (NAFLD) In NAFLD, fat builds up in the liver and eventually causes cirrhosis. This increasingly common liver disease is associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications.
Autoimmune hepatitis This form of hepatitis is caused by the body’s immune system attacking liver cells and causing inflammation, damage, and eventually cirrhosis. Researchers believe genetic factors may make some people more prone to autoimmune diseases. About 70 percent of those with autoimmune hepatitis are female.
Diseases that damage or destroy bile ducts Several diseases can damage or destroy the ducts that carry bile from the liver, causing bile to back up in the liver and leading to cirrhosis. In adults, the most common condition in this category is primary biliary cirrhosis, a disease in which the bile ducts become inflamed and damaged and, ultimately, disappear. Secondary biliary cirrhosis can happen if the ducts are mistakenly tied off or injured during gallbladder surgery. Primary sclerosing cholangitis is another condition that causes damage and scarring of bile ducts. In infants, damaged bile ducts are commonly caused by Alagille syndrome or biliary atresia, conditions in which the ducts are absent or injured.
Inherited diseases Cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are inherited diseases that interfere with how the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly. Cirrhosis can result from these conditions.
Drugs, toxins, and infections Other causes of cirrhosis include drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion.

 

Complications of Cirrhosis

Because the liver becomes lumpy and stiff in cirrhosis, blood cannot flow through it easily, so pressure builds up in the vein that brings blood to the liver. This vein is called the portal vein. When pressure is high in the portal vein, the condition is called portal hypertension. In order to relieve this pressure, the blood passes through other veins. Some of these veins, called varices, can be found in the pipe that carries food from your mouth to your stomach (the esophagus) or in your stomach itself.

When a person has cirrhosis, the high pressure in the portal vein backs up into another organ called the spleen, which becomes enlarged and destroys an excessive number of platelets, the blood particles that help with blood clotting.

With cirrhosis, entrance of blood to the liver is blocked and substances such as ammonia that would normally be cleaned by the liver, escape into the general circulation.

Aside from the problems with liver blood flow, when cirrhosis is advanced there aren’t enough healthy worker cells to get all the work done, so these cells cannot make the substances such as albumin and clotting factors that the liver normally makes.

Liver cancer, also known as hepatocellular carcinoma (HCC), can also develop in cirrhosis when some of the damaged liver cells start to multiply out of control. As liver function deteriorates, one or more complications may develop, often the first signs of the disease.  

 













Edema and ascites When liver damage progresses to an advanced stage, fluid collects in the legs, called edema, and in the abdomen, called ascites. Ascites can lead to bacterial peritonitis, a serious infection.
Bruising and bleeding When the liver slows or stops producing the proteins needed for blood clotting, a person will bruise or bleed easily.
Portal hypertension  Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension.
Esophageal varices and gastropathy When portal hypertension occurs, it may cause enlarged blood vessels in the esophagus, called varices, or in the stomach, called gastropathy, or both. Enlarged blood vessels are more likely to burst due to thin walls and increased pressure. If they burst, serious bleeding can occur in the esophagus or upper stomach, requiring immediate medical attention.
Splenomegaly When portal hypertension occurs, the spleen frequently enlarges and holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.
Jaundice Jaundice occurs when the diseased liver does not remove enough bilirubin from the blood, causing yellowing of the skin and whites of the eyes and darkening of the urine. Bilirubin is the pigment that gives bile its reddish-yellow color.
Gallstones  If cirrhosis prevents bile from flowing freely to and from the gallbladder, the bile hardens as gallstones.
Sensitivity to medications Cirrhosis slows the liver’s ability to filter medications from the blood. When this occurs, medications act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.
Hepatic encephalopathy A failing liver cannot remove toxins from the blood, and they eventually accumulate in the brain. The buildup of toxins in the brain-called hepatic encephalopathy-can decrease mental function and cause coma. Signs of decreased mental function include confusion, personality changes, memory loss, trouble concentrating, and a change in sleep habits.
 Insulin resistance and type 2 diabetes Cirrhosis causes resistance to insulin-a hormone produced by the pancreas that enables the body to use glucose as energy. With insulin resistance, the body’s muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more, but excess glucose builds up in the bloodstream causing type 2 diabetes.
Liver cancer Hepatocellular carcinoma is a type of liver cancer that can occur in people with cirrhosis. Hepatocellular carcinoma has a high mortality rate, but several treatment options are available.
Other problems Cirrhosis can cause immune system dysfunction, leading to the risk of infection. Cirrhosis can also cause kidney and lung failure, known as hepatorenal and hepatopulmonary syndromes.

 

Symptoms of Cirrhosis

Initially, a person may have no symptoms at all. This is called compensated cirrhosis. In fact, a person may live many years with cirrhosis without being aware that his or her liver is scarred. This is because the pressure in the portal vein is not yet too high and there are still enough healthy liver cells to keep up with the body’s needs.

However,  if nothing is done about the cause of cirrhosis, (continuing to drink heavily, for example) or if the underlying disease such as  hepatitis goes untreated, the pressure in the portal vein may increase to the point where the few remaining worker cells are overwhelmed. As cirrhosis progresses, the most common symptoms are:

  • weakness
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • weight loss
  • abdominal pain and bloating when fluid accumulates in the abdomen
  • itching
  • spiderlike blood vessels on the skin

Decompensated Cirrhosis

Cirrhosis is said to have progressed from compensated to decompensated cirrhosis when serious conditions develop as it worsens. These complications can be life-threatening and requires a new liver to replace the diseased one through a liver transplant.  As discussed earlier, another serious complication of cirrhosis is liver cancer, which may occur in the compensated or decompensated stage. There may be no signs of liver cancer until the tumor i slarge and causing pain.





