Topic Overview
What is cirrhosis?
Cirrhosis (say "suh-ROH-sus")
is a very serious condition in which scarring damages the
liver. The liver is a large organ that is part of the
digestive system. It does a wide range of complex jobs that are vital for life.
For example, the liver:
- Makes many important substances, including
bile to help digest food and
clotting factors to help stop bleeding.
-
Controls the amounts of sugar, protein, and fat in the
bloodstream.
- Stores important vitamins and minerals, including
iron.
- Filters poisons from the blood.
- Breaks down
(metabolizes) alcohol and many drugs.
When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue and prevents the
liver from working as it should. For example, the liver may stop producing
enough clotting factors, which can lead to bleeding and bruising. Bile and
poisons may build up in the blood. Scarring can also cause high blood pressure
in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding
in the digestive tract and other serious problems.
Cirrhosis can
be deadly. But early treatment can help stop damage to the liver.
What causes cirrhosis?
Cirrhosis can have many
causes. Some of the main ones include:
Less common causes of cirrhosis include severe reactions
to medicines or long-term exposure to poisons, such as arsenic. Some people
have cirrhosis without an obvious cause.
What are the symptoms?
You may not have symptoms
in the early stages of cirrhosis. As it progresses, it can cause a number of
symptoms, including:
- Extreme tiredness and weakness.
- Nosebleeds and easy bruising.
- Weight
loss.
- Belly pain or discomfort.
- Yellowing of the skin
(jaundice).
- Itching.
- Fluid
buildup in the legs, called edema (say "ih-DEE-muh"), and in the belly, called
ascites (say "uh-SIGH-teez").
- Bleeding in the stomach or in the
esophagus, the tube that leads from the mouth to the stomach.
-
Confusion.
How is cirrhosis diagnosed?
The doctor will start
with a physical exam and questions about your symptoms and past health. If the
doctor suspects cirrhosis, you may have blood tests and imaging tests, such as
an
ultrasound or
CT scan. These tests can help your doctor find out
what is causing the liver damage and how severe it is.
To confirm
that you have cirrhosis, the doctor may do a
liver biopsy. This means he or she will use a needle
to take a sample of liver tissue for testing.
How is it treated?
It is important to get treated
for cirrhosis as soon as possible. Treatment cannot cure cirrhosis. But it can
sometimes prevent or delay further liver damage. Treatment may include
medicines, surgery, or other options, depending on what caused your cirrhosis
and what problems it is causing.
There are things you can do to
help limit the damage to your liver and control the symptoms:
- Do not drink any alcohol. If you don't stop
completely, liver damage may quickly get worse.
- Talk to your
doctor before you take any medicines. This includes both
prescription and over-the-counter drugs, vitamins, supplements, and herbs.
Drugs that can be dangerous include acetaminophen (such as Tylenol) and
anti-inflammatory drugs such as aspirin and ibuprofen (Advil or Motrin, for
example).
- Make sure your
immunizations are up-to-date. You are at higher risk
for infections.
- Follow a
low-sodium diet. This can help prevent fluid buildup,
a common problem in cirrhosis that can become life-threatening.
Symptoms may not appear until a problem is severe. So it
is important to see your doctor for regular checkups and lab tests. You may
also need testing to check for possible problems such as:
- Enlarged veins, called varices (say
"VAIR-uh-seez"), in the digestive tract. Varices can bleed.
- Liver
cancer. People with cirrhosis are at higher risk for liver cancer.
If cirrhosis becomes life-threatening, then
liver transplant may be an option. But transplant is
expensive, organs are hard to find, and it doesn't always work. For these
reasons, doctors have to decide who would get the most benefit from a liver
transplant. Ask your doctor what steps you can take now to improve your overall
health so you can be a good candidate for transplant.
If your
cirrhosis is getting worse, you may choose to get care that focuses on your
comfort and dignity.
Palliative care can provide support and symptom relief
so you can make the most of the time you have left. You may also want to make
important end-of-life decisions, such as writing a
living will. It can be comforting to know that you
will get the type of care you want.
It can be hard to face having
cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor. You
may be able to get counseling or other types of help. Think about joining a
support group. Talking with other people who have cirrhosis can be a big
help.
Frequently Asked Questions
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Learning about cirrhosis:
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Being diagnosed:
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Getting treatment:
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Living with cirrhosis:
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End-of-life issues:
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Symptoms
People who have
cirrhosis sometimes do not have symptoms until
liver damage is extensive. Symptoms of cirrhosis and
its complications may include:
- Fluid buildup in the legs (edema) and the
abdomen (ascites).
- Fatigue.
- Yellowing of the skin
(jaundice).
- Itching
(pruritus).
- Profuse nosebleeds (epistaxis).
- Redness of
the palms.
- Small red spots and tiny lines on the skin called spider
angiomas.
- Bleeding from enlarged veins (varices) in the digestive
tract.
- Bruising easily.
- Weight loss and muscle
wasting.
- Belly pain or discomfort.
- Frequent
infections.
- Confusion.
Complications of cirrhosis
Cirrhosis occurs when
substantial amounts of scar tissue replace normal tissue in the liver. The scar
tissue may block the proper flow of blood from the intestines through the
liver, leading to increased pressure in the veins that supply this area (portal
vein system). This condition is called
portal hypertension. Portal hypertension can lead to
other complications, which may include:
- Fluid buildup in the abdominal cavity (ascites). Ascites is the most common complication of
portal hypertension caused by cirrhosis.
- Bleeding from enlarged
veins (varices) in the digestive tract. This is called
variceal bleeding. Variceal bleeding, especially in
the esophagus and stomach, is a major cause of illness and death in people who
have cirrhosis.
- Increased spleen size. This can lead to a low blood
platelet count.
- Infection of the fluid in the belly (spontaneous bacterial peritonitis, or SBP).
- Altered brain function
(encephalopathy). Encephalopathy usually only occurs in
people who have advanced portal hypertension. But having a procedure to help
reduce portal hypertension (shunting) can
increase the risk of developing encephalopathy.
- Hepatorenal
syndrome. Kidney (renal) failure can occur in cases of advanced liver disease
stemming from cirrhosis. Usually, liver failure is the condition that threatens
a person's life. But in some cases the liver disease may be stable, while
kidney problems are life-threatening. A liver transplant may be needed to
cure renal failure caused by cirrhosis.
- Hepatopulmonary syndrome. Portal
hypertension caused by cirrhosis can cause lung (pulmonary) problems, such as
widening of the blood vessels in the lungs. This widening causes the blood to
move too swiftly through the lungs to pick up enough oxygen. Liver
transplantation is the most effective treatment for this
condition.
- Hepatic hydrothorax. Cirrhosis can cause fluid to build
up between the lungs and the chest (pleural effusion) and press on the
lungs. Treatment can include taking medicines such as
diuretics, restricting salt in the diet, and using
procedures to remove the fluid.
People who have cirrhosis also are at increased risk
of developing liver cancer, mainly
hepatocellular carcinoma.
Exams and Tests
Cirrhosis
is a
potentially life-threatening condition that occurs when inflammation and
scarring damage the
liver. A physical exam and medical history will
be done first to assess symptoms of liver disease, to see whether liver disease
is severe enough to cause signs of cirrhosis, and to help find out possible
causes of liver damage.
A combination of tests may be used to
diagnosis cirrhosis when a physical exam and medical history suggest
that the condition may be present. Blood tests may help your doctor check for
inflammation of the liver, assess liver function, and diagnose the cause of
cirrhosis. Other tests provide images of the liver to look for tumors and
blocked
bile ducts and can be used to evaluate liver size and
blood flow through the liver.
