Archive for the Patient Category

Upper Endoscopy (Gastroscopy)

Upper endoscopy is a procedure that’s also called gastroscopy. It’s a way to look inside your esophagus  (food pipe), stomach, and the upper part of your small intestine. It can be done to look for and treat many conditions. For people with cirrhosis, it’s usually done for swollen veins called varices. Your healthcare team might recommend an upper endoscopy if you’re at risk for varices or if you’re bleeding.

Varices form when pressure in the portal vein (the one that takes blood to the liver) gets too high. They can be dangerous because if they get too big, they can break open and bleed.

The Procedure

Before the upper endoscopy, you’ll be asked not to eat or drink for at least 6 to 8 hours.

When you come into the procedure room, the doctor might numb the back of your throat with a spray. You’ll lie on your left side, and an endoscopy team member will put a mouthguard in place to protect your teeth. You’ll get medicine through an intravenous, or IV, which is a small tube or needle put in a vein. This will help you relax and prevent pain. You probably won’t remember the procedure.

The doctor will put a long, thin tube with a light and camera—called a scope—through your mouth. They use the scope to look in your esophagus and stomach for varices. Varices can be big or small.

If you have large ones in your esophagus or if they’re bleeding, the team might do a band ligation, called banding for short. This is when the doctor gently suctions up the enlarged vein and puts a tiny rubber band around it. In time, the band falls off and will pass through your bowels.

If you have varices in your stomach that need treatment, the doctor will inject them with a glue-like substance that causes the blood inside to harden. This is called sclerotherapy.

After the Procedure

After the upper endoscopy, the team will check on you often. You’ll probably stay in the recovery area for 1 or 2 hours. When it’s safe for you to leave, have a responsible adult drive you home. You may feel sleepy for a while. Don’t do things that need close attention—like driving or signing documents—for at least 8 hours.

As with any procedure, upper endoscopy can have side effects. These side effects are rare. They include bleeding or damage to the lining of your esophagus, stomach, or small intestine. Pay attention to how you feel in the days after your upper endoscopy. If you had banding, you might have some pain or discomfort when you swallow. Drinking fluids and eating soft foods can help. If you have bad pain or you can’t swallow, tell your healthcare team right away.

Go to the emergency department if you throw up blood, have black bowel movements, get a fever, or have trouble breathing.

Depending on what your upper endoscopy showed, you may need more procedures in the coming weeks or months. Your healthcare team will let you know.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Swelling in the legs, ankles, feet

When to Get Help

Go to the emergency department or call 911 if you:

  • are coughing up blood
  • get sudden chest pain
  • have trouble breathing
  • get a fever
  • get a sudden increase in pain, swelling, warmth, or redness to your legs, ankles or feet

Swelling in the legs, ankles, and feet is called peripheral edema. It happens when your body holds on to salt and water. Peripheral edema can happen to people with cirrhosis, especially after they sit or stand for a long time. In addition to cirrhosis, it can sometimes be caused by other conditions like heart failure, infection, blood clots, or kidney disease.

Treatment

Low Sodium (Salt) Diet

Too much sodium (salt) can make your swelling worse, so it’s important to lower your sodium intake.

  • People with cirrhosis should eat LESS THAN 2,000 mg of sodium per day (as a reference, 1 teaspoon of salt, including sea salt, table salt or rock salts have 2300 mg of sodium). Much of the salt we eat is found in our packaged and processed foods and we might not even realize it’s there!
  • There can be a lot of sodium in packaged and canned foods; See this guide to sodium to help you chose which foods to eat
  • Don’t add salt to your food or cooking; herbs, spices, and marinades can help improve the flavour of food without adding sodium

For more information, check out the Nutrition in Cirrhosis Guide Book for Patients

Medications

Diuretic medicines (water pills) like lasix and spironolactone can help get rid of the fluid causing swelling. Talk with your doctor or nurse practitioner about whether these medicines would be a good option for you.

Self Care Tips:

  • Weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.
  • Raise your legs up when sitting down to help blood flow back to your heart. This works best if you are lying down and can get your legs above the level of your heart.
  • Take breaks from standing or sitting in one position; Remember to walk around to increase blood flow to your legs.
  • Wear support stockings in the morning and ask your doctor or nurse practitioner if they can prescribe compression stockings.