Bleeding Varices Internal bleeding from large blood vessels in the esophagus
Ascites A buildup of fluid in the belly.  (pronounced “a-sigh-tees”)
Encephalopathy Confusion from the buildup of toxins in the blood.  (pronounced “en-sef-a-lop-a-thee”)
Jaundice Yellowing of the eyes and skin
Bleeding varices (internal bleeding)

Large blood vessels (varices) in the food tube get bigger and bigger over time and can burst open. When this happens, a person may vomit blood or have stool that is black and tarry. 

The risk of bleeding from varices can be reduced by blood pressure medicines known as beta-blockers or by a surgical procedure in which tiny rubber bands are tied around the varices.

 

 

 

 

Ascites (fluid in the belly)

Another problem caused by high pressure in the veins of the liver is ascites. Fluid leaks out into the belly and it begins to fill it up. This can make the abdomen enlarge like a balloon filled with water. The legs can get swollen too. This can be very uncomfortable.

Eating can be a problem because there is less room for food. Even breathing can be a problem, especially when the person is lying down. But the most dangerous problem with ascites is infection, which can be life-threatening.

Ascites may go away with a low salt diet, and with diuretics (water pills) ordered by your provider. But sometimes a provider must actually drain the fluid from the belly using a special kind of needle.

Encephalopathy (confusion)

A liver that is working poorly may not be able to get rid of toxic substances like ammonia (which comes from the intestines), and it may allow these substances to go into the brain and cause confusion.

Besides confusion, toxins in the brain cause changes in sleep, mood, concentration, and memory. If extremely serious, it can even cause a coma. These are all symptoms of hepatic encephalopathy. With encephalopathy, a persons may have problems driving, writing, calculating, and performing other activities of daily living.

Signs of encephalopathy are trembling and hand “flapping.” Encephalopathy may occur with an infection or internal bleeding, if constipated or with overuse of water pills or take tranquilizers or sleeping pills. 

Jaundice (yellowing of eyes and skin)

A liver that is working poorly cannot get rid of bilirubin, a substance that produces a yellowing of the eyes and skin called jaundice. Too much alcohol and some medicines can also lead to jaundice.

 

How is the severity of cirrhosis measured?

The model for end-stage liver disease (MELD) score measures the severity of cirrhosis. The MELD score was developed to predict the 90-day survival of people with advanced cirrhosis. The MELD score is based on three blood tests:

  • international normalized ratio (INR)-tests the clotting tendency of blood
  • bilirubin-tests the amount of bile pigment in the blood
  • creatinine-tests kidney function

MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of 90-day survival.

How is cirrhosis diagnosed?

The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests, and imaging. The doctor will ask about the person’s medical history and symptoms and perform a thorough physical examination to observe for clinical signs of the disease. For example, on abdominal examination, the liver may feel hard or enlarged with signs of ascites. The doctor will order blood tests that may be helpful in evaluating the liver and increasing the suspicion of cirrhosis.

Patient with cirrhosis may have an upper endoscopy (pronounced “en-dahs-cup-ee”) periodically (see figure at right). A thin tube with a camera can be inserted into the mouth to look for varices in the esophagus (food tube) and the stomach. The endoscopy is repeated every few years to monitor for varices.

To view the liver for signs of enlargement, reduced blood flow, or ascites, the doctor may order a computerized tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or liver scan. The doctor may look at the liver directly by inserting a laparoscope into the abdomen. A laparoscope is an instrument with a camera that relays pictures to a computer screen.

A liver biopsy can confirm the diagnosis of cirrhosis but is not always necessary. A biopsy is usually done if the result might have an impact on treatment. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy. 

How is cirrhosis treated?

Treatment for cirrhosis depends on the cause of the disease and whether complications are present. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for cirrhosis with complications.

Eating a nutritious diet

Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If ascites develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement taken by mouth or through a nasogastric tube-a tiny tube inserted through the nose and throat that reaches into the stomach.

Avoiding alcohol and other substances

People with cirrhosis are encouraged not to consume any alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medications-prescription and over-the-counter-can affect liver function, a doctor should be consulted before taking them.

Treatment for cirrhosis also addresses specific complications

For edema and ascites, the doctor will recommend diuretics-medications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites will require intravenous (IV) antibiotics.

Portal Hypertension

The doctor may prescribe a beta-blocker or nitrate for portal hypertension. Beta-blockers can lower the pressure in the varices and reduce the risk of bleeding. Gastrointestinal bleeding requires an immediate upper endoscopy to look for esophageal varices. The doctor may perform a band-ligation using a special device to compress the varices and stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes.

Hepatic encephalopathy

Hepatic encephalopathy is treated by cleansing the bowel with lactulose-a laxative given orally or in enemas. Antibiotics are added to the treatment if necessary. Patients may be asked to reduce dietary protein intake. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled.
Some people with cirrhosis who develop hepatorenal failure must undergo regular hemodialysis treatment, which uses a machine to clean wastes from the blood. Medications are also given to improve blood flow through the kidneys.

