I see misconceptions and misunderstandings about liver disease and Cirrhosis all the time and I just wanted to write down some things as I understand them, hopefully to clear some of the confusion. I kept this to a general overview, since getting into specific cases or situations would be huge and beyond my pay grade. I'm willing to clarify if needed.
Webster's Dictionary defines Cirrhosis as:
The widespread disruption of normal liver structure by fibrosis and the formation of regenerative nodules that is caused by any of various chronic progressive conditions affecting the liver (such as long-term alcohol abuse or hepatitis).
That's a technical sounding definition, which doesn't matter because, technically, it's wrong.
Hepatitis isn't something separate from long-term alcohol abuse. It's caused BY long-term alcohol abuse. And many other things. ALL Cirrhosis comes from years of Hepatitis. No matter the cause or type of hepatitis, they all end up at the same destination if steps aren't taken to stop their progression.
The following 4 sentences are a basic description of the process that transforms ahealthy liver into a cirrhotic liver:
Hepatitis is NOT a virus. Hepatitis is the irritation or swelling of liver cells from any "insult" to the liver which results in inflammation. A virus can be one of the infectious causes of hepatitis, but do not think "virus" when you hear hepatitis. Hepatitis = Liver Inflammation
Infectious causes of hepatitis:
Non-infectiouscauses of hepatitis:
ALL of the types of hepatitis listed above are also the causes of fibrosis in the liver.
Cirrhosis is severe fibrosis of the liver from an extended period (years) of hepatitis. A healthy liver might sustain one injury, develop hepatitis, rebuild itself, diminish the hepatitis, and then continue on, strong as ever. Two thirds of a healthy liver can be cut away, and that liver will rebuild itself entirely. BUT, when a liver is continually injured over an extended period of years (a chronic viral infection, ongoing alcohol consumption, autoimmune injury, etc),the hepatitis never goes away. The hepatitis remains, never subsiding, forming fibrosis all along the way. Fibrosis replaces healthy liver tissue and partially blocks the flow of blood through the liver. And the fibrosis will continue to replace healthy liver tissue as long as the injury and hepatitis continue.
Fibrosis in the liver is similar to scar tissue anywhere else on or in the body. Scar tissue no longer functions like the healthy tissue it has replaced. The scar from a severe burn or cut won't tan or sweat or grow hair like the surrounding skin. Fibrotic liver tissue doesn't filter blood, or create and distribute nutrients, or clear the blood of drugs and other poisonous substances, or regulate blood clotting,or resist infections by making immune factors, or remove bacteria from the bloodstream. And the severe accumulation of fibrosis called Cirrhosis never will regenerate and perform those functions again. Scar tissue is tough. A scar from a traumatic laceration can grow through a healthy muscle, rendering it useless. I know this. ALL the classic cirrhosis symptoms that we know and experience result from the loss of functioning liver cells and increased resistance to blood flow through the liver (portal hypertension).
Tips for appointments with hepatologists and similar doctors.
1. Be prepared. Don’t be nervous. Take the time before your appointment to write down all of your medications, any pertinent allergies, a brief medical history, and your chief health concerns. Include the names, addresses, and phone numbers of your primary care provider and any specialists that might be linked to your current medical issue.
2. Before your appointment, write down your questions and prioritize them.
3. Maintain copies of your own health records. It can really help expedite matters if you bring copies of your most recent pertinent medical reports.
4. Make eye contact before speaking to your medical provider. Once you begin speaking, your provider may take notes. This does not mean s/he is not listening.
5. Before you start with your list of questions, ask how much time the provider has for questions. Respect these limits, and you will benefit in the long run.
6. Prioritize your health issues. Be brief but clear. Start with the most important details and if there is time, you can add the less important information at the end. If you have any fears or feelings, discuss them.
7. When describing your symptoms, begin with the general picture and end with the specifics. Example: My stomach hurts. I feel nauseous in the morning.
8. Ask for clarification. If your doctor uses words or explanations you do not understand, ask him/her to clarify or simplify words.
9. If you plan to record, be sure to ask the doctor for permission first. Take notes. If the doctor makes suggestions, write them down. Ask him to spell any words you might want to refer to later, such as a diagnosis, medication or procedure. If during the appointment you don’t have time to write everything down, write your notes immediately after while sitting in the lobby.
10. Take a friend, loved one, or an advocate to your appointment. This is especially important for appointments that may be long, complicated, or not routine. Ask your companion to take notes for you. If it’s alright with your provider, you can also record the appointment.
11. If medication is prescribed, ask what the common side effects are and how the medication should be taken.
12. Express any fears or reservations you may have. If your doctor suggests a treatment plan that you have some concerns about, let him/her know. Sometimes these concerns can be easily addressed.
13. If your doctor makes a treatment suggestion and you have fears or reservations about it, ask about other options.
14. Keep an open mind. This can be your strongest ally. It is amazing how many people will avoid a medication because of their fear of side effects, only to find out later that the reality was not anywhere near what they imagined.
15. Ask the physician if there are resources or support groups he/she would recommend.
16. Discuss the follow-up plan. If you are scheduled to have diagnostic tests, ask the doctor when you can expect the results and how these results are conveyed to you. When does your provider want to see you next? Ask if there are any signs or symptoms that could be urgent and should be reported immediately. Ask if there are any possible symptoms that might become an emergency, and if so, what should you do? If the results are going to be disclosed at your next appointment and if there is going to be a long interval between appointments, ask how you can obtain earlier results. Additionally, ask the physician what is the best way to contact his office should a need arise that may not require an office visit.
17. If this is a follow-up appointment, ask for copies of diagnostic test results and surgical reports. You should always keep copies of your records filed and in a place where you can review them easily. It also makes it easier to give copies to other health practitioners.
18. If you run out of time and still have more questions on your list, ask how you might be able to get the answers to your questions without disrupting the physician’s schedule. Ask if you can leave a copy of the questions along with the request that they call you back within a specified time frame. Or can they email you with answers to any remaining questions?
19. Try to get to know other providers in the hepatologist’s office: Nurses, Nurse Practitioners, Appointment Coordinators, Technicians, etc. They can be very helpful and supportive.
If your doctor thinks you may have cirrhosis, he or she will do a physical exam and ask about your medical history to see if you have symptoms of liver disease and to help find out possible causes of liver damage. The following are the tests that may be done to assist in diagnosis and treatment.
Measuring the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:
You may have blood tests to check your liver enzymes. These can help show whether you have had liver inflammation for a long time. These blood tests include:
SOME PEOPLE WITH CIRRHOSIS HAVE NORMAL LIVER ENZYMES.
Tests to check for conditions that may cause cirrhosis include:
Imaging tests can check for tumors and blocked bile ducts. They also can be used to look at liver size and blood flow through the liver. These tests include:
Other tests also may be done to confirm cirrhosis or to look for possible complications. These include:
These are recommendations (copied from around this website) about remedies for the extreme itch that can accompany liver disease. Discuss this with your doctor as always. Reply with your remedy and I'll add it to this list.
Keep your fingernails trimmed as short as possible (so as to not damage your skin).
Rub the affected area with a dry washcloth (so as to not damage your skin).
Make a sugar scrub out of 1 cup granulated sugar and 1/4 cup olive oil. Rubbing it on provides a not too abrasive scratch and you get a moisturizer too. It's easy to rinse off and you can add essential oils for invigorating or calming scents. Honey keeps indefinitely and has antibacterial properties. You can add it if you have any red or open scratches.
Foods that remove bilirubin from your system and reduce itch:
