Fatty liver disease: The sign on your palms affecting 23% of liver disease sufferers

Journal of the American Medical Association: “A NOTE ON PALMAR ERYTHEMA (SO-CALLED LIVER PALMS).”

What Is Palmar Erythema?

Palmar erythema is a skin condition that makes the palms of your hands turn red. It can be hereditary but can also be the result of a variety of health conditions. It’s also relatively common during pregnancy.

Palmar erythema is also known as liver palms, red palms, or Lane’s disease.

Symptoms of Palmar Erythema

Here are some ways to know if the redness on your palms is palmar erythema:

• It’s symmetrical — that is, the redness appears on both palms.
• The redness is blanchable, meaning if you press on it, it goes away.
• Your palms feel slightly warm.
• It’s not painful and not itchy.

The redness usually involves the lower part of your palm but may extend to your fingers. In some cases, it may extend over the fingertips to the nail beds.

If there is redness on the soles of your feet, that’s called plantar erythema.

Americans see their primary care doctors less often than they did a decade ago. Adults under 65 made nearly 25% fewer visits to primary care providers in 2016 than they did in 2018, according to National Public Radio. In the same time period, the number of adults who went at least a year without visiting a primary care provider increased from 38% to 46%.

What Causes the Redness?

Your palms have turned red because of dilated capillaries, which are the smallest blood vessels in your body. How red your palms get seems to vary with how severe the underlying disease is. Some researchers believe this has to do with increased hormone levels.

Primary Palmar Erythema

Primary palmar erythema can be hereditary or caused by pregnancy, or it can be the result of an unknown factor.

Pregnancy. Pregnancy is a common cause of palmar erythema. It’s estimated that it occurs in about two-thirds of lighter-skinned pregnant women and up to one-third of darker-skinned pregnant women. This may happen because of changes to your blood vessels related to an increase in estrogen production during pregnancy.

Many of the changes to your blood vessels in pregnancy are temporary and disappear soon after you give birth.

Hereditary. Palmar erythema can be inherited, but it is a very rare condition. The redness of the palms can appear at birth or later in life and remain from then on. This may happen to at least two members of the family, but some individual cases have also been reported.

There are no signs of inflammation, allergic reaction, or other health conditions that have been linked to palmar erythema. Only a few cases of hereditary palmar erythema have been discussed in medical literature since it was first described by John E. Lane in 1929.

Unknown origin. In some cases, palmar erythema may be idiopathic. This means that there’s no known cause and you have no other associated health conditions.

Secondary Palmar Erythema

Secondary palmar erythema can be the result of an underlying medical condition, medication, or environmental causes. There is a large variety of possible underlying conditions that can cause it.

Liver disease. Palmar erythema is associated with several types of liver diseases. About 23% of those with liver cirrhosis have palmar erythema.

Cirrhosis happens when your liver is severely scarred and your healthy liver tissue is being replaced with scar tissue as it tries to repair itself.

Other liver diseases related to palmar erythema include rare liver diseases like Wilson Disease, an inherited disorder in which excessive amounts of copper build up in your body, and hereditary hemochromatosis, in which your body absorbs too much iron from the food you eat.

Babies and young children with liver disease are less likely to have palmar erythema than teenagers and adults.

Autoimmune diseases.Rheumatoid arthritis is a common autoimmune and inflammatory disease that causes painful swelling in the joints and other parts of the body.

In a study of 152 people with rheumatoid arthritis, 61% were found to have palmar erythema. Another study compared patients with rheumatoid arthritis with those who had other internal diseases. Palmar erythema was significantly higher in those with rheumatoid arthritis.

Other conditions that have been associated with palmar erythema include:

Diabetes. People with diabetes tend to get skin infections, and their wounds also heal slower. An estimated 4.1% of people with Type 1 and Type 2 diabetes mellitus have palmar erythema.