Let your healthcare provider know if you:

  • lose weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week
  • notice more swelling in your belly, legs, or feet
  • have a harder time breathing when you’re active or lying down

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
  3. Davison SN on behalf of the Kidney Supportive Care Research Group. Conservative Kidney Management Pathway; Available from: https//:www.CKMcare.com.
  4. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013 Apr;57(4):1651-3. doi: 10.1002/hep.26359. PMID: 23463403.
Last reviewed March 15, 2021

Pleural Effusion (fluid around the lungs)

When to Get Help

Contact your healthcare provider right away, go to the nearest emergency department, or have someone call 911 if you have:

  • trouble breathing
  • sharp pain in your chest that doesn’t go away
  • a fever
  • nausea and vomiting

What is Pleural Effusion?

Pleural effusion (or hepatic hydrothorax) is the buildup of fluid in the space between the lungs and the chest wall (called the pleural space). When fluid builds up in the pleural space, the lungs may not be able to expand completely. This can make it hard to breathe. The lung, or part of it, may also collapse.

In cirrhosis, pleural effusion is cause by high pressure in the portal vein (called portal hypertension). In many cases, the fluid build up starts in the abdomen (ascites) but eventually passes through holes in the diaphragm, into the chest (pleural effusion).

Symptoms of pleural effusion can include:

  • chest pain
  • cough
  • trouble breathing or shortness of breath

Pleural effusion is usually diagnosed with a physical exam and tests like a chest X-ray or CT scan. To help find out what caused the fluid to build up, your doctor may also order bloodwork or lab tests on a sample of the fluid from around your lungs.

Treatment

A very small pleural effusion may not cause any symptoms or need to be treated. In other cases where the pleural effusion is causing symptoms or there is concern about infection, treatment may be needed.

Low Sodium (Salt) Diet

Too much sodium can make your body hold on to extra fluid. This fluid can pool in your belly, chest and legs. Eating foods with less sodium can help control fluid build up.

  • Aim to eat less than 2000 mg of sodium a day.
  • One teaspoon of salt has about 2300 mg of sodium.
  • All types of salt contain the same amount of sodium, including table salt, sea salt, and Himalayan salt.

Tips to reduce sodium:

  • At first, foods may taste bland. Over time, your taste buds get used to less salt.
  • Don’t add salt to your food while cooking or at the table.
  • Choose fresh, unprocessed, and homemade foods.
  • Eat less processed, packaged, or restaurant foods.
  • Limit condiments and sauces (ketchup, mustard, soy sauce, gravies, salad dressings).
  • Limit pickled foods, olives, chutneys, and dips.
  • To boost flavours, try adding spices, seasoning mixes with no salt added, lemon, lime, vinegar, fresh or dry herbs, garlic, or onions

Read food labels

Diuretic Medicines

Diuretic medicines such as furosemide and spironolactone can also help to get rid of the fluid that has built up around your lungs and other parts of the body. They help to both prevent and treat problems with pleural effusion.

If you are taking diuretics, it is important to weigh yourself daily to monitor the effect of diuretics. One litre of pleural fluid weighs about 2.2 pounds (1 kg). Gradual weight loss is a sign of decreasing pleural effusion – this is expected and desired when diuretics are first started. Losing weight too quickly can be dangerous.

You should also have your blood work checked as recommended by your healthcare team because diuretics can effect your kidneys and electrolyte levels. Your dose of diuretics can be adjusted by your healthcare team if you are losing weight too quickly, having side effects, or they don’t seem to be working.

Let your healthcare team know if you are experiencing:

  • dizziness
  • a decrease in urination
  • confusion or sleepiness
  • have ongoing or worsening trouble with breathing
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week

Thoracentesis

Thoracentesis is a procedure used to drain pleural fluid.

Sometimes thoracentesis is used to take a sample of the fluid for determining why it’s building up. Thoracentesis might also be used if you have cirrhosis and the following circumstances:

  • You have a large amount of pleural fluid. It’s causing extreme discomfort and difficulty breathing. A thoracentesis may relieve these symptoms before you begin treatment with one or more diuretics.
  • You haven’t responded to a low-salt diet and diuretic medicines, or your body is unable to tolerate diuretic medications. In this situation, you may require thoracentesis repeatedly.
  • Your doctor suspects the fluid is infected.

Other Treatments

Your healthcare team may recommend other treatment options. Options available to you will depend on lots of different factors like your age, other medical conditions and how sick your liver is. Some other treatment options might include:

Self Care Tips:

If you’re being treated for pleural effusion:

  • weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone. Most people will see changes in weight readings, even before they notice changes in how their abdomen looks or feels.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.