Other treatments

Other treatments address the specific causes of cirrhosis. Treatment for cirrhosis caused by hepatitis depends on the specific type of hepatitis. For example, interferon and other antiviral drugs are prescribed for viral hepatitis, and autoimmune hepatitis requires corticosteroids and other drugs that suppress the immune system.

Medications are given to treat various symptoms of cirrhosis, such as itching and abdominal pain.

When is a liver transplant indicated for cirrhosis?

A liver transplant is considered necessary when complications cannot be controlled by treatment. Liver transplantation is a major operation in which the diseased liver is removed and replaced with a healthy one from an organ donor. A team of health professionals determines the risks and benefits of the procedure for each patient. Survival rates have improved over the past several years because of drugs that suppress the immune system and keep it from attacking and damaging the new liver.

The number of people who need a liver transplant far exceeds the number of available organs. A person needing a transplant must go through a complicated evaluation process before being added to a long transplant waiting list. Generally, organs are given to people with the best chance of living the longest after a transplant. Survival after a transplant requires intensive follow-up and cooperation on the part of the patient and caregiver.

Treatment of liver cirrhosis

Treatment of liver cirrhosis

The choice of methods for treating cirrhosis of the liver depends on many factors, but, regardless of them, the therapeutic course is aimed at eliminating the cause of cirrhosis (a disease that caused liver damage), compulsory adherence to a diet and taking medications. A separate item in the treatment program is the prevention and elimination of complications that could worsen the situation.

Elimination of causes

  • If cirrhosis of the liver develops against the background of viral hepatitis, first of all, the entire therapeutic course is aimed at treating this disease.
  • In case of alcoholic and toxic (medicinal) cirrhosis, the main thing in the treatment is the exclusion of the substance damaging the liver (ethanol, drugs).
  • Biliary (autoimmune) cirrhosis of the liver, which is caused by stagnation of bile due to inflammation of the bile ducts, requires not only the use of immunosuppressants to suppress the aggressive action of the immune system, but also, if necessary, surgical intervention to eliminate stagnation of bile.
  • Congenital cirrhosis, manifested due to hereditary diseases leading to liver damage, requires urgent treatment of these diseases.

Drug treatment

The choice of medication should be made only by your attending physician, since the use of a particular drug depends on the cause of liver damage, the stage of cirrhosis, and general health. Self-medication is dangerous!

Main directions of drug therapy:

  • Preparations aimed at increasing the metabolism of liver cells, stabilizing and restoring them (Heptral, Hepa-merz, glutamic and lipoic acid, Essentiale, Cocarboxylase, vitamins).
  • Transfusion therapy (transfusion of blood, plasma) – blood products and blood components, blood substitutes, electrolyte solutions have a hemostatic (hemostatic) effect, affect the blood coagulation system, and increase the number of platelets.

Indications for the use of transfusion therapy are liver failure, portal hypertension, hypersplenism, ascites, electrolyte imbalance.

  • Glucocorticoid hormones are prescribed only when indicated.As a rule, these drugs are indicated for viral and biliary cirrhosis, manifestations of hypersplenism, with active severity of alcoholic cirrhosis (especially in combination with alcoholic hepatitis, liver failure or encephalopathy).
  • Enzyme preparations are used to eliminate constipation, adsorbents to cleanse the intestines. The purpose of using these medicines is to reduce the absorption of toxic substances into the blood.
  • Diuretics – drugs that help remove excess water from the body, are used in the case of the development of ascites (complications in which a large amount of water accumulates in the abdominal cavity).
  • Vitamins

Diet

Diet is the main method of both treatment and prevention of the subsequent progression of the disease. The selection of a diet should be carried out only by your attending physician, since any restriction or preference for some products over others should be correlated with the stage of development of the disease, the degree of liver damage, the presence of concomitant complications and diseases.

Diet food for liver cirrhosis not only fully meets the physiological needs of the body, but also maximally spares the affected liver, stomach, intestines, which leads to the restoration of their disturbed functions.

Main goals of the therapeutic diet:

  • prevent further progression of the disease
  • regeneration of liver cells
  • improvement of the functional state of the liver
  • restoring metabolism and increasing immunity
  • preventive measures

As a rule, with decompensated cirrhosis, when the liver is still capable of performing its functions, the diet includes foods rich in proteins and amino acids (cottage cheese, lean fish, milk, beef, eggs, buckwheat, oatmeal, millet, bread, vegetables).Proteins that improve metabolism and strengthen the body’s defenses are also extremely necessary for diagnosed alcoholic cirrhosis, since when the liver is damaged, the level of protein in the blood is very low.

Diet with decompensated cirrhosis, when the liver is no longer able to completely remove waste products and neutralize metabolic end products (for example, ammonia), it is necessary, on the contrary, to limit protein intake. In advanced cases, when the condition continues to deteriorate, protein is generally excluded from the diet.

Fat intake also depends on the degree of liver damage. With compensated cirrhosis, the use of vegetable and milk fats in a limited amount is allowed (the use of animal fats is unacceptable). With decompensated cirrhosis and, in the event of nausea, vomiting, diarrhea, fats are excluded from the diet.

In addition, all patients with cirrhosis of the liver should give up alcohol, fried and smoked foods, sausages, canned food, mushrooms, tomatoes, and chocolate.

The main dishes recommended for consumption are vegetable soups, lean boiled meat, cereals, dairy products with low fat content, fruits, jelly.

The main principle of the diet for liver cirrhosis is the use of foods with high digestibility, the mandatory presence of vitamins in the diet and a large amount of liquid. In addition, you need to take food every 3-4 hours in small portions.