Liver biopsy,
in which a sample of liver tissue is removed and analyzed, also may be done. It
is the only test that can confirm a diagnosis of cirrhosis.
Blood tests that assess liver function
Measuring
the levels of certain chemicals produced by the liver can help evaluate
remaining liver function. Blood tests may be used to measure:
Blood tests for inflammation of the liver
Blood
tests may be done to look at levels of liver enzymes. These tests can help show
whether there is ongoing liver inflammation, although some people with
cirrhosis have normal liver enzymes. The blood tests include:
-
Aspartate aminotransferase (AST). An increased AST level (also called SGOT) may
indicate injury to the liver and the death of liver cells.
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Alanine aminotransferase (ALT). An increased ALT level
(also called SGPT) also may indicate injury to the liver and the death of liver
cells.
- Lactate dehydrogenase (LDH). An increased LDH level
also may indicate injury to the liver and the death of liver
cells.
-
Alkaline phosphatase (ALP). An
increased ALP level may indicate blockage of bile
ducts.
- Gamma-glutamyl transpeptidase (GGT). An increased level of
GGT is seen with alcohol use or diseases of the bile ducts. The level of GGT
also may increase with the use of certain medicines, such as dilantin and
phenobarbital. But GGT may increase without inflammation.
Blood tests that may diagnose a cause of cirrhosis
Tests that may be done to check for conditions that may cause cirrhosis
include:
Tests that provide an image of the liver
Imaging
tests can check for tumors and blocked bile ducts and can be used to evaluate
liver size and blood flow through the liver. These tests include:
Other tests
Other tests also may be done to
confirm a diagnosis of cirrhosis or to look for possible complications. These
include:
-
Liver biopsy, the only test that can directly confirm a diagnosis of
cirrhosis. Examination of liver tissue also may reveal signs of inflammation. A
liver biopsy may be done by inserting a needle between two of the right lower
ribs to remove a sample of liver tissue. The tissue sample is then
analyzed.
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Paracentesis, to help diagnose the
cause of fluid buildup in the abdominal cavity (ascites) or to
detect infection in the abdominal fluid (spontaneous bacterial peritonitis). Paracentesis is a procedure in which a needle is inserted
through the abdominal wall to remove fluid from the abdominal cavity. The fluid
can then be analyzed.
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Endoscopy, to
look for enlarged veins (varices) in the digestive tract that could cause
variceal bleeding. Endoscopy allows a doctor to
examine the inside of organs, canals, and cavities in the body using a thin,
flexible, lighted viewing instrument called an endoscope.
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Endoscopic retrograde cholangiopancreatogram (ERCP),
to look inside the tubes (bile ducts) that drain the liver, pancreas, and
gallbladder. ERCP may be done if your doctor thinks a condition called primary
sclerosing cholangitis (PSC) might be leading to your liver problems.
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Alpha-fetoprotein (AFP) testing, to screen for cancer
of the liver (hepatocellular carcinoma). This is a blood test.
-
Ammonia testing, to look for excess ammonia in the
blood, which can cause altered brain function (encephalopathy).
Treatment Overview
Cirrhosis
is a
potentially life-threatening condition that occurs when inflammation and
scarring damage the
liver. No treatment will cure cirrhosis or repair
scarring in the liver that has already occurred. But treatment can sometimes
prevent or delay further liver damage. The main components of treatment
include:
- Treating the cause of cirrhosis, when possible,
to prevent further liver damage.
- Avoiding substances that may
further damage the liver, especially alcohol.
- Preventing and
treating the symptoms and complications of cirrhosis.
- Having a
liver transplant if your liver damage becomes severe, as long as you are a
suitable candidate for liver transplantation and a liver is available.
Initial treatment
If you have just been diagnosed
with
cirrhosis, which occurs when inflammation and scarring
damage the liver, your doctor will recommend that you:
- Stop drinking alcohol. You need to quit
completely.
- Talk to your doctor about all medicines you take,
including nonprescription drugs such as acetaminophen, ibuprofen (Advil or
Motrin) and naproxen (Aleve).
- Begin following a low-sodium diet if
fluid retention is occurring. Reducing your sodium intake can help prevent
fluid buildup in your abdomen (ascites) and chest. For more
information, see:
Cirrhosis: Eating a Low-Salt Diet.
- Get immunized (if you have not already)
against
hepatitis A(What is a PDF document?) and
hepatitis B(What is a PDF document?),
influenza, and
pneumococcus(What is a PDF document?).
Taking these steps may help prevent complications and
further damage to your liver and help you control symptoms.
Initial treatment of cirrhosis will also include treatment for any
complications that have already started. You may need medicines, surgery,
or other treatment, depending on what complications you have.
Ongoing treatment
Cirrhosis
is a
potentially life-threatening condition that occurs when inflammation and
scarring damage the liver. Ongoing treatment for the disease focuses on
watching for, trying to prevent, and treating symptoms and
complications.
You must continue to:
- Avoid all alcohol.
- Make sure your
doctor knows all of the medicines you are taking, including nonprescription
drugs.
- Begin or stay on a low-sodium diet if fluid retention begins
or continues, to help reduce fluid buildup and its complications. For
more information, see:
- Cirrhosis: Eating a Low-Salt Diet.
Depending on what complications you have, you may need
medicines, surgeries, or other treatments.
Fluid buildup in the
abdomen (ascites) is one of the most common problems for people
with cirrhosis. It can become life-threatening if it is not controlled.
Following a low-sodium diet can help reduce fluid buildup in the abdomen. But
you may also need:
-
Diuretic medicines, such as
spironolactone and furosemide, to help get rid of fluid that has built up in the
belly and other parts of the body. These medicines can help both prevent and
treat problems with ascites. Your doctor may prescribe a diuretic for you to
take over the long term.
-
Paracentesis with or without a protein
(albumin) infusion. Paracentesis is a procedure in which a needle is inserted
through the abdominal wall to remove fluid from the abdominal cavity. It may be
used to treat severe ascites that is causing symptoms and is not responding to
standard treatment with diuretics and a low-sodium diet.
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Antibiotics, such as ciprofloxacin or
cefotaxime, if you have a bacterial infection in your abdomen
(spontaneous bacterial peritonitis, or SBP) as a result of fluid
buildup.
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Transjugular intrahepatic portosystemic shunt (TIPS).
This procedure can divert fluid from the abdominal cavity and may be used to
treat ascites that does not respond to other forms of treatment.
Bleeding from enlarged veins in the digestive tract
(variceal bleeding) is another common and potentially
life-threatening problem for people with cirrhosis. Be sure that you avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen if you have variceal bleeding or are at
high risk for it. You may also need:
-
Beta-blocker medicines, such as
propranolol and nadolol. These medicines reduce the risk of variceal bleeding
caused by
portal hypertension. Beta-blockers may help lower the
pressure in the portal veins, which can reduce your risk of having a first
episode of variceal bleeding. These medicines also may be used to reduce the
risk of recurrent bleeding.
-
Vasoconstrictor medicines such as octreotide. These medicines are used to treat a sudden (acute) episode of
variceal bleeding. They reduce blood flow through the portal veins by
temporarily narrowing the blood vessels.
-
Endoscopic variceal banding or sclerotherapy. These techniques may be used to treat
and prevent variceal bleeding in the esophagus.
-
Shunts. These procedures redirect the
flow of blood through other areas of the body. One type of shunt is a
transjugular intrahepatic portosystemic shunt (TIPS).
This procedure may be used to treat variceal bleeding that does not respond to
other less invasive or less risky forms of treatment.
- Balloon
tamponade. A
doctor inserts and inflates a balloon in the lower part of the esophagus or upper part of the stomach. The balloon presses
against the enlarged veins to stop bleeding. Insertion of a
balloon tamponade is a temporary treatment that may be done to stop
severe variceal bleeding and help stabilize your condition before another
therapy is tried or before you can be moved to a facility that can treat you. It also may be done if nothing else has worked to stop bleeding. This treatment is rarely
needed.