Let your healthcare provider know if you:

  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

Ascites (fluid in the abdomen)

 

When to Get Help

Contact your healthcare provider right away or go to the emergency department if you have:

  • trouble breathing
  • new or sharp pain in your belly that doesn’t go away
  • a fever
  • nausea and vomiting
To view this video with Spanish subtitles, Click Here.

What is Ascites?

The most common major complication of cirrhosis is ascites (pronounced “a-sigh-tees”). When pressure in the portal vein gets too high (called portal hypertension), fluid leaks out and builds up. This can make your abdomen enlarge like a balloon filled with water. Ascites might be diagnosed with a physical exam. You may need other tests like an ultrasound (to look for fluid) or paracentesis (to take a sample of the fluid for testing).

Ascites can be very uncomfortable. Eating can be a problem because you have less room for food. Even breathing can be a problem, especially when you’re lying down. It can also lead to fluid buildup in the space around your lungs (called pleural effusion or hepatic hydrothorax), or abdominal hernias – especially umbilical hernias (when tissue from inside the abdomen bulges out through a weak spot in the navel or belly button).

The most dangerous problem associated with ascites is an infection called spontaneous bacterial peritonitis (SBP), which can be life-threatening. Some symptoms of SBP are fever, abdominal pain, nausea and vomiting, or confusion. If you get spontaneous bacterial peritonitis (SBP), you will need antibiotics to treat it. After you recover, you will probably be prescribed another antibiotic to reduce your risk of getting SBP again.

Treatment

Treatment for ascites caused by cirrhosis can include more than one of the options listed below.

Low Sodium (Salt) Diet

Restricting sodium is an important part of ascites treatment. Too much sodium can make your body hold on to extra fluid. This fluid can pool in your belly, chest and legs. Eating foods with less sodium can help control ascites.

  • Aim to eat less than 2000 mg of sodium a day.
  • One teaspoon of salt has about 2300 mg of sodium.
  • All types of salt contain the same amount of sodium, including table salt, sea salt, and Himalayan salt.

Tips to reduce sodium:

  • At first, foods may taste bland. Over time, your taste buds get used to less salt.
  • Don’t add salt to your food while cooking or at the table.
  • Choose fresh, unprocessed, and homemade foods.
  • Eat less processed, packaged, or restaurant foods.
  • Limit condiments and sauces (ketchup, mustard, soy sauce, gravies, salad dressings).
  • Limit pickled foods, olives, chutneys, and dips.
  • To boost flavours, try adding spices, seasoning mixes with no salt added, lemon, lime, vinegar, fresh or dry herbs, garlic, or onions

To access liver-friendly recipes and cooking videos, click here

Read food labels

Diuretic Medicine

Diuretic medicines such as furosemide and spironolactone can also help to get rid of the fluid that has built up in the abdomen (belly) and other parts of the body. If you have ascites, your doctor may prescribe a diuretic for you to take.

If you are taking diuretics, it is important to weigh yourself daily to monitor the effect of diuretics. One litre of ascites weighs about 2.2 pounds (1 kg). Gradual weight loss is a sign of decreasing ascites – this is expected and desired when diuretics are first started. Losing weight too quickly can be dangerous.

You should also have your blood work checked as recommended by your healthcare team because diuretics can effect your kidneys and electrolyte levels. Your dose of diuretics can be adjusted by your healthcare team if you are losing weight too quickly, having side effects, or they don’t seem to be working.

Let your healthcare team know if you are experiencing:

  • dizziness
  • a decrease in urination
  • confusion or sleepiness
  • have ongoing or worsening swelling in your abdomen (belly)
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week

Paracentesis

Paracentesis is a procedure used to remove ascites fluid.

Sometimes paracentesis is used to take a sample of the fluid for determining why it’s building up. Paracentesis might also be used if you have cirrhosis and the following circumstances:

  • You have severe ascites. It’s causing extreme discomfort, abdominal pain, and difficulty breathing. A paracentesis treatment may relieve the discomfort before you begin treatment with one or more diuretics.
  • You haven’t responded to the standard ascites treatment of a low-salt diet and diuretic medicines, or your body is unable to tolerate diuretic medications. This is the case in less than 10% of people with ascites. In this situation, you may require paracentesis repeatedly.
  • Your doctor suspects the fluid is infected.

Other Treatments

Your healthcare team may recommend other treatment options. Options available to you will depend on lots of different factors like your age, other medical conditions and how sick your liver is. Some other treatment options might include:

Self Care Tips:

  • weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone. Most people will see changes in weight readings, even before they notice changes in how their abdomen looks or feels.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.