Surgical treatment

Surgical treatment for liver cirrhosis is a radical method used in the most extreme cases, when therapeutic treatment can no longer lead to a positive result.Neglected cases of the disease, in which other forms of treatment are impossible, require a liver transplant.

Liver transplantation is an operation that removes the affected organ and replaces it with liver tissue taken from a healthy donor.

Liver transplantation is indicated for patients with decompensated cirrhosis who, in addition to the underlying disease, have various complications – complicated bleeding, ascites, hepatorenal syndrome, hepatic encephalopathy, bacterial peritonitis.

Liver cirrhosis: treatment – a: care

Prevention of cardiovascular diseases

As a prophylaxis, along with a balanced diet rich in omega-3, doctors recommend regular physical activity to patients without fail.

Clinically proven link between physical activity (PA) and indicators such as:

  • tissue sensitivity to insulin;
  • the level of lipids in the blood, including triglycerides, a high level of which can be a marker of high cholesterol levels;
  • blood pressure normalization.

In addition, physical activity helps to reduce the body mass index, which is one of the factors in calculating cardiovascular risk (CVR).

Types of liver cirrhosis and methods of its treatment

Most often, cirrhosis is the result of a long course of various liver diseases. Therefore, before starting treatment for cirrhosis, it is necessary to establish the causes of its occurrence.

There are the following main types of the disease:

– Alcoholic: the disease becomes a consequence of progressive alcoholic liver disease caused by excessive drinking.

– Metabolic: non-alcoholic fatty liver disease, which develops with a violation of glucose and lipid metabolism.

– Infectious: cirrhosis develops against the background of viral hepatitis.

– Autoimmune: as a result of malfunctions of the immune system, which begins to attack the body’s own cells.

– Others: toxic, cryptogenic.

Practice shows that liver cirrhosis in 50% of all cases is caused by several reasons at once.However, chronic alcoholism is almost always a catalyst for the disease.

Treatment of liver cirrhosis: methods and their effectiveness

Methods for the treatment of cirrhosis include: treatment of the underlying disease that led to the development of cirrhosis (complete rejection of alcohol in the case of an alcoholic cause, treatment of viral hepatitis, weight loss in the case of non-alcoholic fatty liver disease) and surgery. Additional medications can also be used for the purpose of symptomatic therapy.

The basis for the treatment of liver cirrhosis is drug therapy. And although a complete cure is possible only through transplantation, modern drugs and techniques significantly improve the quality and duration of a patient’s life, if prescribed in a timely manner and performed in full. Remember: at an early stage, you can stop the destruction of cells, and with an advanced disease, complications are inevitable.

How long can you live with liver cirrhosis?

In the case of timely diagnosis of cirrhosis and its systematic treatment, the patient can fully live for 10 or more years.However, in each case, this figure may change.

The patient’s life expectancy depends on:

– Causes of the disease: alcohol, viruses, intoxication, heredity. The most dangerous are viral and alcoholic cirrhosis of the liver.

– The degree of organ damage before the start of drug treatment.

– Age and gender of the patient. Cirrhosis is more difficult for women and the elderly.

– Concomitant diseases complicating the course of the disease.

– Strict adherence to the doctor’s instructions.

– Opportunities to completely eliminate negative factors.

According to the degree of liver damage, cirrhosis is divided into:

– Compensated

Most of the liver cells are still working in full volume, but the process of replacing healthy tissue with fibrous tissue has already begun. With proper treatment at this stage, the progression of the disease can be stopped.

– Subcompensated

If cirrhosis of the liver is not detected at the previous stage and progresses, the first symptoms of the disease appear due to a decrease in the number of healthy hepatocytes (liver cells).

– Decompensated

With uncompensated cirrhosis, the liver can no longer perform its functions. Most often, liver transplantation is indispensable.

Treatment

It is possible and necessary to treat cirrhosis regardless of the stage of the disease. In this case, treatment includes not only liver support, but also the prevention of complications (internal bleeding, abdominal ascites, hepatic encephalopathy).

Depending on the cause of cirrhosis, you can improve your condition:

1.Completely giving up alcohol.

2. Having started taking antiviral drugs prescribed by a doctor in case of viral cirrhosis of the liver.

3. Adhering to the strict diet recommended for all liver diseases.

Remember: cirrhosis is not a sentence. Medical and surgical treatment can improve the course of the disease. It is only necessary to identify it in a timely manner and strictly follow all the instructions of specialists in order to improve the quality of life.

References

1. Belousov Yu. B., Khanina N. Yu. Approaches to the choice of the dose of drugs in patients with liver cirrhosis // Farmateka. – 2006. No. 1 (116). – S. 76-84.

2. Schiff, Yu. R. Liver diseases according to Schiff. Alcohol, drug, genetic and metabolic diseases / Eugene R. Schiff, Michael F. Sorrell, Willis S. Maddray; per. from English ed. N. A. Mukhina [and others]. – Moscow: GEOTAR-Media, 2011 .– 476 p.

3. Ivashkin V. T., Bueverov A.O. Present and future of clinical hepatology // Diseases of the digestive system (for specialists and general practitioners): breast cancer library. 2002. – T. 4, No. 1. – S. 13-15.

4. Loginov AS, Blok Yu. E. Chronic hepatitis and cirrhosis of the liver. M.: Medicine, 1986 .– 256 p.

Co-author, editor and medical expert:

Shimbaretsky Georgy Alekseevich

Born on 23.06.1984.

