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What are different treatment options available for treating cirrhosis?

Treatment of cirrhosis includes
– Preventing further damage to the liver,
– Treating the complications of cirrhosis,
– Preventing liver cancer or detecting it early,
– Liver transplantation.

Many medicines have been studied, such as
– Steroids
– Penicillamine (Cuprimine, Depen)
– An anti-inflammatory agent (colchicine)
– Researchers are studying various experimental treatments for cirrhosis.

Ascites
– Your health care provider may prescribe water pills (a diuretic).
– This removes extra fluid from your body.
– This medication will make you urinate more often.
– Your health care provider may insert a needle into your abdomen to directly remove large amounts of fluid.
– However, the fluid usually collects again.
– If the fluid becomes infected, you will have to stay in the hospital and receive IV antibiotics.

Hepatic encephalopathy
– You will be given lactulose, a drink that reduces the amounts of toxins that are absorbed into your intestinal tract.
– You may be started on a low-protein diet.
– These 2 treatments may be combined to improve symptoms in 75 percent of cases.

Clotting disorders
Adequate protein intake and vitamin supplements can help to correct clotting disorders.

Itching
Medications are available to reduce itching.

Surgery: Liver Transplantation
– In this operation, the diseased liver is removed and replaced with a healthy liver that is taken from an organ donor.
– About 80-90 percent of people undergoing liver transplantation survive.
– As in all transplantation procedures, supportive before and after the procedure is very important in determining the success of the operation.

Portal Hypertension
– Some people are treated with a drug called a beta-blocker to lower the pressure in the blood vessels.
– Various surgeries can be performed to redirect liver blood flow into the circulatory system.
– Reducing liver blood pressures.
– However, surgery may worsen hepatic encephalopathy or ascites.

Bleeding varices
If you have bleeding from varices in the esophagus or stomach, you are at high risk of bleeding to death.
– You will have to stay in the hospital until the bleeding is under control.
– You have a 1 in 2 chance of dying during that hospital stay if you suffer from bleeding varicose veins in your esophagus.
– If you have significant blood loss, treatment will focus on restoring lost fluids.
– You will be monitored carefully until bleeding is controlled and your blood circulation is stabilized.
– Two large IV lines will be placed to replace lost fluids.
– You will need supplemental oxygen until you begin to replace some of the lost blood.
– You may need blood transfusions.
– Balloon inflation to compress the vein.
– Medications that decrease blood flow into the liver.
– Tying off the bleeding vein.

Hepatorenal Syndrome
– Liver transplant is the only treatment that works in this advanced disease.

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

How to prevent further damage to the liver
– Consume a balanced diet and one multivitamin daily.
– Patients with PBC with impaired absorption of fat soluble vitamins may need additional vitamins D and K.
– Avoid drugs (including alcohol) that cause liver damage.
– All patients with cirrhosis should avoid alcohol.
– Most patients with alcohol induced cirrhosis experience an improvement in liver function with abstinence from alcohol.
– Even patients with chronic hepatitis B and C can substantially reduce liver damage.
– It will slow the progression towards cirrhosis with abstinence from alcohol.
– Avoid nonsteroidal antiinflammatory drugs (NSAIDs, e.g., ibuprofen).
– Patients with cirrhosis can experience worsening of liver and kidney function with NSAIDs.
– Eradicate hepatitis B and hepatitis C virus by using anti-viral medications.
– Immunize patients with cirrhosis against infection with hepatitis A and B to prevent a serious deterioration in liver function.

Treating the complications of cirrhosis
– Propranolol (Inderal), a beta blocker, is effective in lowering pressure in the portal vein and is used to prevent initial bleeding and rebleeding from varices in patients with cirrhosis.
– Octreotide (Sandostatin) also decreases portal vein pressure and has been used to treat variceal bleeding.
– During upper endoscopy (EGD), either sclerotherapy or band ligation can be performed to obliterate varices and stop active bleeding and prevent rebleeding.
– Transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical procedure to decrease the pressure in the portal vein.
– A surgical operation to create a shunt (passage) from the high-pressure portal vein to veins with lower pressure can lower blood flow and pressure in the portal vein and prevent varices from bleeding.

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