Let your healthcare provider know if you:

  • feel dizzy
  • are not passing enough urine
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • have ongoing or worsening swelling in your abdomen (belly)
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

When to Go to Emergency

When to Get Help:

If you have cirrhosis and get any of the symptoms below, DO NOT DRIVE. Call 911 or get someone to take you to an emergency room immediately. Say you have cirrhosis, and describe what’s happening to you.

Cirrhosis ComplicationSymptoms
Bleeding Varices
Bleeding from varices (enlarged veins) in the esophagus (food pipe) or stomach bursting open
You vomit blood or something that looks like coffee grounds

You have black, tar-like bowel movements
Encephalopathy
Confusion or sleepiness from a buildup of toxins in the blood
You have a fever

You have severe confusion or sleepiness

You can’t speak, walk, or follow directions properly

You have severe nausea and vomiting
Infection in Ascites or Pleural Fluid
Infection in fluid buildup in the abdomen (belly) or around the lungs
You have new or sharp pain in your belly or chest that doesn’t go away

You have a fever

You have trouble breathing

You have severe nausea and vomiting
Jaundice
Yellowing of the eyes and skin
Your eyes and skin have suddenly turned yellow

The Green sleeve

The Green sleeve is a plastic pocket that holds important Advance Care Planning documents and other forms that outline a patient’s goals for health care. It is given to patients cared for in AHS who have had discussions, or completed documents, that refer to decision-making about their current or future health care. The information contained in the Green Sleeve is to give all health care providers, in any setting, access to a patient’s goals of care and interventional guidelines that have been discussed with the patient.

  • Take it with you to medical appointments or if you go to the hospital. Don’t forget to bring it home!
  • When at home keep your Green Sleeve on or near your fridge. If you have to call 9-1-1 emergency responders will look for it there.

Note: This section was adapted from content on MyHealth.Alberta.ca.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

Hepatitis C

Hepatitis C is a contagious virus that can cause liver disease liver disease. it is sometimes called HCV for short.

Hepatitis means inflammation of the liver. When the liver’s inflamed (swollen and irritated), it has a harder time functioning properly. When this happens for a prolonged time, the liver starts to lose its ability to function, and a person may get sick.

Some people who get infected with hepatitis C never feel sick and recover completely. Others develop acute or chronic hepatitis C.

Risk Factors

High Risk
  • You received a blood transfusion, blood products, or an organ transplant before July 1990 in Canada
  • You’ve been in jail
  • You use or have used injection drugs, even if it was just once or many years ago
  • You’ve been injected or scratched during vaccination, surgery, blood transfusion, or a religious/ceremonial ritual in regions where hepatitis C is common
Moderate to Low Risk
  • Having a sex partner infected with hepatitis C (low risk)
  • Born to a mother infected with hepatitis C
  • Manicures or pedicures with improperly sterilized equipment
  • Tattoos or body piercing
  • Traumatic or rough sex or sex toys that can tear body tissue
  • Vaginal sex during menstruation
  • Multiple sex partners
  • Having a sexually transmitted infection (STI) such as lymphogranuloma venereum (LGV)
  • Medical procedures with improperly sterilized equipment
  • You’ve had kidney treatment (hemodialysis)
  • You’ve had an injury from a needle
  • Sharing cocaine (snorting) equipment
  • Sharing personal hygiene items with an infected person such as nail clippers, razors, or toothbrushes
  • You have another infectious disease such as hepatitis B or HIV
Considered Safe
  • Breastfeeding (unless your nipples are cracked and bleeding)
  • Coughing or sneezing
  • Hugging and kissing or other casual contact
  • Oral sex (unless blood is present)
  • Sharing food, drinks, or eating utensils
  • Touching or shaking hands
  • Using toilet seats

Symptoms

The symptoms of hepatitis C are often mild. Most people carry the virus for years and don’t notice any symptoms. When they do notice symptoms, the most common ones are:

  • “brain fog” (the sense that you’re not thinking and concentrating normally)
  • fatigue
  • joint pain
  • loss of appetite
  • weight loss

Diagnosis

You don’t need a liver biopsy to determine if you have hepatitis C. Usually, two lab tests are used to diagnose it: hepatitis C antibody (Anti-HCV) and hepatitis C RNA (HCV RNA).

Hepatitis C Antibody (Anti-HCV)

This is the first hepatitis C test your healthcare providers will perform. It will find out if your body has antibodies against hepatitis C. A positive result means that at some point in your life, you were exposed to the hepatitis C virus, and you developed antibodies to it. But it doesn’t tell us if you’re still infected. So, if this test is positive, your healthcare providers will perform the hepatitis C RNA (HCV RNA) test to find out if you’re still infected.

