Liver cirrhosis is an end-stage liver disease. The liver cells can not become normal once the liver becomes cirrhotic. The definitive and sustainable treatment of liver cirrhosis is liver transplantation. However, not all patients with liver cirrhosis require liver transplantation. A cirrhotic patient may not need a transplantation for a long time if proper care is taken of certain things.
Diet
Liver cirrhosis affects a lot of functions, carried out by liver. A major function of liver is protein synthesis. If adequate protein is not supplemented by diet, one may develop protein insufficiency and loss of muscle mass. So, protein-rich diet is a must of patients with liver cirrhosis. Dal, sprouts, paneer, tofu etc. are good vegetarian sources of proteins. Boiled egg-whites, chicken, fish etc. are good non-vegetarian sources of proteins. A patient with fluid in abdomen (ascites) is often advised salt and water restriction in diet.
Diabetic patients may often see changes in blood sugar levels once liver function deteriorates, as liver is an important site of glucose synthesis. Accordingly, a need may arise to change the dosage of anti-diabetic medicines. Similarly, anti-hypertensive medicines also may warrant a change in dosage.
Physical activity
At least 60 minutes of physical activity is essential in a day. This may comprise of yoga, walking, light physical exercises and others. Liver cirrhosis is known to reduce the appetite. Physical activity maintains the appetite and the body keeps on getting sufficient nutrients daily from food.
Prevention of infections
As the liver cirrhosis progresses, the immunity reduces. Such patients are at high risk of recurrent infections affecting lungs, kidneys, lower limb skin (cellulitis) and others. So, it is very important to protect oneself from such infections and take early treatment if infection sets in.
Regular follow-up with physician
One has to be on regular follow-up with treating physician. Cirrhotic patients may have many ups and downs in their health and need to have regular evaluation to diagnose a problem early in course. This evaluation should be carried out at least every 3 months or as advised by the physician. It includes blood tests to check liver function and impact of liver dysfunction on other organ systems like kidneys, hemoglobin, blood protein (albumin) levels, blood coagulation system and others. Liver cirrhosis is a precancerous condition. So, regular monitoring of tumor markers and abdominal ultrasound to look for any tumor development in liver among other things, is also important. Often, other imaging in form of CT scan and MRI may be needed in certain patients.
Cirrhotic patients with fluid in abdomen (ascites) may need ascitic tapping (removal of fluid under ultrasound guidance) off and on, if the fluid is causing difficulty in breathing or eating or carrying out daily routine activities. Such tapping should always be done in a hospital, which is well-equipped to deal with complications, as sometimes the procedure may be risky.
Cirrhotic patients may also be prescribed certain medicines to support the liver and other organs dependent on liver. These medicines need to be taken regularly as per the physician guidance.
When does one need liver transplantation?
The liver function starts declining as the cirrhosis progresses. When the liver function declines, it starts impacting other organ systems of the body, which is medically called ‘a decompensated state’. When the body is compensating for the failing liver and patient is doing well clinically, liver transplantation can be safely deferred. In a decompensated state, when there are complications that reduce the expected survival to less than 1 year, one needs a liver transplantation to prolong life. Such complications are recurrent hepatic encephalopathy (a state of altered senses or loss of consciousness due to accumulation of ammonia in brain), spontaneous bacterial peritonitis (infection in ascitic fluid), hepato-renal syndrome (deranged kidney function due to liver failure), refractory ascites (ascites which is not responding to medicines and need frequent tapping), hepato-pulmonary syndrome (lung dysfunction due to liver disease) and frequent gastro-intestinal bleeds (blood in vomit or stools).
