Cirrhosis (cont)
Splenomegaly and Low Platelets
Portal hypertension usually causes spleen enlargement (splenomegaly). At times the spleen becomes so large it can be felt below the left rib cage. An enlarged spleen traps certain blood cells – white blood cells (infection fighters) and platelets (aids clotting). Occasionally the platelet count is low enough to notice problems with bruising and bleeding.
Liver Cancer
Patients with cirrhosis are at increased risk for liver cancer (hepatocellular carcinoma). This is a cancer that originates in the liver. There are usually no symptoms. To screen for this cancer, a blood test, alphafetoprotein (AFP), and right upper quadrant ultrasound (or other liver imaging tests) are obtained every six months. If cancer is found early, it can be treated and cured.
Mental Impairment/ Hepatic Encephalopathy
In more advanced cases of cirrhosis, changes in mental capacity can occur. This mental impairment (encephalopathy) can range from forgetfulness and trouble concentrating to coma and death. This condition is not fully understood but probably involves some blood bypassing the liver going directly to the brain and the liver’s decreased capacity to breakdown certain toxins. One of the toxins is ammonia. Measurement of the ammonia blood level is not helpful as almost all people with cirrhosis will have abnormal levels but few have encephalopathy.
Encephalopathy is treated with lactulose, a liquid medication. The correct dose of the medication causes 3-4 soft or loose stools per day. This change in bowel function can be bothersome, but is necessary to clear toxins from your blood. If encephalopathy is present, lactulose should not be discontinued to avoid this problem. Conditions such as dehydration, constipation, infection, surgery and gastrointestinal bleeding can precipitate encephalopathy.
Liver Transplantation
Necessity for liver transplantation is based on the MELD scoring system. This score is calculated on three lab tests: creatinine, INR and bilirubin. Eligibility is limited by a few conditions such as age, other serious health problems and recent history of most cancers. A complete medical evaluation is performed by the transplant center to determine medical fitness for the surgery. If alcohol or drug abuse is present, official listing for transplantation is postponed for 6 months after sobriety is achieved.
General Recommendations:
- Get vaccinated for hepatitis A and hepatitis B if you are not already immune. Blood tests will be used to determine immunity.
- Salt (sodium) restriction is very important to control fluid retention. Aim for less than 2000mg of sodium per day.
- Follow a balanced diet.
- Even if you are not experiencing symptoms or complications of cirrhosis, office visits every six months are recommended to screen for cancer.
- Alcohol should be avoided.
- Acetaminophen (Tylenol) may be used in doses of 2 – 3 grams (four to six 500 mg tablets) per day.
- Avoid aspirin and non-steroidal anti-inflammatory drugs (ibuprofen and naproxen) because these medications can cause fluid retention or kidney dysfunction.