When should you contact your doctor / attend A&E? West Hertfordshire Hospitals • If you notice your stools are black and tarry. NHS Trust • If you feel more confused. • If your tummy gets swollen or painful. • If you notice your skin and eyes turning yellow.

Further information For more information consult the British Liver Trust website at: http://www.britishlivertrust.org.uk/liver-information/liver-conditions/cirrhosis/ References Adapted from the Liver Cirrhosis, A toolkit for patients, University of Michigan Health System. If you have any questions, please call 01923 217530 A guide to...

Endoscopy Unit Watford General Hospital Vicarage Road Watford Hertfordshire WD18 0HB

Tel: 01923 217530 If you need this leaflet in another language, Liver Cirrhosis large print, Braille or audio version, please call 01923 217187 or email [email protected] Patient information

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Author(s): Dr Mohamed Shariff/Dr Sam Curtis/Dr Sabina Beg Department: Endoscopy Unit Ratified Date / Review Date July 2014 / July 2016 Endoscopy Unit Version Number 1 Medical Illustration: 58304A_©MedIll WHHT_Mohamed Shariff Liver Cirrhosis A5leaflet July14v1 Watford General Hospital PrintRoom_White/4pp What is the liver? Ascites The liver is the body’s largest internal organ. It is an essential organ and the • Ascites is a build up of fluid in the tummy. body cannot survive without it. The liver has many important functions including: • This can make the abdomen (tummy) enlarge like a balloon filled with water. • Preventing infections The legs can get swollen too. This can be very uncomfortable. • Removing bacteria and toxins from the blood • The more salt you eat, the more fluid will build up. It is important that • Digesting food and processing medications and hormones you follow a low salt diet. • Making proteins that help the blood clot • If you notice your tummy getting swollen you should contact your doctor. • Storing vitamins, minerals, fats, and sugars for use by the body. Encephalopathy What is liver cirrhosis? • Encephalopathy is when you become confused from the build up of toxins in When something attacks and damages the liver, liver cells are killed and scar the blood. tissue is formed. This scarring process is called fibrosis and it happens slowly • It can also make you feel tired and irritable. over many years. When the whole liver is scarred, it shrinks and hardens. This is • Encephalopathy can be brought on by constipation, infections and certain called cirrhosis and usually this damage cannot be undone. Heavy drinking and drugs, e.g. codeine and morphine based drugs. viruses (like hepatitis B or C) are common causes of cirrhosis. There are, however, • To avoid becoming confused, you should try to avoid becoming other causes of cirrhosis as well. All patients with liver cirrhosis should try to constipated and aim to open your bowels 2-3 times a day. avoid drinking alcohol as it can further damage the liver. • Sometimes your doctor will prescribe you lactulose which is a laxative that can help prevent encephalopathy and keep your bowels open regularly. What happens when you have cirrhosis? • If you have had encephalopathy before, you should not be driving and Cirrhosis causes the liver to become lumpy and stiff. This prevents blood from should contact your doctor or the DVLA for advice. flowing through the liver easily and causes the build-up of pressure in the portal vein, the vein that carries blood to the liver. High pressure in the portal vein is Jaundice called portal hypertension. To relieve this pressure, the blood goes around the • Jaundice is yellowing of the eyes and skin. portal vein, through other veins. Some of these veins, called varices, can be • It results from a build up of a chemical called bilirubin in the blood. found in the pipe that carries food from your mouth to your stomach (the • If you have cirrhosis and notice jaundice for the first time, it may be a sign of oesophagus) or in your stomach itself. worsening of your liver function, an infection or other new problems. • If you suddenly develop jaundice, you should contact your doctor. Important problems that can arise from cirrhosis: Bleeding varices / bleeding from the gut Liver Cancer • Varices are enlarged blood vessels around the oesophagus. These blood • People with liver cirrhosis are at increased risk of liver cancer, called vessels can sometimes bleed hepatocellular carcinoma (HCC). • If you vomit blood or your stool turns black and tarry you may be bleeding • This cancer can occur if some of the sick liver cells start to multiply out of from the gut and you should go to the nearest Accident & Emergency control. Department immediately • People with cirrhosis may have regular ultrasound scans of their liver to look • Patients with cirrhosis must avoid pain medications called “non-steroidal anti- for liver cancer. A special blood test (alphafetoprotein) can also help to check inflammatories (NSAIDS)”. These include over-the-counter medications such for liver cancer. as ibuprofen as these can make bleeding from the gut worse or cause kidney problems. It is important that you do not start any new medication without Other general problems that can occur in cirrhosis discussing this with your pharmacist or doctor. • Low energy, poor appetite, weight loss, loss of muscle mass.