Education:

2007- Nizhny Novgorod State Medical Academy.

2009 – Graduated from residency in the specialty “Health Organization” and “Public Health”.

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90,000 treatment and diagnosis of causes, symptoms in Moscow

General description

Biliary cirrhosis is a chronic autoimmune disease that occurs as a result of impaired outflow of bile through the intrahepatic and biliary tract (cholestasis) and is characterized by the replacement of parenchymal liver tissue with connective tissue (fibrosis).The prognosis of the disease itself depends on the diagnosis and, in undiagnosed cases, leads to a deterioration in development: progressive destruction of the parenchyma with the formations of foci of fibrosis, as a result of which cirrhosis of the liver and liver failure occurs.

According to statistics in economically developed countries, biliary cirrhosis is diagnosed in people aged 30 to 55 years, more often in men. The ratio of the incidence of men to women is approximately 3 to 1.

Causes of occurrence:

Due to the occurrence, 2 types of biliary cirrhosis are distinguished:

Primary biliary cirrhosis – the mechanism of occurrence is that autoimmune inflammation occurs in the liver tissue itself.Antibodies are produced against liver cells (hepatocytes) and they are perceived by the human body as foreign. A defense system joins the process itself, in the form of lymphocytes, macrophages, mast cells, which produce biologically active substances and antibodies. All of them together destroy hepatocytes, cause disturbances in blood supply, metabolism and stagnation of bile, leading to a general destruction of the architectonics (structure) of the liver.

  • Genetic predisposition
  • People with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, thyrotoxicosis, scleroderma, polyarteritis nodosa, sarcoidosis
  • From scientific sources it is known that about 15% of cases of the disease are promoted by an infectious substrate such as herpes virus, rubella, Epstein-Barr

Secondary biliary cirrhosis of the liver, occurs due to blockage or narrowing of the lumen of the intrahepatic bile ducts.

  • Developmental anomalies (congenital or acquired) of bile ducts and gallbladder
  • Gallstone disease
  • Narrowing or blockage of the lumen of the biliary tract after surgery on the abdominal organs, benign tumors
  • Compression from the outside of the biliary tract by an inflamed pancreas or tumor

Symptoms of biliary cirrhosis

Main non-specific symptoms:

  • Weakness
  • Headache
  • Dizziness
  • Decreased appetite
  • Impaired memory and attention
  • Weight loss
  • Apathy
  • Disturbed sleep at night and drowsiness during the day

Symptoms of hepatocellular failure:

  • Vomiting of intestinal contents
  • Intense pain in the right hypochondrium
  • Bloating of intestines
  • Alternating diarrhea and constipation
  • Jaundice (yellowing of the skin and mucous membranes)
  • Skin itching
  • Darkening of urine
  • Discoloration of feces
  • Appearance under the skin of the eyelids, ears and phalanges of the fingers of yellow tuberous inclusions (xanthem)
  • Enlargement of liver and spleen

Portal hypertension symptoms:

  • “Medusa’s head” – a symptom that combines the presence of an enlarged abdomen and the presence of a pronounced venous network on the skin of the anterior abdominal wall
  • Vomiting “coffee grounds” – a symptom that indicates bleeding from the veins of the esophagus or stomach
  • “Tar-like” stool – a symptom indicating bleeding from the small intestine
  • Dark red blood secreted from the rectum during the act of defecation – a symptom indicating the presence of bleeding from hemorrhoidal veins located in the rectum
  • Palmar erythema – redness of palms
  • Appearance of telangiectasias on the skin – spider veins

Diagnostics

  • Complete blood count
  • General urinalysis
  • Biochemical blood test
  • Liver tests
  • Coagulogram
  • Lipidogram
  • Puncture liver biopsy to verify the diagnosis.
  • Ultrasound of the liver
  • CT scan of the liver
  • MRI liver
  • Retrograde cholangiography

Treatment of biliary cirrhosis

Treatment of cirrhosis of the liver consists in the use of special drugs and strict adherence to the diet, but the formed cirrhosis of the liver is an irreversible condition.

The following groups of drugs are used: drugs of ursodeoxycholic acid (Ursosan, Levodexa), hepatoprotectors (Heptal, Hepa-Merz) and in the absence of the effect of drugs, liver transplantation (transplant) is used.

90,000 Treatment of liver cirrhosis in Israel

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Treatment of liver cirrhosis in Israel is carried out in a comprehensive manner and is aimed at alleviating the patient’s condition, improving the quality of his life. According to the doctors of the Liver Clinic of the Institute of Gastroenterology of the Rambam Clinic, one of the most important principles in the fight against liver cirrhosis is prevention.

With the development of liver cirrhosis, the normal tissue of this organ is replaced by scar tissue (fibrosis).The disease progresses slowly and often does not cause symptoms in the early stages, then, as the functionality of the liver decreases, clinical manifestations of the disease appear.

Liver functions

The liver is the largest internal organ located in the upper right abdomen.

Liver cells perform many functions, including:

  • Storage of glycogen – the body’s energy reserve, which, if necessary, is split into glucose.
  • Processing of fats, proteins and carbohydrates from digested food.
  • Synthesis of blood coagulation factors.
  • Neutralization and elimination of toxic substances from the body that enter through the digestive system, including drugs, alcohol, etc.
  • Production of bile necessary for the absorption of fats from the digestive system

What is liver cirrhosis?