Thyroid disease. Palmar erythema affects up to 18% of those with thyrotoxicosis, which is when you have too much thyroid hormones in your blood.

Brain tumors. In a study of 107 people with brain tumours, 25% were found to have palmar erythema. The intensity of the redness depended on the type of tumor and its growth.

HIV. There has been one reported case of palmar erythema linked to HIV.

Medications. Some medications may cause palmar erythema. For example, if you take topiramate for treatment of paranoid schizophrenia. In a rare case, a pregnant woman given albuterol to prevent premature labor developed palmar erythema.

Other medications that may be linked to palmar erythema include amiodarone, gemfibrozil, and cholestyramine.

Environmental causes. Smoking, alcoholism, and mercury poisoning are some environmental causes of palmar erythema.

There are a few other possible conditions that researchers say may be associated with palmar erythema. These include:

Skin conditions. A recent case of palmar erythema in a three-year-old boy with no other problems had doctors puzzled until they learned that he had been using hand sanitizer every 20 to 30 minutes throughout the day. They determined that it was an unusual presentation of contact dermatitis.

COVID-19. Skin rashes have appeared in some people with COVID-19. In one case of a woman who tested positive for Covid-19, palmar erythema was the only symptom. She didn’t have other typical COVID-19 symptoms, nor did she have other health conditions related to palmar erythema.

How is Palmar Erythema Diagnosed?

Your doctor will be able to diagnose palmar erythema by inspecting your palms, but they’ll also review your medical history and perform a physical exam.‌

As there are many possible underlying disorders that can result in the redness of your palms, your doctor may order one or more diagnostic tests. These include tests that measure:

• Liver function
• Blood urea nitrogen or creatinine
• Complete blood count
• Fasting glucose levels
• Iron levels
• Hepatitis C
• Hepatitis B
• Thyroid-stimulating hormone

Other tests may include:

• Bone marrow biopsy
• Chest X-ray
• CT scan of chest, abdomen, and/or pelvis
• Magnetic resonance imaging (MRI) of the brain
• Tests for antibodies

How Is Palmar Erythema Treated?

There’s no standard treatment for palmar erythema. If you have an underlying condition causing the palmar erythema, your doctor will work to treat it. If the cause is related to a medication, it’s advisable to stop it or change to a different class of drug.

Show Sources

SOURCES:‌

Adolescent Medical Clinics: “Wilson’s disease and hemochromatosis.”

American Family Physician: “Common Skin Conditions During Pregnancy.”

American Journal of Clinical Dermatology: “Palmar Erythema.”

Case Reports in Dermatology: “Erythema Palmare Hereditarium (‘Red Palms’, ‘Lane’s Disease’).”

Cureus: “Palmar Erythema as the Sole Manifestation of COVID-19.”

Cutis: “Palmar Telangiectases as a Manifestation of Graves Disease.”

Dermatology: “Palmar erythema: cutaneous marker of neoplasms.”

European Journal of Dermatology: “Palmar erythema: inaugural manifestation of HIV infection.”

Journal of the American Medical Association: “A NOTE ON PALMAR ERYTHEMA (SO-CALLED LIVER PALMS).”

Journal of Tropical Pediatrics: “Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know the Offender?.”

Mayo Clinic: “Cirrhosis.”

Pediatric Dermatology: “Lane’s Disease (Erythema Palmare Hereditarium): A Report of Five Cases and a Review of the Literature.”

QJM: An International Journal of Medicine: “Palmar and plantar erythema, pulmonary fibrosis and the anti-synthetase syndrome.”

Rheumatology: Current Research: “Dermatologic Manifestations of Rheumatoid Arthritis.”

Fatty liver disease: The sign on your palms affecting 23% of liver disease sufferers

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Cirrhosis of the liver describes a condition where scar tissue gradually replaces healthy liver cells. It is a progressive disease, developing slowly over many years. If it is allowed to continue, the build-up of scar tissue can eventually stop liver function. There is an unusual condition which changes a person’s palms to another colour.