Hepatitis C RNA (HCV RNA)

The hepatitis C RNA (HCV RNA) test will be used to find out if you still have the virus in your body. If the HCV RNA test is positive, you have chronic hepatitis C and should be considered for treatment to clear it.

Genotypes

Hepatitis C genotypes are different strains of the hepatitis C virus. There are six genotypes around the world. In Canada, the more common genotypes are 1, 2, and 3. Genotypes matter very little now, because the newer treatments are effective against all genotypes. In many jurisdictions, genotypes are no longer tested or reported.

Treatment

Since 2010, the medical community has made enormous progress in treating chronic hepatitis C. New medications called direct-acting antivirals (DAAs) act on the virus itself to rid it from the body. This is different than older medications like interferon, which works by stimulating an immune response.

These newer treatments are very effective and have cure rates of over 95%. Interferon is no longer used for hepatitis C treatment.

The newer treatments take less time (between 8 to 12 weeks), have fewer side effects, and appear to be effective at all stages of the disease.

Because these treatments are newer, they’re still expensive. But the cost is generally covered by provincial drug benefit programs or private insurance companies. Virtually all patients in Canada can now access these life-saving treatments that cure hepatitis C.

Alternative Therapies

If you’re trying alternative therapies such as herbal remedies, homeopathic medicines, and minerals, tell your healthcare providers. Please note: no alternative therapies have been proven safe and effective for clearing (curing) hepatitis C.

Q&A

Can You Get Hepatitis C More Than Once?

Yes. Although your body’s immune system makes antibodies to fight hepatitis C, these antibodies don’t fully protect you. The virus changes so quickly that it can escape your body’s defenses. This means that you can’t have lifelong protection from hepatitis C, and this is the reason why there’s no current vaccine for hepatitis C available. If you’re treated for hepatitis C and get rid of the virus, you can still be infected again. Therefore, what you do—or don’t do—can affect your level of risk for getting hepatitis C again.

What Happens to People with Hepatitis C?

Some people clear their body of the virus on their own in the weeks after they’re infected. But most people who get hepatitis C develop a chronic infection.

When a chronic infection occurs, the hepatitis C virus multiplies in the liver. Parts of the virus trigger the immune system into action. While trying to rid the body of the infection, the immune system kills infected liver cells.

Chronic hepatitis C progresses slowly over 10 to 40 years. But for some people, the interaction between their immune system and liver can result in scarring of the liver (fibrosis or cirrhosis) and loss of liver function.

Statistics on Outcomes of Hepatitis C

Someone with hepatitis C has a 20% chance that their liver scarring will progress from fibrosis to cirrhosis in the first 20 years. Alcohol markedly increases this risk. A heavy drinker with hepatitis C has many times the risk of developing cirrhosis compared to a non-drinker with hepatitis C. Alcohol and hepatitis C both damage the liver. Together, the risk of serious liver damage is much higher than either alone.

How Can You Protect Yourself and Others?

If you have hepatitis C, you can give the virus to other people. This is true even if you feel fine. To protect others from getting hepatitis C, follow these suggestions:

  • Don’t donate blood, body organs, tissues, or sperm.
  • Don’t let anyone else use your razor, toothbrush, or other personal care items.
  • Cover open cuts or sores on your skin with a bandage until they’re healed.
  • Don’t inject drugs. If you’re injecting drugs, talk with your healthcare provider about trying to stop, and call the Alberta Addiction Helpline at 1-866-332-2322 for help. If you don’t stop, never share your needles, or works (cotton, cooker, spoon, etc.) with anyone else.
  • Practice safer sex. Use a latex barrier, such as a condom, every time you have sex. Using condoms also reduces your chances of getting sexually transmitted infections (STIs).

Following these suggestions can also protect you from other diseases such as hepatitis B and HIV.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Hepatitis B

Hepatitis means inflammation of the liver. When the liver’s inflamed (swollen and irritated), it has a harder time functioning properly.

Hepatitis viruses cause inflammation. There are different types of hepatitis viruses such as hepatitis B and C. Other hepatitis viruses such as hepatitis A and E may cause serious inflammation of the liver, but they resolve on their own in most cases and don’t lead to cirrhosis.

Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus. It’s common worldwide. In regions where hepatitis B is most common, such as countries in Asia and Africa, at least one in five people may be infected with the virus.

Hepatitis B ranges in severity and can be either acute or chronic.