With cirrhosis of the liver, a change in the structure of the liver occurs, and normal cells are replaced by cicatricial (fibrotic) tissue.Scar tissue develops gradually, changing the structure and reducing liver function. The liver is unable to filter toxins and synthesize the necessary substances, the normal outflow of bile is disrupted, which can lead to jaundice. The overgrowth of scar tissue can also affect blood flow through the liver and lead to the development of portal hypertension – an increase in pressure in the portal vein due to compression of the small vessels of the liver by overgrown scar tissue.

Causes of liver cirrhosis

Among the main causes of liver cirrhosis, infection with hepatitis B and C viruses and alcoholism are distinguished.

Alcoholic cirrhosis of the liver

Liver cells are destroyed by alcohol, excessive alcohol consumption can damage liver cells. It should be emphasized that alcoholic cirrhosis develops not only among alcoholics, but also among people who regularly and in large quantities consuming alcoholic beverages.

According to statistics, every tenth alcoholic eventually develops cirrhosis of the liver. This usually occurs after 10 or more years of alcoholism.It is still not fully understood why some people are more prone to alcoholic cirrhosis of the liver.

Supposedly there are genetic reasons behind this. Among alcoholic women, cirrhosis of the liver is more common than in men.

Hepatitis C and cirrhosis

Chronic infection with the hepatitis C virus causes a long-term inflammatory process in the liver, which can ultimately lead to the formation of scar tissue, and as a result to cirrhosis of the liver. According to medical statistics, every fifth patient with chronic hepatitis C develops liver cirrhosis.This is a slowly developing process that can last about 20 years or more from the moment the body becomes infected.

There are a number of additional reasons that can lead to the development of cirrhosis of the liver, one of the most relevant in this list is fatty liver hepatosis resulting from obesity, which is becoming an epidemic in a modern urbanized society.

Symptoms of liver cirrhosis

At the initial stages, the disease is asymptomatic, however, as pathological liver damage develops, the following clinical manifestations of liver cirrhosis are noted:

  • Fatigue and weakness.
  • Swelling in the legs and abdominal cavity (ascites)
  • Loss of appetite, nausea, vomiting
  • Weight loss
  • Bleeding tendency
  • Jaundice
  • Skin itching (due to excess toxins)
  • Enlargement of the spleen
  • Internal bleeding due to portal hypertension

In severe cases, mental health changes are observed due to the accumulation of toxins, which can lead to confusion, forgetfulness and difficulty concentrating.Eventually this can lead to a hepatic coma. These changes are called hepatic encephalopathy.

Diagnosis of liver cirrhosis in Israel

To make the correct diagnosis in the Israeli clinic “Rambam”, after collecting anamnesis and physical examination of the patient, the gastroenterologist directs the patient to the following diagnostic tests:

  • A detailed biochemical blood test, including checking for markers of viral hepatitis;
  • Ultrasound examination (US) or computed tomography (CT) of the liver to assess pathological changes in the liver and other abdominal organs
  • Liver biopsy – taking a small sample of liver tissue, will provide comprehensive information about the condition of the organ and is used to make a diagnosis.

Treatment for liver cirrhosis in Israel

Cirrhosis of the liver is a chronic disease and cannot be completely cured, but there is a chance to slow down the development of pathological changes, get rid of unpleasant symptoms and slow down the development of complications.

Doctors of the Institute of Gastroenterology at the Rambam Hospital first of all recommend making changes in the way of life.

  • Regardless of the cause of the development of hepatitis, alcohol should be completely abandoned.
  • Adequate food intake (including calories and protein) and regular exercise are important to prevent excessive weight and muscle loss.
  • A low sodium diet will help avoid fluid buildup in the body.
  • Care must be taken when taking medications.
  • Inform doctors and pharmacists about medicines taken on an ongoing basis.

Treatment of liver cirrhosis in Israel is aimed at eliminating the causes of the disease, as it can slow down or stop the progression of the disease.For this purpose, a number of therapeutic measures are applied:

  • Immunomodulators for the treatment of viral hepatitis.
  • Steroid drugs or other immunosuppressive drugs are used to treat autoimmune diseases that cause liver damage.
  • Diuretics for ascites
  • Hepatoprotectors – drugs that protect liver cells.
  • Plasmapheresis procedures to cleanse the blood from toxins.
  • Medicines for the elimination of itching.
  • In case of zinc deficiency, which is characteristic of cirrhosis, zinc preparations are prescribed.
  • Vaccination for protection against hepatitis A, influenza and pneumococcal infection.
  • Prevention and treatment of osteoporosis.
  • Medicines that lower portal hypertension.
  • Paracentesis – punctures of the abdominal wall, allowing to remove fluid accumulated in the abdomen (ascites).
  • It should be borne in mind that the treatment of internal bleeding requires urgent medical attention.Various surgical methods are used to stop and prevent recurrence of bleeding
  • In especially difficult cases, with excessively extensive scarring, liver transplantation may be the only treatment option.

All pharmacological preparations used in the course of treatment at the Rambam Medical Center are original and prescribed in accordance with effective treatment protocols, based on the individual characteristics of the patient.

Forecast

Until recently, the process of tissue scarring in liver cirrhosis was considered irreversible.However, recent clinical studies have shown that the correct treatment, started in the early stages of liver cirrhosis, helps to achieve a stable remission and return to the form of chronic inflammation. Highly effective therapy and extensive experience of Israeli doctors in the treatment of liver cirrhosis help to achieve excellent treatment results. Israeli scientists continue research on the restoration of liver cells using stem cells.