Cirrhosis is scarring of the liver. The scar tissue prevents the liver working properly.

Fatty liver disease doesn’t usually cause any symptoms, but when it does, signs may include fatigue and pain or discomfort in the upper right abdomen, advises Mayo Clinic.

Some individuals with fatty liver disease can develop non-alcoholic steatohepatitis, an “aggressive” form of the condition, it adds.

When this happens, other symptoms may develop which you can spot for yourself on your palms.

If noticing an unusual red colour blemished on your palms it could indicate your liver is in trouble.

Red palms are also known as palmar erythema, or liver palms, and the reddening typically occurs on the lower part of the palm.

The redness in the palms is caused by dilated capillaries in the hands which draw more blood to the surface.

The degree of redness can vary depending on:

• Temperature
• Pressure applied to your hands
• Your emotional state
• If you’re holding your arms up.

Other symptoms of a failing liver include:

• Yellowing of the skin and whites of the eyes (jaundice)
• Vomiting blood
• Itchy skin
• Dark, tarry-looking poo
• A tendency to bleed or bruise more easily
• Swollen legs (oedema) or tummy (ascites) from a build-up of fluid.

There aren’t any treatments available to reduce the redness itself.

With secondary palmar erythema, the redness may lessen as the root cause is treated.

If liver disease is the main cause, speaking to your GP about how to improve your liver health is vital.

If a drug you’re taking is causing the redness, you should also talk with your doctor about alternative medications.

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02/02/2022 Health News Comments Off on Fatty liver disease: The sign on your palms affecting 23% of liver disease sufferers

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Cirrhosis of the Liver

Cirrhosis is a late-stage result of liver disease and its complications. You may not have symptoms in the beginning stages of the disease. Common causes include alcohol use disorder, hepatitis and non-alcohol related fatty liver disease. Treatment depends on the cause of cirrhosis and how much damage exists. Liver transplantation may be an option if your liver is failing.

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Overview

What is cirrhosis of the liver?

Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Scar tissue keeps your liver from working properly.

Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.

The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Late-stage cirrhosis is life-threatening.

How common is cirrhosis?

Scientists estimate that cirrhosis of the liver affects about one in 400 adults in the U.S. It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis. Cirrhosis causes about 26,000 deaths each year in the U.S. and is the seventh leading cause of death in the U.S. among adults 25 to 64 years of age.

Who gets cirrhosis, who is most at risk?

You are more likely to get cirrhosis of the liver if you:

• Use alcohol for many years.
• Have viral hepatitis.
• Have diabetes.
• Have obesity.
• Inject drugs using shared needles.
• Have a history of liver disease.
• Have unprotected sex.

Is cirrhosis cancer?

No, cirrhosis of the liver isn’t cancer. However, most people who have liver cancer have cirrhosis. If you have cirrhosis, you have an increased risk of liver cancer. If you have hepatitis B or hepatitis C, you have an increased risk of liver cancer because these diseases often lead to cirrhosis. Any cause of liver disease can lead to cirrhosis, which increases your chance of liver cancer. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.)

Is cirrhosis a hereditary disease?

Cirrhosis itself is not an inherited (passed from parent to child) disease. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases.

Can cirrhosis be reversed?

Generally no. If you have been told you have cirrhosis, you have a late-stage liver disease and the damage that is already done is permanent. There are many liver diseases and complications of liver diseases that can lead to cirrhosis. If your liver disease or complication is caught early and successfully managed, it may be possible to slow or stop the progression of disease.

Is cirrhosis fatal?

Having a diagnosis of cirrhosis of the liver doesn’t mean you have an immediately fatal condition. However, as cirrhosis continues, more scarring occurs and liver function continues to decline. Eventually, your failing liver may become a life-threatening condition. Yet there’s still hope. You and your medical team will discuss if you are a candidate for a liver transplant. If so, you will begin the process of being placed on a national liver transplant recipient list.