Changes in mental function (encephalopathy) may
occur when the liver cannot filter poisons from the bloodstream, especially
substances produced by bacteria in the large intestine. As these toxins build
up in your blood, they can affect your brain function. To prevent or treat
encephalopathy, you may need to:
- Take
lactulose, a medicine that helps prevent the buildup
of ammonia and other natural toxins in the large intestine. Your doctor may also have you take another medicine called rifaximin.
- Eat a
modest amount of protein. Your body needs protein to function well but, if your
liver damage is severe, your body may not be able to use protein properly. This can contribute to the buildup of harmful toxins. A
registered dietitian can help you learn to eat a
healthy diet.
- Avoid sedative medicines, such as sleeping pills,
antianxiety medicines, and narcotics. These can make symptoms of encephalopathy
worse.
Working with your doctor to monitor your condition is
also important, especially because symptoms may not start until a problem has
become severe. In addition to regular checkups and lab tests,
you will also need periodic screening for enlarged veins (varices) and liver cancer
(hepatocellular carcinoma).
- The American College of Gastroenterology
recommends testing for varices with endoscopy for all people who have
been diagnosed with cirrhosis. If your initial test does not find any varices, you can be
tested again in 2 to 3 years. If you already have large varices, you may need
more frequent testing and treatment with beta-blocker medicines to try to
prevent future bleeding episodes. If you have had an episode of variceal
bleeding, you may need more frequent testing and beta-blocker medicine. Or
your doctor may recommend variceal banding to help prevent future
bleeding.1
- Testing to check for liver cancer should take place every 6
months. You will likely have a test for alpha-fetoprotein
and a liver ultrasound.2
Cirrhosis is usually a progressive condition. Before your
condition becomes severe, you may want to talk to your doctor about future
treatment options. You may want to discuss:
- Whether you will be a good candidate for a
liver transplant if your disease becomes advanced. Talk about what steps you
can take now to improve your overall health so that you can increase your
chances of being considered a good candidate.
- What level of
medical intervention you want as you approach the end of life. Some people want
every possible medical treatment to sustain life. Others prefer measures to
maintain comfort without prolonging life. Advanced cirrhosis can affect your
brain function, so it makes sense to think about these issues while you are still
able to make and communicate decisions.
Treatment if the condition gets worse
Cirrhosis
is a
potentially life-threatening condition that occurs when inflammation and
scarring damage the liver. As cirrhosis and liver damage get worse, you may
have more problems with fluid buildup in the abdomen (ascites), bleeding
from enlarged veins in the digestive tract (variceal bleeding),
changes in mental function (encephalopathy), and
other complications. You may need a combination of medicines, surgeries, and
other treatments, depending on the nature and severity of the problems.
Receiving a liver from an organ donor (liver transplantation) is the only
treatment that will restore normal liver function and cure
portal hypertension. Liver transplantation is usually
considered only when liver damage is severe and threatening your life. Most
people who receive liver transplants have end-stage cirrhosis and severe
complications of portal hypertension.
Liver transplant surgery is
very expensive. You may have to wait a long time for a transplant because so
few organs are available. Even if a transplant occurs, it may not be
successful. With these things in mind, doctors must decide who will benefit
most from receiving a liver transplant.
- Liver transplantation may be an option if you
have end-stage cirrhosis and are a good candidate for the surgery. Good
candidates include those who:
- Have not abused alcohol or illegal drugs
for the previous 6 months.
- Have a good support system of family and
friends.
- Can stay on a complicated regimen of post-transplant
medicines to prevent the body from rejecting the liver.
- Liver transplant may not be a good option if
you have other serious medical conditions (such as heart or lung conditions)
that reduce your chance of surviving surgery or that would reduce your life
expectancy even if you received a new liver.
