Liver Disease

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Treatment

Treatment for liver disease varies, depending on the underlying cause and how far the disease has progressed. When diagnosed early, some forms of liver disease can be treated with lifestyle changes. For example, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) can be reversed by weight loss through exercise and healthy diet, by controlling blood sugar and cholesterol levels, and by avoiding toxic substances (e.g., alcohol, unnecessary medications).

If detected early, primary biliary cirrhosis can be treated with ursodeoxycholic acid (UDCA; a type of bile acid). UDCA may prolong healthy liver function and postpone the need for a liver transplant. Diarrhea is the most common side effect of UDCA. Other side effects include minor aches and pains and difficulty swallowing.

Hepatitis Treatment
Hepatitis A usually resolves with rest, appropriate nutrition, and reducing stress on the liver. Patients who have HAV should avoid alcohol, smoking, and taking unnecessary medications. Even over-the-counter medications can stress the liver. In rare cases, hospitalization may be necessary if complications (e.g., dehydration, severe pain, mental confusion, bleeding) occur.

Treatment for hepatitis B and C often involves a combination of antiviral medications, assessment and continued observation of the liver, and management of debilitating symptoms or complications that occur.

In adults, most hepatitis B infections are acute (i.e., they resolve and do not cause long-term complications). Chronic hepatitis B and C infections require treatment by a physician who specializes in diseases of the liver (hepatologist).

Antiviral drugs (e.g., interferon, entecavir, lamivudine) can slow the progression of, and sometimes eliminate the virus that causes hepatitis and can prevent or reduce liver damage. Some antiviral drugs are taken by injection and some are taken orally (in pill form). Before prescribing antiviral medications, physicians obtain a complete medical history to help determine which medications may be more effective.

Side effects of antivirals vary from mild flu-like symptoms to vision loss (rare). Patients who experience severe side effects should contact a physician immediately. Women who are pregnant should not use antiviral medication for hepatitis B or C.

Non-viral hepatitis (e.g., autoimmune hepatitis) is treated using steroids (e.g., prednisone, azathioprine) that suppress the immune system. Steroids can increase the risk for infection and patients who are taking them should wash their hands frequently and avoid contact with people who are ill.

Toxic hepatitis (e.g., acetaminophen overdose) can be treated with acetylcysteine Mucomyst®) if it is administered within 24 hours. Some cases of toxic hepatitis can be treated by eliminating exposure to the toxin. In severe cases, patients may require hospitalization or liver transplant.

Chronic Liver Disease
Treatment for chronic liver disease (e.g., cirrhosis) often involves medications and procedures to reduce complications, prevent further damage, and relieve symptoms. Patients who have chronic liver disease should avoid alcohol and unnecessary medication and should be sure to eat a healthy diet.

Medication that lowers blood pressure may be prescribed for portal hypertension to help prevent bleeding in other areas of the digestive system.

Other Treatments
If swelling occurs in the legs or abdomen, a low sodium diet (1-1.5g/day) and diuretic medications may be recommended. In severe cases, fluid is drained from the abdomen (called paracentesis).

A low-protein diet may be recommended to prevent ammonia from building up in the body, which can cause hepatic encephalopathy (brain and nervous system damage).

Medications (e.g., cholesterol-lowering medications, antihistamines) may be prescribed to help relieve itching.

If bleeding occurs through weakened blood vessels (varices), procedures that involve applying a drug to narrow the vessels (called endoscopic sclerotherapy) or using latex bands to tie off the vessels (called endoscopic ligation) may be performed. These procedures are performed using a long tube that is passed through the mouth into the digestive tract (endoscope).

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