Symptoms and Causes

What are the symptoms of cirrhosis?

The symptoms of cirrhosis depend on the stage of your disease. In the beginning stages, you may not have any symptoms. If you do have symptoms, some are general and could easily be mistaken for symptoms of many other diseases and illnesses.

Early symptoms and signs of cirrhosis include:

• Loss of appetite.
• Feeling weak or tired.
• Nausea.
• Fever.
• Unexpected weight loss.

As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including:

• Easy bruising and bleeding.
• Yellow tint to your skin or the whites of your eyes (jaundice).
• Itchy skin.
• Swelling (edema) in your legs, feet and ankles.
• Fluid buildup in your belly/abdomen (ascites).
• Brownish or orange color to your urine.
• Light-colored stools.
• Confusion, difficulty thinking, memory loss, personality changes.
• Blood in your stool.
• Redness in the palms of your hands.
• Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
• In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles.
• In women: premature menopause (no longer having your menstrual period).

Is cirrhosis painful?

Yes, cirrhosis can be painful, especially as the disease worsens. Pain is reported by up to 82% of people who have cirrhosis and more than half of these individuals say their pain is long-lasting (chronic).

Most people with liver disease report abdominal pain. Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs. General abdominal pain and discomfort can also be related to swelling from fluid retention and enlargement of your spleen and liver caused by cirrhosis.

Pain can come both from the diseases that lead to cirrhosis and/or cirrhosis can make the pain from existing diseases worse. For instance, if you have non-alcohol related fatty liver disease and have obesity, you may also have osteoarthritis and cirrhosis makes your bone and joint pain worse. Cirrhosis also causes an inflammatory state in your entire body. Inflammation and your body’s reaction to inflammation can cause general pain.

What causes cirrhosis?

The most common causes of cirrhosis of the liver are:

• Alcohol use disorder (alcohol-related liver disease) caused by long-term [chronic] use of alcohol.
• Chronic viral infections of the liver (hepatitis B and hepatitis C).
• Fatty liver associated with obesity and diabetes, but not alcohol. This condition is called non-alcohol related steatohepatitis.

Anything that damages the liver can lead to cirrhosis. Other causes include:

• Inherited diseases:
  • Alpha-1 antitrypsin deficiency (build-up of an abnormal protein in the liver)
  • Hemochromatosis (excess iron stored in the liver).
  • Wilson disease (excess copper stored in the liver).
  • Cystic fibrosis (sticky, thick mucus builds up in the liver).
  • Glycogen storage diseases (liver can’t store or break down glycogen, a form of sugar).
  • Alagille syndrome (born with fewer than normal number of bile ducts; affects bile flow and causes jaundice).
  • Primary biliary cholangitis (bile ducts become injured, then inflamed, then permanently damaged).
  • Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver).
  • Blocked bile duct (can cause infections, backup of products in the liver).
  • Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing damage, scarring, loss of liver tissue and cirrhosis).

  Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if injury – from whatever cause – continues, liver cells start to die. Over time, scar tissue replaces the damaged liver cells and the liver can’t function properly.

  What are the complications of cirrhosis?

  There are many complications of cirrhosis of the liver. Because cirrhosis develops over many years, some of these complications may be your first noticeable signs and symptoms of the disease.

  Portal hypertension: This is the most common serious complication. Portal hypertension is an increase in the pressure in your portal vein (the large blood vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through your liver as a result of cirrhosis. When blood flow through veins is partially blocked, veins in your esophagus, stomach or intestines can become enlarged (a condition called varices). As the pressure in these veins builds, the veins can bleed or even burst, causing severe internal bleeding.