Acute Hepatitis BChronic Hepatitis B
A mild, short-term illness lasting a few weeks.A serious, long-term, lifelong illness.
Happens within the first 6 months after someone is exposed to the virus.Occurs when the virus stays in a person’s body.
Acute infection can—but doesn’t always—lead to chronic infection (chronic hepatitis B).The younger people are when they’re infected with the hepatitis B virus, the greater their chance of developing chronic hepatitis B.

Causes

The hepatitis B virus is not in food or water. It’s in blood and other body fluids, and it’s contagious. It passes from person to person when blood, semen, or other body fluid infected with the virus enters the body of a person who’s not infected.

In North America, the vast majority of people with chronic hepatitis B have immigrated from an area where it’s common, such as Asia and Africa, and they were infected at birth.

Adults who get hepatitis B, usually through sex, will clear the infection themselves in about 99% of cases. Therefore, they will have only acute hepatitis B—not chronic—and will not have long-term health problems.

Hepatitis B is Not Passed ByHepatitis B Can Be Passed By
Coughing or sneezingBirth (spread from an infected mother to her baby during birth)
Hugging and kissing or other casual contactDirect contact with the blood or open sores of an infected person
Sharing food, drinks, or eating utensilsImproperly sterilized equipment used during manicures and pedicures; medical or dental procedures; and tattoos and body piercing
Touching or shaking handsSex with an infected partner
Using toilet seatsSharing needles, syringes, or other drug-injection equipment
Sharing personal hygiene items with an infected person such as nail clippers, razors, or toothbrushes

Symptoms

What happens when you get hepatitis B depends largely on the age when you’re infected and how well your immune system copes with the virus.

You may have hepatitis B for years and never have any symptoms. You can still spread the virus to others even if you don’t have symptoms.

Acute Hepatitis B Symptoms and Complications

If you’re infected as an adult, you may have a brief illness with mild or moderate symptoms such as:

  • abdominal discomfort
  • dark urine
  • fatigue (feeling tired all the time)
  • jaundice (yellowing of the eyes and skin)
  • loss of appetite (not feeling hungry)

If you’re infected as an adult, you have a 99% chance of clearing the infection and developing lifelong protection against the virus. The acute infection rarely leads to severe illness that requires a liver transplant (less than 1% of cases).

Chronic Hepatitis B Symptoms and Complications

Most babies and children exposed to the hepatitis B virus never have signs or symptoms. Unfortunately, they’re more likely to become carriers of hepatitis B for life because their immune system is unable to clear the virus from their body. In these cases, their chronic infection is often not detected until much later in life when:

  • they’re screened because they come from an area where the virus is common or
  • they become seriously ill with liver disease as adults.

Chronic hepatitis B goes through different phases that show how well your body’s coping with the virus. Most people have an inactive disease and stay healthy, but one in four will have an active disease. If untreated, this may lead to cirrhosis and/or liver failure. Liver cancer is also a risk for all patients with chronic hepatitis B. Therefore, screening for hepatitis B is important.

People who are healthy with an inactive disease are still at risk of the virus becoming active again. This can happen spontaneously, or when their immune system is weakened by other viral infections or medicines such as chemotherapy, especially corticosteroids.

Diagnosis

To confirm if you have hepatitis B, you’ll need lab tests such as the following:

Lab TestIf This Test is Positive, it Means:
Hepatitis B Surface Antibody (Anti-HBs or HBsAb)You have antibodies against hepatitis B and are protected from getting the disease.

You were either vaccinated against hepatitis B or exposed to it at some point in your life.
Hepatitis B Core Antibody (Anti-HBc)You’ve been exposed to hepatitis B and have developed an antibody to just one part of the virus. This antibody does not give you immunity.

You need more tests to find out if you have the disease.
Hepatitis B Surface Antigen (HBsAg)You currently have a hepatitis B infection.

You can spread the virus to others.
Hepatitis B e Antigen (HBeAg)You may have very active hepatitis B and should be followed closely by your doctor. You may also need to take hepatitis B medications.

You may be very contagious to others.

Treatment

Not all people with hepatitis B need treatment. Choosing the right time for treatment is not a simple decision. It’s based on the results of your lab tests, your age, and the amount of scarring and inflammation in your liver. A liver biopsy may also be required. If you have cirrhosis, you might be a candidate for treatment as well.

You will definitely need treatment if you have an active disease that causes a lot of damage to your liver. You’ll also need treatment if you’re going to take medications that weaken your immune system.

When and how to treat your hepatitis B are decisions between you and your doctor. Availability of medications may also vary based on health insurance plans.