90,000 Causes of cirrhosis of the liver – viral infection and alcohol intoxication

In economically developed countries, cirrhosis is one of the six leading causes of death in patients aged 35 to 60 years.Every year 40 million people die in the world, in Russia – up to 30 thousand. Our country is in fourth place in the world in terms of the increase in mortality from cirrhosis of the liver after Ukraine, Belarus and Lithuania. Three times more often the disease occurs in men than in women. Cirrhosis can develop in all age groups, but more often after 40 years. In this case, the disease is difficult to treat.

Cirrhosis of the liver is a pathology characterized by extensive damage to the organ, in which its tissues are destroyed, which are replaced by fibrous fibers.As a result, all liver functions are impaired.

How cirrhosis develops

The main causes of the disease are viral infection and alcohol intoxication. In 70 percent of cases, cirrhosis develops with a long course of viral and parasitic infections, most often viral hepatitis B and C. In recent years, combined cirrhosis has doubled, when liver cells are destroyed by viruses against the background of alcohol intoxication. More rare causes of cirrhosis are biliary tract diseases, congestive heart failure, various chemical and drug intoxication, hereditary metabolic disorders.

The development of cirrhosis occurs gradually and depends on the course of the disease that caused it. This process can take from a year in severe viral hepatitis to several decades in chronic hepatitis. The sex and age of the patient, the presence of concomitant diseases and compliance with all medical recommendations affect the course of the pathology. A significant role is played by the strength of immunity, the patient’s refusal from bad habits and food addictions. Elderly patients die much faster and harder than younger ones.However, young people are more likely to suffer from cirrhosis caused by excessive alcohol and drug use. Women get sick more severely and die much faster than men.

Symptoms and prognosis

Cirrhosis occurs in four stages. Each of them is characterized by certain symptoms and prognosis. Moreover, at the third and fourth stages, pathological processes are already irreversible, therefore it is very important to detect them in a timely manner and seek qualified help.

Cirrhosis of the liver, I degree .This is the stage of compensation. It often goes unnoticed. Clinical manifestations of the disease in the form of weakness, fatigue, appetite disorders are considered signs of mental or physical stress or vitamin deficiency. The patient often does not know about the development of pathology, does not experience negative sensations. If, when drinking alcohol or consuming fatty and spicy foods, there is a slight severity under the ribs, a bitter taste and dry mouth, this is an alarming signal of the onset of an inflammatory process in the liver tissues, leading to the formation of fibrous areas.Along with inflammation in the liver, fatty degeneration of cells occurs, which interferes with the normal functioning of the blood vessels. The formation of fibrous areas is more typical for men, especially those who abuse alcohol, and fatty degeneration is more typical for women who do not adhere to the norms of a healthy diet. Life expectancy at this stage without treatment, according to experts, is up to seven years. But at the same time, it was found that when cirrhosis is detected at the first stage and adequate treatment, the survival rate is 50 percent.The main condition for prolonging life is timely diagnosis and adequate treatment.

Cirrhosis II degree . If the patient does not go to the doctor in a timely manner, continues to lead an unhealthy lifestyle, eat improperly and consume alcohol, then very soon the disease goes into the second stage – subcompensation. In this case, liver cells begin to break down faster, leading to unpleasant symptoms. Connective cicatricial or adipose tissue grows rapidly, covering an ever larger area, leading to necrosis.During this period, the patient manifests symptoms such as nausea and vomiting, yellowing of the skin, discoloration of feces and urine, pain in the right side. For no apparent reason, body temperature can rise to 38 degrees. Life expectancy is reduced and can be up to five years.

Stage III liver cirrhosis . Decompensation stage. The disease begins to progress, leading to the development of liver failure. This is a very dangerous period in which such serious complications as hepatic coma, pneumonia, sepsis, venous thrombosis, hepatocellular carcinoma – liver cancer can develop.Sudden bleeding is possible. The main symptoms are diarrhea, vomiting, weakness, muscle atrophy, fever. The condition is accompanied by circulatory disorders, varicose veins of internal organs. Portal hypertension develops – an increase in pressure in the portal vein system. This leads to the appearance of ascites – the accumulation of exudate in the abdominal cavity. An enlargement of the liver, compaction and deformation of its surface, sharpening of the edge are revealed. The spleen is enlarged. Also a characteristic symptom is the “head of a jellyfish” – overfilling of the veins of the anterior abdominal wall.Ascites leads to limited mobility of the diaphragm, peptic erosions, ulcers and bleeding from varicose veins of the esophagus, abdominal hernias, bacterial peritonitis.

The patient needs an emergency liver transplant, otherwise his life will be a maximum of three years.

Cirrhosis IV degree . Terminal stage. At this stage of the development of the disease, the liver completely decomposes, deformation and physiological changes of all internal organs occur. Life expectancy does not even reach a year.This condition is not amenable to any treatment, organ transplant is pointless. The last days of life are accompanied by severe pain.

How to treat?

After a number of diagnostic measures: laboratory tests, ultrasound, esophagogastroduodenoscopy, biopsy, scintigraphy, CT – therapy is prescribed. Specialists whose help may be needed: gastroenterologist, surgeon, hepatologist.