  Additional complications of portal hypertension include:

  • Swelling (edema) in your legs, ankles or feet.
  • Buildup of fluids in your abdomen (called ascites).
  • Swelling/enlargement of your spleen (splenomegaly).
  • Formation and dilation (expansion) of blood vessels in the lungs (hepatopulmonary syndrome), leading to low levels of oxygen in the blood and body and shortness of breath.
  • Failure of kidney function as a result of having portal hypertension as a complication of cirrhosis (hepatorenal syndrome). This is a type of kidney failure.
  • Confusion, difficulty thinking, changes in your behavior, even coma. This occur when toxins from your intestines aren’t removed by your damaged liver and circulate in the bloodstream and buildup in your brain (a condition called hepatic encephalopathy).

  Hypersplenism: Hypersplenism is an overactive spleen. This condition causes quick and premature destruction of blood cells.

  Infections: Cirrhosis increases your risk of getting and fighting serious infections, such as bacterial peritonitis (infection of the tissue that lines the inner wall of your abdomen).

  Malnutrition: Your liver processes nutrients. A damaged liver makes this more difficult and leads to weight loss and general weakness.

  Liver cancer: Most people who develop liver cancer have cirrhosis of the liver.

  Liver failure: Many diseases and conditions cause liver failure including cirrhosis of the liver. As its name implies, liver failure occurs when your liver isn’t working well enough to perform its many functions.

  Diagnosis and Tests

  How is cirrhosis of the liver diagnosed?

  Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol use, injectable drug use or have had hepatitis B or C and have the symptoms listed in this article.

  To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:

  • Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).
  • Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
    • Lower than normal levels of albumin and blood clotting factors (lower levels means your liver has lost its ability to make these proteins).
    • Raised levels of liver enzymes (suggests inflammation).
    • Higher level of iron (may indicate hemochromatosis).
    • Presence of autoantibodies (may indicate autoimmune hepatitis or primary biliary cirrhosis).
    • Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood).
    • High white blood cell count (indicates an infection).
    • High creatinine level (a sign of kidney disease that suggests late-stage cirrhosis).
    • Lower levels of sodium (is an indicator of cirrhosis).
    • Raised level of alpha-fetoprotein (indicates presence of liver cancer).

    In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.

    • Imaging tests: Imaging test show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered include computerized tomography (CT) scan, abdominal ultrasound and magnetic resonance imaging (MRI). A special ultrasound, called a transient elastography, measures the fat content and amount of stiffness in your liver. Two different types of endoscopies might be ordered: an endoscopic retrograde cholangiopancreatography to detect bile duct problems, and/or upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach or intestines.
    • Biopsy: A sample of liver tissue (biopsy) is removed from your liver and examined under the microscope. A liver biopsy can confirm a diagnosis of cirrhosis, determine other causes or extent of liver damage or enlargement or diagnosis liver cancer.

    Are there stages of cirrhosis?

    If you have been diagnosed with cirrhosis of the liver, you are already beyond the early stages of liver disease. Having cirrhosis means your liver has scar tissue in it because it has been damaged.

    Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Some specific liver diseases also have their own scoring systems. However, not every liver disease has a scoring system and there’s no scoring system if you happen to have more than one liver disease at the same time.

    For these reasons, perhaps it’s easier to talk about cirrhosis according to a classification system you are more likely to hear from your healthcare provider. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis.

    Compensated cirrhosis means you have cirrhosis but you don’t yet have noticeable symptoms (you are asymptomatic). Your lab work and imaging findings may not be abnormal. A liver biopsy may be the only way to confirm a diagnosis of cirrhosis. Median survival in patients with compensated cirrhosis is approximately nine to 12 years. (Median is the middle point in set of numbers, so an equal number of individuals survived less than 9 to 12 years as the number of individuals who survived over this time range.)

    Decompensated cirrhosis means your cirrhosis has worsened to the point that you have noticeable symptoms. Your healthcare provider recognizes your condition based on your history, physical and lab findings. You have at least one complication, which includes jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome, variceal bleeding or liver cancer. You are usually admitted to the hospital for care. Median survival in patients with decompensated cirrhosis is approximately two years.

    Management and Treatment

    Is there a cure for cirrhosis of the liver?

    No, there is no cure for cirrhosis. The damage already done to your liver is permanent. However, depending on the underlying cause of your cirrhosis, there may be actions you can take to keep your cirrhosis from getting worse. These actions include:

    • Stop drinking alcohol.
    • Treat chronic hepatitis (if you have it).
    • Avoid medications that stress the liver.
    • Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet.

    Follow other tips listed under the Prevention section in this article.

    What are the goals of cirrhosis treatment?

    The goals of treatment for cirrhosis of the liver are to:

    • Slow further damage to your liver.
    • Prevent and treat symptoms.
    • Prevent and treat complications.

    How is cirrhosis of the liver treated?

    Treatment depends on what’s causing your cirrhosis and how much damage exists.

    Although there is no cure for cirrhosis, treatments can delay or stop its progress and reduce complications.

    Treatments for the causes of cirrhosis are as follows:

    • Alcohol-related liver disease: If you’ve developed cirrhosis from alcohol use, talk with your provider about how to stop drinking alcohol. If you need help, ask your healthcare provider for recommendations for alcohol addiction treatment programs.
    • Hepatitis B or C: Several approved antiviral medications are available to treat hepatitis types B and C.
    • Non-alcohol related fatty liver disease: Management of non-alcohol related fatty liver disease includes losing weight, following a healthy diet, getting physical exercise and following your provider’s instructions for managing your diabetes.
    • Inherited liver diseases: Treatment depends on the specific inherited disease. Treatments are aimed at treating symptoms and managing complications. Treatment of alpha-1 antitrypsin deficiency may include medicine to reduce swelling in your abdomen and legs, antibiotics to treat infections and other medicines for complications. For hemochromatosis, treatment is to remove blood to reduce the level of iron in your blood. For Wilson disease, treatment is medicines to remove copper from your body and zinc to prevent absorption of cooper. For cystic fibrosis, medications are prescribed to improve lung function, methods to clear mucous and treatment of complications. Treatment for glycogen storage diseases that involve the liver is to keep glucose at the right level.
    • Autoimmune hepatitis: Treatment includes medications to suppress your immune system.
    • Diseases that damage or block bile ducts in the liver: Treatments include medications such as ursodiol (Actigall®) or surgery to open narrowed or blocked bile ducts.
    • Heart failure: Treatment depends on the cause and stage of your heart failure. Medications include drugs to treat high blood pressure, reduce cholesterol, remove excess fluids (edema) from your body and improve heart pumping function. Other treatments include implantation of devices to help pump blood or monitor heart rhythm, surgeries to unblock arteries or replace or repair heart valves and transplant surgery to replace your heart.
    • Medications that may be contributing to cirrhosis: Your provider will review all of your medications to determine if any are causing problems for your liver and if so, stop the drug, lower the dosage or change to a different drug if possible.

    How are the complications of cirrhosis treated?

    Portal hypertension: Portal hypertension is mainly the result of chronic end-stage liver disease. Treatment consists of treating its many complications. Treatments of portal hypertension include:

    • Giving beta blockers or nitrates to lower blood pressure in your veins.
    • Cutting off blood flow through the varices to stop or reduce further bleeding with procedure using tiny elastic bands (band ligation) or with sclerotherapy.
    • Redirecting blood from the portal vein to reduce pressure in the portal vein and to control variceal bleeding. This is achieved using either one of two techniques – distal splenorenal shunt or transjugular intrahepatic portosystemic shunt.
    • Prescribing lactulose to absorb toxins in the blood that result from hepatic encephalopathy, which cause symptoms including confusion and other mental changes.
    • Draining excess fluid in your abdomen (ascites) in a procedure called paracentesis or taking a diuretic medication to decrease extra fluids (edema) in your legs and other areas of your body.