Even if you don’t need treatment for your hepatitis B, you will need regular screening for liver cancer. This is done with abdominal ultrasound every 6 months. Cancers detected early may be cured. This screening needs to start at age 40 in males, age 50 in females, and at age 20 in those of African birth.

Types of Treatment Available

If you know you’ve been exposed to the hepatitis B virus in the last seven days, you can receive an injection of hepatitis B immune globulin. This might prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.

There are two types of treatment for chronic hepatitis B:

  1. Interferon. This is a medication given by needle. It’s rarely used due to its many side effects and the effective antiviral medicines noted below.
  2. Antiviral medicines. These are oral medications (taken by mouth) and include adefovir, entecavir, lamivudine, telbivudine, and tenofovir. Hepatitis B can develop resistance to these drugs. To avoid this, remember to take your medications every day. Entecavir and tenofovir are the best choices with only a very small chance of the virus becoming resistant.

These medications can’t cure hepatitis B, but they do control the virus so that further damage to your liver can be prevented.

Taking Medications and Monitoring Your Hepatitis B

Your doctor will recommend hepatitis B medications if you have liver inflammation and a very active virus. These are indicated by a high viral load, which means a high amount of hepatitis B virus in your blood. You’ll also have a high level of ALT, one of the liver enzymes that helps the liver do its work. A high ALT level indicates the liver is being damaged.

Hepatitis B medications are important during phases of prolonged liver inflammation. Your healthcare providers will track the phase of your hepatitis B by the results of your lab tests. Because infected people go through various phases of hepatitis B, it’s recommended that they have lab tests regularly.

If you’re on hepatitis B medications, your healthcare providers will monitor you closely. You’ll need lab tests every 3 to 6 months to monitor your viral load and ALT level. You’ll also need other tests such as hepatitis B e antigen (HBeAg), and you’ll need to see your doctor regularly.

 

Q&A

Is There a Cure for Hepatitis B?

No. Even if treatment is successful, it doesn’t completely get rid of the hepatitis B virus. However, successful treatment can stop the virus from multiplying. It can also stop liver inflammation. Stopping the inflammation will reduce the chance of developing cirrhosis or liver cancer.

That being said, 1 – 3% of people will completely clear the virus from their body each year. This can occur on or off treatment.

How Can You Protect Yourself and Others?

To avoid getting the hepatitis B virus or spreading it to others:

  • Use a condom when you have sex.
  • Don’t share needles.
  • Wear latex or plastic gloves if you have to touch others’ blood.
  • Don’t share toothbrushes or razors.
  • Don’t get a tattoo. Or make sure the needles have been cleaned properly and are sterile.
  • Babies of mothers with chronic hepatitis B must receive both a vaccine and a special hepatitis B immune globulin (HBIG) at birth.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Fatty Liver Disease (Non-Alcoholic)

Fatty liver disease is when fat builds up in the liver. The liver can be damaged and become enlarged. The scientific name for fatty liver disease is non-alcoholic fatty liver disease (NAFLD). It may take many years for NAFLD to become severe enough to cause liver damage.

When it does cause damage in some cases, the fat in the liver leads to inflammation and, with time, scarring. This more severe type of NAFLD is called non-alcoholic steatohepatitis (NASH). It may progress to cirrhosis and liver cancer.

Causes

Fatty liver disease occurs most often in people with diabetes, high blood pressure, obesity, or high cholesterol. These conditions tend to occur together, and when combined in one person, they’re referred to as metabolic syndrome. Metabolic syndrome is becoming increasingly common as our population becomes less active and eats an unhealthy diet.

Most people who have fatty liver disease are 40 to 50 years old and have one or more of the risk factors listed above. But fatty liver disease can happen in people who have none of these risk factors. We now even see it in children.

Symptoms

In the early stages of fatty liver disease, you may have no symptoms. Most people feel fine and don’t know they have it.

As the disease progresses and liver damage gets worse, you may have vague symptoms such as:

  • an ache in the upper right part of your belly
  • fatigue
  • poor energy levels

Diagnosis

Fatty liver disease can be diagnosed with blood tests and radiology tests such as an ultrasound, CT scan, or MRI. A liver biopsy may also be needed. Talk to your healthcare provider if you’re overweight or if you have high blood sugar or cholesterol.

