Until recently, it was thought that a liver with cirrhosis could not be healed. This is usually the case because most diseases that cause scarring of your liver (fibrosis) are long-term and difficult to ‘cure’.

The treatment of Hepatitis B and C, as already mentioned, gives hope for the development of new drugs to combat scarring of the liver. More research, however, needs to be done before any
new treatments become widely available.

Another aspect of treatment is to deal with the complications of cirrhosis as early as possible. For this reason your doctor may suggest you have regular tests to identify problems even before you notice any symptoms. You may also be given other drugs to reduce blood pressure, to prevent and treat infections and to help support your body’s functions.

Medicines including beta blockers such as propranolol can reduce the risk of bleeding and reduce the severity of any bleed, should it occur. If there is a serious bleed, initial treatment is to replace the fluid and then to identify and correct the cause of bleeding. There are several techniques aimed at stemming the bleeding which involve endoscopy.

One of these is called banding, where a single vein (called an oesophageal varix) is sucked into a ring at the end of the endoscope. A small band is then placed around the base of the varix which will control the bleeding.

Injection sclerotherapy is also used and involves injecting a substance into the veins of the gullet to induce clotting and scar tissue that will help stop the veins from bleeding.

If bleeding can not be stopped by endoscopy, a Sengstaken tube is passed down the throat into the stomach. This device has two balloons which once inflated, put pressure on the varices and help control the bleeding. People are heavily sedated for this procedure.

If bleeding still cannot be controlled a procedure to lower pressure in the portal vein called a transjugular intrahepatic portosystemic stent shunt (TIPSS) may be needed. In this procedure a metal tube (stent) is passed across your liver to join two large veins (the portal vein and hepatic vein). This creates a bypass (shunt) so the blood flows straight into the hepatic vein relieving the pressure which causes the varices.

Ascites (fluid building in your abdominal cavity, appearing like a bulge across your tummy area) and peripheral oedema (swelling in your ankles and legs) are very common in people with advanced cirrhosis. Ascites can be uncomfortable and make it hard for people to breathe and eat normally. In addition, there is a risk of infection in the fluid, called spontaneous bacterial peritonitis (SBP), which can be life threatening and is treated with antibiotics.

The main treatments for ascites and oedema are sodium restriction (low salt diet and diuretics, such as spironolactone and Furosemide). It can be helpful to see a dietitian about how to manage on such a strict diet. Some patients benefit from having the fluid drained off the abdomen with a needle and tube. This usually needs to be repeated every few weeks. Patients considered at higher risk of infection may be offered prophylactic (preventative) antibiotics to take every day.

Download our publication: Ascites

Many people with cirrhosis experience episodes of hepatic encephalopathy, most at a level where it is not very noticeable. In overt stages (where it is noticeable), it can show up as sleep disturbance, mild confusion, subtle personality changes and slightly poorer performances in tests such as drawing a star and connecting dots. It can also feature problems in movement (called ataxia) and speech, slurring of words, tremor and a particular symptom of fl apping hands when you extend your arms (called asterixis). In some people the sleepiness can progress to a loss of consciousness and even to a coma, where it can be life-threatening.

The main treatment for encephalopathy is lactulose (a sweet syrupy medicine). This not only acts as a laxative but also helps the body remove the toxins that build up in the body when the liver is failing. People are given enough lactulose so that they have one or two loose bowel movements each day. They may also be given other laxatives and/ or an enema. Most periods of encephalopathy are triggered by problems such as an infection, constipation, dehydration, a medicine or a bleed. It is important that patients seek medical advice so the cause of an episode can be identified and treated.

Download our publication: Hepatic encephalopathy (HE)

Liver cirrhosis can cause low platelet levels which makes it harder for your blood to clot. Platelets are small, gold-coloured blood cells that help to control bleeding. If you have a wound or bruise the platelets in your blood clump together and form a clot. The clot plugs the wound and stops the bleeding.

If you have fewer than 150,000 platelets in every microlitre of blood it is medically known as thrombocytopaenia. Your platelet levels will be monitored by your clinical team and they will tell you if you have a low platelet count. Most of the time this won’t cause any problems, but if your platelet levels are very low (under 50,000 per microlitre of blood) it increases the risk of bleeding if you have any type of surgery, including dental surgery.

There are 2 main treatments to increase platelet levels before surgery – platelet transfusion or medicines. Most people will be offered a platelet transfusion. The medicines take several days to have an effect so they can only be used for planned (elective) surgery.

Always tell your doctor or dentist if you have a low platelet count.

Read our factsheet to find out more about having a low platelet count and how it can be treated ahead of surgery.

People with decompensated cirrhosis who are already very ill with problems such as encephalopathy, jaundice and bleeding problems, are at risk of a serious complication called hepatorenal syndrome, which is kidney failure in liver disease. For most patients, a liver transplant is needed, for some urgently.

Some people with cirrhosis develop liver cancer, most commonly hepatocellular carcinoma (HCC). The aim is to detect and treat liver cancer as early as possible.

Treatment can involve cutting out the part of the liver affected by cancer. There are a variety of other treatments aimed at controlling the cancer, including injections of chemotherapy, radio frequency ablation and oral medicines. A liver transplant may be an option for some patients.

If your liver is very badly damaged, a liver transplant may be needed. This is a procedure where a diseased liver is removed during a lengthy operation and replaced with a healthy donor liver.

A liver transplant is usually only recommended if other treatments are no longer helpful and your life is threatened by end stage liver disease. It is a major operation and you will need to plan it carefully with your medical team, family and friends.

Liver transplantation is usually very successful although in some cases it is possible for liver diseases to return and affect your new liver.

Discuss any worries you have about your suitability for treatment with your specialist nurse or doctor and those nearest to you