Liver Cirrhosis and Biliary Issues: Treatment Options

Cirrhosis and bile issues?

Hello, Director: I have been undergoing blood tests for monitoring at the Hepatobiliary and Gastroenterology Department of a hospital in Zhongli for a long time.
A few years ago, my GGT level was found to be over 300, and the doctor has been prescribing GENURSO 100MG/TAB for me.
I have blood tests every three months, and this time the report showed a GGT level of 115, which is elevated.
My GOT and GPT levels are within the normal range, and I have been consistently undergoing ultrasound examinations.
Last year, it was found that I have early-stage liver cirrhosis, which the doctor said is likely caused by cholestatic virus-induced liver cirrhosis.
Currently, my total bilirubin is 2.56, direct bilirubin is 1.65, both of which are elevated, and my platelet count is low at 93, leading to fluid accumulation in the lungs.
The pulmonology department drained the fluid from my lungs for testing, and the doctor said the results were mostly normal, indicating it is likely related to liver issues.
Is there any treatment available for the current liver problems? It seems inadequate to just observe without any treatment, as it could worsen over time.
I am unsure which hospital would be best for diagnosis and treatment.
Thank you in advance for your response, Director.

Yang, 50~59 year old female. Ask Date: 2022/02/03

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 54-year-old male has a medical history indicating that he has liver cirrhosis, which is attributed to chronic hepatitis.
The causes of cirrhosis can include viral hepatitis such as hepatitis B and C, alcoholic liver disease, autoimmune conditions, cardiac issues, biliary causes, non-alcoholic fatty liver disease, and metabolic disorders.
Identifying the underlying cause is essential for appropriate treatment.
Based on your medical history, you may have primary biliary cholangitis, previously known as primary biliary cirrhosis, which is a chronic inflammatory liver disease related to the immune system.
It involves the unexplained destruction of bile ducts within the liver, leading to bile accumulation, which can be toxic to the liver over time, resulting in fibrosis and ultimately cirrhosis.

Currently, you are being treated with Ursodeoxycholic acid (UDCA), and there are other medications under development.
In addition to monitoring changes in liver function, it is important to be aware of symptoms related to bile accumulation, such as fatigue, pruritus, associated with Sjögren's syndrome, osteoporosis, and deficiencies in fat-soluble vitamins.
Early-stage cirrhosis may not present symptoms, but as the disease progresses, severe cases may exhibit jaundice, esophageal varices, gastrointestinal bleeding, ascites, or pleural effusion, which are manifestations of portal hypertension that require management of complications.

As liver function deteriorates, issues such as difficult-to-manage ascites and severe hepatic encephalopathy may arise, and in severe cases, liver transplantation should be considered.
Patients with cirrhosis need to be vigilant about the risk of developing liver cancer and should undergo regular follow-up examinations, including imaging studies like abdominal ultrasound and blood tumor markers, to facilitate early detection and treatment.
If a liver transplant is necessary, evaluation at a medical center may be required.

Wishing you peace and health,
Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/03

More Info

Liver cirrhosis and biliary issues are complex medical conditions that require careful management and treatment. Based on your description, it appears that you have been diagnosed with early-stage liver cirrhosis, likely due to biliary issues, as indicated by elevated GGT levels and bilirubin levels. The management of liver cirrhosis, especially when it is related to biliary problems, involves several key components.

Understanding Liver Cirrhosis
Liver cirrhosis is the result of long-term, continuous damage to the liver and may be due to various causes, including chronic viral hepatitis (like hepatitis B and C), alcohol abuse, autoimmune diseases, and biliary diseases such as primary biliary cholangitis (formerly known as primary biliary cirrhosis). In your case, the mention of biliary issues suggests that there may be an obstruction or damage to the bile ducts, which can lead to cholestasis (bile accumulation) and subsequent liver damage.

Treatment Options
1. Medications:
- Ursodeoxycholic Acid (UDCA): This is the medication you are currently taking (GENURSO), which helps improve bile flow and reduce liver damage in conditions like primary biliary cholangitis. It is important to continue this medication as prescribed by your doctor.

- Other Medications: Depending on the underlying cause of your liver cirrhosis, other medications may be considered. For instance, if there is an autoimmune component, immunosuppressants might be necessary.

2. Monitoring and Regular Check-ups:
- Regular blood tests and imaging studies (like ultrasounds) are crucial to monitor liver function and detect any complications early. Your elevated bilirubin levels and low platelet count indicate that your liver is under stress, and close monitoring is essential.

3. Management of Complications:
- Ascites and Pleural Effusion: The fluid accumulation in your lungs and abdomen (ascites) is a common complication of cirrhosis. Diuretics may be prescribed to help manage fluid retention, and in some cases, therapeutic paracentesis (draining fluid) may be necessary.

- Nutritional Support: A low-sodium diet is often recommended to help manage fluid retention. Additionally, a diet low in protein may be advised to reduce the burden on the liver, but this should be tailored to your specific needs and monitored by a healthcare professional.

4. Liver Transplantation:
- In cases where liver function deteriorates significantly, and complications become unmanageable, liver transplantation may be considered. This is a complex process that requires evaluation by a transplant center. The waiting list for liver transplants can be long, but it is essential to discuss this option with your healthcare provider if your condition continues to worsen.

5. Lifestyle Modifications:
- Avoiding alcohol and maintaining a healthy lifestyle can significantly impact your liver health. Regular follow-ups with your healthcare provider are essential to manage your condition effectively.

Seeking Specialized Care
Given the complexity of your condition, it may be beneficial to seek care at a specialized liver clinic or a university hospital with a hepatology department. These centers often have access to the latest treatments and clinical trials, which may provide additional options for managing your liver disease.

Conclusion
In summary, while liver cirrhosis and biliary issues can be challenging, there are various treatment options available to manage the condition and its complications. It is crucial to maintain open communication with your healthcare team, adhere to prescribed treatments, and seek specialized care when necessary. Regular monitoring and lifestyle adjustments can also play a significant role in managing your liver health. If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized advice and support.

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