Palliative care
If your cirrhosis gets worse, you
may want to think about
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life—not just in your
body, but also in your mind and spirit. Palliative care can be combined with
curative care.
Palliative care may help you manage symptoms or
side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans concerning your
medical care, or help your family better understand your illness and how to
support you.
If you want to know more about palliative care, talk to
your doctor. He or she may be able to manage your care or refer you to a doctor
who specializes in this type of care.
For more information, see
the topic
Palliative Care.
End-of-life issues
If you have not already made
decisions about the issues that may arise at the end of life, consider doing so
now. Many people find it helpful and comforting to state their health care
choices in writing (with an advance directive such as a living will) while they
are still able to make and communicate these decisions. You may also think
about who you would choose as your health care agent to make and carry out
decisions about your care if you were unable to speak for yourself. For more
information, see the topics:
If you made some health care decisions earlier in your
disease, you may want to revisit them with your family and your doctor to make
sure they still represent what you want.
A time may come when
your goals change from treating or curing an illness to maintaining comfort and
dignity. Your primary doctor will be able to address questions or concerns
about maintaining comfort when cure is no longer an option. Hospice care health
professionals can provide palliative care and comforting surroundings for
someone who is preparing to die.
For more information, see the
topic
Hospice Care.
Home Treatment
Cirrhosis
is a
potentially life-threatening condition that occurs when inflammation and
scarring damage the liver. The following lifestyle changes may reduce symptoms
caused by complications of the disease and may slow new
liver damage.
Giving up alcohol
In the United States, drinking
excessive amounts of alcohol is the most common cause of cirrhosis. If you are
diagnosed with cirrhosis, it is extremely important that you stop drinking
alcohol completely, even if alcohol was not the cause of your cirrhosis. If you
do not stop, liver damage may quickly become worse. For information about how
to quit drinking if you need help, see the topic
Alcohol Abuse and Dependence.
Changing your diet
Changes in your diet may be
needed, such as restricting the amount of salt or protein you
eat.
If your body is retaining fluid, the most important
dietary change you need to make is to reduce your sodium intake by reducing the
amount of salt in your diet. People with liver damage tend to retain sodium.
This can contribute to fluid buildup in your abdomen (ascites), the most
common complication of cirrhosis. For more information, see:
-
Cirrhosis: Eating a Low-Salt Diet.
If you are at risk for altered mental function (encephalopathy) because of advanced liver disease,
your doctor may want you to temporarily limit the amount of protein you eat.
You will still need protein in your diet to be well nourished, but you may need
to get most of your protein from vegetable sources (rather than animal sources).
And you may need to avoid eating large amounts of protein at one time.
Avoiding harmful medicines
Some medicines should
be used carefully or not taken by people who have cirrhosis. For example,
acetaminophen (such as Tylenol) can speed up liver damage if you have
cirrhosis and you are still drinking alcohol.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen and aspirin, increase the risk of
variceal bleeding if you have enlarged veins (varices)
in the digestive tract. NSAIDs can also raise your risk for ascites. Talk to your doctor or pharmacist about what medicines
are safe for you.
Certain prescription medicines used to treat
other conditions may be harmful if you have cirrhosis. Make sure your doctor
knows all the medicines (including all nonprescription medicines, vitamins, herbs, and supplements) that you are taking.
Improving your general health
Taking other steps
to improve your overall health may help you cope with the symptoms of
cirrhosis.
- Stop smoking. Quitting tobacco use will
improve your overall health, which may help make you a better candidate for a
liver transplant if you need one.
- Your doctor may encourage you to
take a multivitamin. Do not take one containing extra iron unless your doctor
tells you to, and do not take iron supplements.
- Brush and floss
your teeth daily to avoid dental problems that could lead to infection (abscess). Be gentle when you floss so you don't make
your gums bleed.