It will not be possible to completely get rid of cirrhosis, but timely treatment, proper nutrition, and a healthy lifestyle can significantly prolong the patient’s life.The only chance to slow down the development of the lesion is a strict diet, refusal from alcohol and drugs not prescribed by a doctor, strengthening the immune system, sparing physical activity.

The selection of drugs for cirrhosis should be carried out exclusively by a specialist, since only he is able to assess their compatibility, safety and efficacy in specific situations.

The earlier therapy is started, the greater the chances of prolonging life.

Diet

The diet for CP should be complete, containing proteins, carbohydrates, fats, half of which are of plant origin.

Prohibited foods :

• containing food additives and dyes

• fried, salted, pickled and smoked foods

• sweets containing a large amount of fat and carbohydrates

• animal fats, meat and meat broths from fatty grades

• dairy products with a high percentage of fat content

• vegetables: legumes, radishes, garlic, onions

• too acidic fruits and berries

• soda, tea and coffee.

Allowed products :

• first courses without frying

• meat and fish products from lean meats and fish

• eggs: boiled, omelette, steamed

• vegetable salads with vegetable oil dressing

• bakery products only from wheat flour, preferably of the highest grade and better dried

• low-fat dairy and sour milk products

• from sweets – jelly, jam, marshmallows

• compotes, juices, weak tea.

The list of permitted and prohibited foods for a specific type of cirrhosis is voiced by the gastroenterologist during the consultation.

Myths

There is a lot of information around cirrhosis that has not been scientifically confirmed. It misleads the sick. Major misconceptions associated with cirrhosis:

– Cirrhosis is just a common horror story, just like HIV.

– If you drink high-quality alcoholic beverages, then cirrhosis is not terrible.

– Only people with alcohol addiction suffer from cirrhosis.

– Treatment with this diagnosis is ineffectual.

– It is very simple to cure cirrhosis today.

– There are drugs that can completely restore liver tissue and get rid of this pathology.

– Hepatitis is a 100% transition to cirrhosis.

All these myths about cirrhosis are the result of poor awareness of people about the main causes of the disease, its complications and consequences. It is fundamentally wrong to think that the disease will affect only someone else – everyone can suffer from cirrhosis.

Liver health

Caring for liver health often manifests itself post factum with guilt and a desire to fix things as quickly as possible. Prejudices and stereotypes do not give rest: “it is not far from cirrhosis”, “the liver may fail,” “I have played out to the point of liver failure.”

Where is the truth? And how to distinguish a problem from popular fiction?

By Maria Vladislavovna Matsievich, Ph.D., chief specialist of MEDSI in the direction of “Hepatology”, gastroenterologist, hepatologist.

The liver is a multitasking organ, which accounts for more than 2 million functions, the main of which are the production of blood proteins, including components of the immune and coagulation systems, the formation of bile necessary for the & nbsp digestion of food, storage of reserve reserves of glucose – the main “fuel” of the body in the form glycogen, ridding the body of harmful substances in the bloodstream, including alcohol, and the production of cholesterol. Liver failure occurs when the liver does not cope with these important tasks, it usually manifests itself at the stage of cirrhosis, but it can also happen with the development of acute hepatitis, which is aggressive and lightning fast.

Contrary to popular belief, the liver is unique in its ability to resist any aggressive factors. These include hepatitis B and C viruses, alcohol abuse, obesity, and autoimmune and genetic problems. Nevertheless, long-term, and most importantly, asymptomatic liver inflammation associated with the influence of these unfavorable factors leads to the formation of scar tissue in it, and when there is a lot of it, cirrhosis is formed. At this stage, many functions of the organ gradually begin to be disrupted.For many, such a diagnosis is associated with a sad ending, but cirrhosis is not a sentence. Timely identified causes of the disease, effective treatment can restore the liver to its previous health.
In the case of a long-term untreated or unrecognized disease, liver failure can be a life-threatening complication that requires immediate medical attention.

The symptoms of liver failure are manifold and may develop gradually as the liver stops functioning.

The disease can begin with an increase in general weakness, fatigue, sleep and memory disturbances. These symptoms appear due to the fact that toxins enter the bloodstream, and then into the brain, which the liver is not able to utilize, as it was before. As liver failure progresses, symptoms become more severe. Yellowing of the skin and eyes – the formation of jaundice – signs of a complete “shutdown” of the liver from its usual work. An increase in the volume of the abdomen can be an indicator of the accumulation of fluid in the abdominal cavity, the appearance of vomiting with blood or black stools – a sign of bleeding from the esophagus and intestines.

A musty, sweet smell from the mouth is often emitted from a person with liver failure. All these symptoms require immediate medical attention.

Liver disease and liver failure are usually treated by a hepatologist. Such patients need treatment and supervision by specialists exclusively in a round-the-clock hospital! Treatment of liver failure requires the introduction of protein solutions, donated blood and plasma, the appointment of diuretic, hormonal and vascular therapy.With the ineffectiveness of the therapeutic measures used, the only salvation is liver transplantation.

Not only regular examinations (determining the level of liver enzymes, general blood counts, ultrasound examination of the abdominal cavity), but also timely vaccination against hepatitis B, reducing alcohol consumption, maintaining a healthy weight and an active image will help not to bring your liver to such a development of events life, lack of uncontrolled intake of medicines and unjustified use of dietary supplements.Self-medication, the use of hepatoprotectors, the use of traditional medicine are unacceptable. All this creates only an apparent improvement, contributes to the progression of liver disease and removes from the possibility of a complete cure.