    Bacterial peritonitis: Antibiotics and infusion of a protein (albumin) will be prescribed. Typically patients are admitted to the hospital for treatment and monitoring. Following a diagnosis of bacterial peritonitis, an oral antibiotic will be prescribed for daily use to prevent recurrence of infection.

    Liver cancer: Treatment depends on the stage of your cancer and other factors. One or more treatments may be tried. Options include surgery to remove part of your liver or your whole liver (to be replaced with a new liver as part of a liver transplantation) and nonsurgical tumor-destroying methods including ablation, chemotherapy, targeted therapy (drugs zero in on cancer genes or tissue), immunotherapy and radiation bead therapy (inject bead that give off radiation into the blood vessels that feed the tumor).

    Kidney failure: Treatment may include medication, dialysis and kidney transplant, depending on the cause and extent of failure.

    Liver failure: Treatment depends on if you have acute or chronic failure. For chronic liver failure, diet and lifestyle changes include stopping alcohol and medications that harm the liver; eating less red meat, cheese and eggs; losing weight; managing high blood pressure and diabetes and cutting down on salt.

    Acute treatments for liver failure include intravenous fluids to maintain blood pressure, laxatives to help flush toxins from the body and blood glucose monitoring.

    If you have either acute or chronic liver failure, your liver specialist may recommend a liver transplant. Liver transplants can come from a living or deceased donor. Only a portion of the donor liver needs to be transplanted. The liver is the only human organ capable of growing back.

    Many tests are required of both you (the liver transplant recipient) and the person donating a portion of their liver or the cadaver liver (liver from a deceased person). If your doctors determine that you need a liver transplant, you will be placed on a national liver transplant waiting list, which lists patients by blood type, body size and severity of end-stage liver disease.

    Prevention

    How can I prevent cirrhosis of the liver?

    Food and drink issues:

    • Use alcohol only in moderation. If you do drink alcohol, limit how much you drink and how often. If you drink more than two drinks a day if you are a man or more than one if you are a woman, you are increasing your risk. A drink is a glass of wine or a 12-ounce can of beer or a 1.5 ounce serving of hard liquor. If you have liver disease, you shouldn’t drink alcohol at all.
    • Eat a well-balanced, low-fat diet, such as the Mediterranean diet. A well-balanced healthy diet consists of fruits, vegetables, lean proteins and whole grains.
    • Don’t eat raw seafood, especially oysters and clams. These foods can contain a bacteria that can cause serious illness.
    • Cut back on the amount of salt in your diet. Use other seasonings to flavor your foods.

    Healthy body habits:

    • Maintain a weight that’s healthy for you. Excess body fat can damage your liver. Ask your healthcare provider for a weight loss plan if you are overweight.
    • Exercise regularly.
    • See your healthcare provider regularly for check-ups. Follow medical recommendations to manage obesity, diabetes, hypertension (high blood pressure) and cholesterol (high bad cholesterol [LDL] and/or low good cholesterol [HDL]) and high triglycerides.
    • Quit smoking if you smoke.

    Healthy liver practices:

    • Avoid high-risk behaviors that can lead to infection with hepatitis B or C, such as sharing needles for illegal drug use or having unprotected sex.
    • Get vaccinated against hepatitis B. If you already have hepatitis, ask your provider if drug treatment is appropriate for you.
    • Get your annual flu shot and ask if a pneumonia vaccine makes sense for you (people with cirrhosis are more likely to get infections).
    • Avoid nonsteroidal anti-inflammatory drugs (such as ibuprofen [Advil®, Motrin®] indomethacin [Indocin®] celecoxib [Celebrex®] and aspirin) and high doses of acetaminophen (Tylenol®). Acetaminophen can be taken safely at a dose up to 2,000 mg daily. These drugs can cause or worsen liver function.
    • Take all medications and keep all appointments as recommended by your healthcare provider.

    Outlook / Prognosis

    What can I expect if I have cirrhosis?

