Bay Area Medical Information (BAMI.us)
Cirrhosis
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In the News

May 2006
Tylenol can be deadly, even when used as directed Over-the-counter flu remedies such as Nyquil or Theraflu are often used for relief of symptoms thought to be from the flu, but in actuality could turn out to be the symptoms of acute hepatitis. A choice that could trigger acute liver failure. In many cases acetaminophen is an excellent drug, but a person with acute or chronic liver diseases needs to avoid Tylenol and acetaminophen products altogether.

In a recent study of 72 patients with severe, life-threatening hepatitis, 12.5% of these patients had evidence of acetaminophen toxicity. An important finding in this study was that the acetaminophen toxicity occurred when the patients used the over-the-counter flu medicines in doses directed on the label. Acetaminophen overdose is a leading cause of liver failure and liver transplants. People with liver disease are frequently unaware that they are using acetaminophen-containing compounds, which could put them at risk for liver failure.

Acetaminophen is listed as an ingredient in at least 26 over-the-counter products, including Coricidin D, Triaminic, NyQuil, DayQuil, Dristan, Midol and Pamprin. Two of the most popular prescription compounds, Vicodin and Percocet, also contain acetaminophen. MedPage TodayOften overdoses occur by taking acetaminophen in addition to a cold remedy. Frequently people don't read the labels or are unaware of acetaminophen's potential for toxicity.

The Liver -- A Vital Organ
Your liver is very important to your health and one of the largest and most essential organs in your body.  Most people don't realize the vital significance of the liver and the role it plays in maintaining good health. 

To help you understand one of the many functions of the liver, imagine a 3-pound sponge tucked under your ribs on the right.  All circulating blood passes through the liver.  This virtual "sponge" acts as a big filter cleaning the blood and removing toxins.  It also helps to metabolize various vitamins and medications in the process.  Nutrients from the food you ingest also pass through the liver and are extracted for essential use by the body's tissues.   When the liver doesn't function properly toxins, medications, vitamins, etc. can accumulate and become very harmful.  Furthermore, the body becomes malnourished due to a lack of essential nutrients that would have otherwise been extracted by a normally functioning liver.  Bile acids are produced by the liver and can be stored in the gallbladder or flow directly by way of bile ducts into the intestinal tract.  These bile acids then assist in the absorption of nutrients.  The complex process of blood clotting is also a major function of the liver.  Needless to say, our survival and overall well being depends on a normally functioning liver.

About Cirrhosis

Cirrhosis is a chronic liver disease that results from ongoing inflammation of the liver.  The body's attempt to correct this inflammation and repair the liver, often results in scarring which seriously disrupts the normal function of the liver.  As cirrhosis develops, scar tissue grows around normal liver cells and  can block the flow of bile through the ducts. This leads to a back up bile in the liver and bloodstream and results in a yellowing of the skin, known as jaundice.  As cirrhosis progresses, the scar tissue also begins to impair the normal flow of blood from the intestines through the liver, resulting in increased pressure in the veins that supply this area.  This condition, called portal hypertension, can lead to serious complications including fluid buildup in the abdomen and bleeding from enlarged veins in the digestive tract.

Cirrhosis has various causes with the most common being the result of drinking excessive alcohol over a long period of time.  Other common causes are the result of viral infections, such as Hepatitis B and Hepatitis C.  Undiagnosed hereditary disorders can also lead to cirrhosis.  The most common of these is hemochromatosis which results in increased amounts of iron being stored in the liver. 

Cirrhosis is a very serious condition and requires close monitoring by  health care professionals.  It is essential that you follow their advice.

  • The key to treatment of cirrhosis is to correct the underlying cause. This could involve completely avoiding alcohol, obtaining treatment for viral hepatitis, or an inherited disorder.  It is also important to eliminate certain substances from your diet or environment that could be aggravating the condition. While some diseases cannot be cured, appropriate treatment can stabilize the condition and minimize symptoms and complications.
  • Serious complications of cirrhosis can occur, such as internal bleeding, (sudden onset of black-tarry stools, or vomiting blood) which can be life-threatening.  Prompt diagnosis and management of these complications is essential.
  • Many medications, vitamins, nutrients, alcohol and other toxins are filtered through the liver and can further damage a diseased liver. Always check with your health care provider before taking any new medications,  vitamins, dietary supplements or other over-the-counter products such as herbal and "natural" remedies.  Often times, dosages of medications need to be reduced in patients with chronic liver disease. A common over-the-counter product, Tylenol and all products containing acetaminophen, should be avoided in people with acute or chronic liver disease.  
  • Avoid all alcohol.  This is especially critical for those whose disease was caused by alcohol.
  • Good nutrition is important in the management of cirrhosis. A well-balanced diet including plenty of fruits, vegetables, grains, and  milk can allow for optimal function of liver cells.  While proteins are also very important in a well-balanced diet, excessive protein intake should be avoided, especially in patients with more advanced disease.  Too much protein can raise the amount of ammonia in the bloodstream, possibly resulting in mental impairment.
  • Limit the sodium in your diet to help prevent your body from retaining extra fluid.  This will help you feel better and may prevent or delay complications such as ascites (fluid build up in the abdomen) and breathing difficulties (fluid build up in the lungs) and lower extremity swelling.  A helpful way to monitor one's fluid status is to monitor daily body weight and to alert your health care provider if there are sudden changes (ex: greater than or equal to 2 pounds in a day, or 5 pounds in a week).
  • Get vaccinations against Hepatitis A and Hepatitis B. There is currently no vaccine against the virus that causes hepatitis C.
  • Make sure that the water you drink and the food you eat are clean. Most cases of infection with Hepatitis A result from poor cleanliness, especially in restaurants and cafeterias.
  • Patients with cirrhosis should avoid eating uncooked shellfish, which  may carry organisms that can cause hepatitis or other diseases. (See link to video tutorial below for further precautions in avoiding exposure to hepatitis.)
Educational Video Tutorials
"Hepatitis C" video tutorial from Medline Plus  Home Page. Locate the "Interactive  Tutorials" button  in the upper R hand column.  This will take you to an extensive list of available videos; scroll down to "Hepatitis C" and follow the directions. Medline Plus is a service of the National Library of Medicine and the National Institute of Health.
Internet References
US National Library of Medicine & Nat'l Institute of Health This site provides extensive information and links to the latest news, overview of the basics, treatment, disease management, nutrition, emotional coping, clinical trials, research, and national organizations for liver disease.
Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Last updated May 2006

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