- Make sure you have been vaccinated against:
Using complementary and alternative medicines wisely
In general, you should avoid most herbal and other supplements, which may
make liver disease worse.
Kava is particularly bad for people with liver
problems.
Limited research has shown that the herbal supplement
milk thistle may help protect the liver, but other research has not shown a
benefit.3 Milk thistle will not reverse existing liver
damage, and it will not cure infection with the hepatitis B or hepatitis C
virus. Milk thistle should not be used by people who have complications from cirrhosis (such as variceal bleeding or ascites). Talk to your doctor about whether you should try milk thistle (or any
other alternative treatment).
Making decisions about end stages of life
Cirrhosis can be a progressive, fatal condition. You may want to discuss health care and other legal issues that may arise near the end of
life.
Many people find it helpful and comforting to state their
health care choices in writing (with an advance directive or living will) while
they are still able to make and communicate these decisions. Some people want
every possible medical treatment to sustain life, while others prefer measures
to maintain their comfort without prolonging life. It may be helpful to think
about what kind of medical treatment you want. Also think about whom to choose
as your health care agent to make and carry out decisions about your care if
you become unable to speak for yourself.
For more information, see
the topics:
A time may come when your goals change from treating or
curing an illness to maintaining comfort and dignity. Your primary doctor will be able to address questions or concerns about maintaining
comfort when cure is no longer an option. Hospice care health professionals can
provide palliative care and comforting surroundings for someone who is
preparing to die.
For more information, see the topic
Hospice Care.
Other Places To Get Help
Organizations
|
American Gastroenterological
Association
|
| 4930 Del Ray Avenue |
| Bethesda, MD 20814 |
| Phone: |
(301) 654-2055 |
| Fax: |
(301) 654-5920 |
| Web Address: |
www.gastro.org |
| |
|
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
and disorders.
|
|
|
American Liver Foundation (ALF)
|
| 75 Maiden Lane |
| Suite 603 |
| New York, NY 10038 |
| Phone: |
1-800-GO-LIVER (1-800-465-4837) |
| Fax: |
(212) 483-8179 |
| Web Address: |
www.liverfoundation.org |
| |
|
The American Liver Foundation (ALF) funds research and
informs the public about liver disease. A nationwide network of chapters and
support groups exists to help people with liver disease and their families. ALF
also sponsors a national organ donor program to increase public awareness of
the continuing need for organs.
|
|
|
National Digestive Diseases Information Clearinghouse
|
| 2 Information Way |
| Bethesda, MD 20892-3570 |
| Phone: |
1-800-891-5389 |
| Fax: |
(703) 738-4929 |
| TDD: |
1-866-569-1162
toll-free |
| Email: |
nddic@info.niddk.nih.gov |
| Web Address: |
www.digestive.niddk.nih.gov |
| |
|
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
|
|
References
Citations
-
Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086–2102.
-
National Cancer Institute (2009). Liver (Hepatocellular) Cancer Screening PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/screening/hepatocellular/healthprofessional.
-
Milk thistle (2005). Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted
- Angulo P, Lindor KD (2006). Primary biliary
cirrhosis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1885–1898.
Philadelphia: Saunders Elsevier.
- Talwalkar JA, Lindor KD (2006). Primary biliary
cirrhosis. In M Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 579–587. Philadelphia: Saunders Elsevier.
- Bacon BR (2008). Cirrhosis and its
complications. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 1971–1980. New York:
McGraw-Hill.
- Bataller R (2008). Cirrhosis of the liver. In EG Nabel, ed., ACP Medicine, section 4, chap. 9. Hamilton, ON: BC Decker.
- Carithers RL, McClain C (2006). Alcoholic liver
disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1771–1792.
Philadelphia: Saunders.
Credits
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By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Kathleen Romito, MD - Family Medicine |
|
Specialist Medical Reviewer
|
W. Thomas London, MD - Hepatology |
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Last Revised
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August 10, 2010 |