    Damage already done to your liver is permanent. But your liver is a large organ. If part of your liver is still working, you might be able to slow the progression of disease, depending on its cause. For instance, if your cirrhosis is caused by alcohol use, talk to your provider about how to stop drinking. If you have obesity or diabetes, you will need to lose weight and manage your blood sugar so you can lower the damage caused by fatty liver disease.

    You and your healthcare provider or team will work together to determine what’s causing your cirrhosis and what complications may have resulted from your cirrhosis and treat them accordingly.

    What’s the life expectancy for people with cirrhosis?

    Life expectancy depends on several factors including the cause and severity of your cirrhosis, your response to treatments, the presence of cirrhosis complications, your age and any other existing general health problems. Ask your liver specialist about your life expectancy since every person is unique, with unique overall health issues and specific liver health issues.

    If your cirrhosis is advanced, liver transplantation may be an option. You and your doctors will discuss if this is an option for you.

    What’s a Child-Turcotte-Pugh score and MELD score?

    A Child-Turcotte-Pugh (CTP) score, also known simply as the Child-Pugh score, is a clinical score that tells your doctors how severe your liver disease is and forecasts your expected survival rate. The scoring system provides a score on the presence of five clinical measures (the lab values of bilirubin, serum albumin and prothrombin time; presence of ascites and hepatic encephalopathy) and the degree of severity of each of these measures.

    Child-Turcotte-Pugh Score
    Class Status	Severity of Liver Disease	Two-Year Survival Rate
    Class A	Mild	85%
    Class B	Moderate	60%
    Class C	Severe	35%

    The Model for End-stage Liver Disease (MELD) score is a score that is used to rank the urgency for a liver transplant. The worse your liver function is, the higher your MELD score and the higher your position is on the transplant list. The Pediatric End-stage Liver Disease (PELD) score is similar to MELD but is a scoring system for children under the age of 12.

    Living With

    When should I call 911 or go to the emergency room?

    If you have cirrhosis and experience the following, call 911:

    • Your poop (stools) are black and tarry or contain blood (may be maroon or bright red in color).
    • You are vomiting blood.
    • The whites of your eyes are turning yellow.
    • You have difficulty breathing.
    • You have abdominal swelling.
    • You have muscle tremors or shakiness.
    • You are confused, irritable, disoriented, sleepy, forgetful or “foggy.”
    • You have a change in your level of consciousness or alertness; you pass out.

    What type of healthcare providers will treat my cirrhosis?

    Depending on the stage of your cirrhosis, different healthcare providers may be involved in your care. Healthcare professionals likely to be part of your care team include:

    • Your primary care provider.
    • Gastroenterologist (doctor who specializes in conditions of your digestive tract).
    • Hepatologist (doctor who specializes in conditions of your liver).
    • Nephrologist (doctor who specializes in conditions of your kidney).
    • Dietitian.
    • Members of a liver transplant team include: hepatologist, transplant surgeon, anesthesiologist, infectious disease specialist, nephrologist, dietitian, transplant pharmacist, physical and occupational therapist, case manager/social worker and nurses.

    A note from Cleveland Clinic

    Cirrhosis of the liver is a late-stage result of liver disease and its complications. Cirrhosis causes your liver to not function properly. Your liver plays a vital role in many of the processes and functions that keep you alive.

    Although scarring from liver disease causes permanent damage, it’s still possible to live a long life. Depending on the underlying cause, it’s possible to slow or stop cirrhosis from worsening. Many of the causes and complications that lead to cirrhosis are treatable or manageable. If you drink alcohol, stop. If you have non-alcohol related fatty liver disease, lose weight and manage your metabolic risk factors. If you have diabetes, make sure you are following your healthcare provider’s management recommendations. Take all medications for all your medical conditions as directed by your healthcare team. Get vaccinated for hepatitis A and B.

    If you have end-stage cirrhosis, don’t lose hope. You and your healthcare team will work together to closely manage your condition and put you on a wait list for a donor liver.