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    Cirrhosis of the Liver

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    Know the Warning Signs of Cirrhosis

    Cirrhosis is defined as a scarring process where liver cells are replaced or destroyed and are unable to function. Cirrhosis can be caused by many different factors. Alcohol is only one of many causes of cirrhosis. The most common causes of cirrhosis in the world are the viruses such as Hepatitis B and Hepatitis C.

    When the liver does not function properly, patients may experience one or more warning signs. Abnormal liver function is a warning sign of cirrhosis that is measured by a blood test. Examples include:

    • "thin" blood (An increased or prolonged prothrombin time – also called a P.T. – this test is now also defined as an "INR." The INR number increases as the liver fails.)

    • high bilirubin – greater than 2.0 mg/dL is a concern

    • low albumin – less than 3.5 mg/dL is a concern

    • low cholesterol – less than 100 mg/dL is a concern

    • low platelets – less than 100,000 is a concern (Platelets are cells involved in blood clotting.)
    When the liver does not function properly, patients may experience other warning signs. Please notify your hepatologist or liver specialist if any of these symptoms occur:
    • Swollen feet

    • Swollen abdomen (ascites)

    • Confusion (encephalopathy)

    • Progressive memory loss

    • Difficulty sleeping during the night and increased sleeping during the day

    • Vomiting blood

    • Passing blood, purple or black bowel movements

    • Yellow eyes and/or skin

    • Flapping of the extended hands (asterixis)

    • Muscle loss
    Note: Worsening signs of cirrhosis included bloody or tarry stools, vomiting blood, and/or worsening signs of encephalopathy such as severe confusion, drowsiness, disorientation, or coma. Please seek immediate medical attention in your local Emergency Room if these symptoms occur.

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    What Can You Expect at California Pacific Medical Center?

    • You will consult with a specialized doctor (hepatologist) or a gastroenterologist who has an interest in liver disease.

    • You will discuss liver transplantation with a hepatologist, if needed. Transplantation is one of many options.

    • Learn treatment options for cirrhosis.

    • Learn the probable or definite cause of your cirrhosis.

    • Participate in a review of the possible complications from cirrhosis.

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    Screening Tests – Evaluating for Increased Risk of Liver Cancer

    If you have cirrhosis, there is a markedly increased risk of liver cancer. It is important to discuss with your doctor the need for screening tests for liver cancer. These screening tests may include:

    • Ultrasound of the liver (a liver scan).

    • Alpha-fetoprotein blood test (Note: This is a liver cancer marker test).

    • Other advanced testing as indicated by your doctor.

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    Treatment Recommendations for Patients Diagnosed with Cirrhosis

    • Hepatitis A & B Vaccinations: You should be vaccinated for Hepatitis B (HBV) (unless you have Hepatitis B infection) and Hepatitis A (HAV) if you are not immune.


    • Alcohol-Free Diet: Patients with cirrhosis should not drink any alcohol. Your diet should be alcohol-free.


    • Diet Recommendations: Your diet should be low in sodium (salt), high in carbohydrates. Do not eat raw shellfish. Five small meals per day with starches and protein are important, avoid red meat, avoid fat.


    • Avoiding Certain Medications: Patients with cirrhosis should not take Non-Steroidal Anti-Inflammatory Drugs (NSAID) such as Advil (Ibuprofen), Motrin (Ibuprofen), or aspirin-type drugs. Tylenol (Acetaminophen) is safe if you take less than six 325 mg tablets each day (2,000 mg per day). Because cirrhosis patients are at increased risk of ulcer disease, you should discuss with your doctor about taking an anti-ulcer drug.

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    Frequently Asked Questions

    Question: What is cirrhosis of the liver?
    Answer: Cirrhosis is defined as a scarring process where liver cells are replaced or destroyed and are unable to function.

    Question: What are the warning signs that show the liver is not functioning properly?
    Answer: Warning signs: swollen feet and abdomen, confusion, memory loss, difficulty sleeping at night, increased sleeping during the day, vomiting blood, passing blood, purple or black bowel movements, yellow eyes and/or skin, abnormal liver function, flapping of the hands, and muscle loss. Also, liver dysfunction can be measured by a blood test.

    Question: What screening tests are available to diagnose cirrhosis?
    Answer: An ultrasound of the liver and an Alpha-fetoprotein blood test.



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    Produced by the Center for Patient and Community Education in association with the Division of Hepatology and Complex GI at California Pacific Medical Center. Last updated: 5/04.

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).
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