Treatment

There are a number of effective ways to treat fatty liver disease:

  • Lose weight. Weight loss is a key aspect of treatment. Fatty liver disease can be reversed if you lose weight. Make a weight loss plan with your healthcare providers, and exercise to keep weight off.
  • Exercise. Exercise means exerting yourself. You will know because you’ll feel breathless, and you’ll sweat. Start slowly if you’ve been inactive, for example brisk walks 5 to 10 minutes long. Build up to 30-minute brisk walks five days a week, adding in hills or stairs. Your healthcare providers can help guide you.
  • Avoid alcohol. The current medical recommendation is that if you have fatty liver disease, you should avoid all alcohol. This is because alcohol also increases liver fat and may compound the problem.
  • Get treatment for high blood sugar, hypertension, and elevated cholesterol. Medications can help to lower blood sugar, blood pressure, and cholesterol. In turn, this reduces fat in the liver. Ask your healthcare provider if you have these conditions and if medications are a good option for you.

You can have both fatty liver disease and another liver disease at the same time. Having two liver diseases can cause more liver damage and serious medical complications. If you have two liver diseases, it’s even more important to lose weight and exercise. By doing these things, you can treat both diseases at the same time.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. Canadian Liver Foundation
Last reviewed March 15, 2021

Hemochromatosis

Hemochromatosis is an inherited disease that causes the body to absorb too much iron. It’s one of the most common genetic diseases in Canada, affecting about 1 in 300. Normally, people absorb only enough iron to meet the body’s daily requirements. The remainder is usually excreted through the bowels. But with hemochromatosis, the body keeps absorbing iron and storing it in different organs and tissues long after its needs are met.

Your liver is the first organ to store iron. When its storage capacity is exhausted, iron continues to build up in the heart, the skin, the pancreas, the pituitary gland, and elsewhere in the body. If left untreated, it can create damage in the liver, which may lead to liver failure and liver cancer. Likewise, damage to the heart can result in heart failure or sudden death, and damage to the pancreas may lead to diabetes.

Causes

Hemochromatosis is hereditary. To have the disease, a patient must have inherited two defective genes, one from each parent. Siblings of an affected person have a 25% chance of getting this disease. Children of a parent with hemochromatosis are less likely to be affected, since the other parent must be also be a carrier of the defective gene.

Symptoms

In people with hemochromatosis, the liver begins to retain iron at birth, but it may take 20 to 30 years before symptoms begin to appear. In the early stages of hemochromatosis, there may be no signs. But when symptoms show, they include:

  • arthritis (swelling in the joints, particularly in the knees and the knuckles of the middle and index fingers)
  • fatigue

In the later stages of the disease, symptoms include:

  • abdominal pain or tenderness
  • ascites (enlarged abdomen from fluid buildup)
  • bronze or grey-coloured skin
  • diabetes
  • heart failure
  • jaundice (yellowing of the skin and eyes)
  • bleeding varices (enlarged veins in the esophagus)

Diagnosis

Doctors use blood tests to detect hemochromatosis. They measure iron levels in the blood and the total amount of iron deposited in the tissues. The most common tests are for transferrin saturation and serum ferritin.

A genetic test is the most common test used to diagnose hemochromatosis. This requires a blood sample, which is analyzed by a lab that specializes in DNA testing. This genetic test has eliminated the need for a liver biopsy in many patients with hemochromatosis.

But sometimes it’s necessary for your doctor to order a liver biopsy to see the extent of liver damage and check the amount of iron stored there.

If someone is diagnosed with hemochromatosis, their siblings and children over the age of 18 should be checked. Screening is most important for siblings, since they have a 25% chance of inheriting both the defective genes from their parents.

Genetic screening has allowed for diagnosis at birth, before iron overload sets in. But testing for hemochromatosis within families usually starts in the teen years rather than with children or infants.

Treatment

The first goal of treatment is to reduce the amount of iron stored in your body. This is usually done by a process called venesection or phlebotomy (blood letting) on a weekly basis. It’s a lot like donating blood.

Red blood cells contain iron. When you undergo phlebotomy, you lose red blood cells and excess iron (caused by hemochromatosis). This treatment can take months or even two or three years depending on the amount of excess iron in your body.

You must continue to have your iron levels monitored regularly, even after the phlebotomy treatment has removed the excess iron. Phlebotomy may be reduced to a less frequent “maintenance” level, for example four times a year.

Generally, phlebotomy treatment isn’t used for patients with cirrhosis and low hemoglobin levels.

Injury to the liver from hemochromatosis is reversible if you start treatment before cirrhosis develops. However, there is an increased risk of liver cancer in hemochromatosis patients who have cirrhosis.

Q&A

Is a Special Diet Needed?

No. However, you shouldn’t use iron supplements, multi-vitamins, or mineral preparations containing iron.

You should also avoid vitamin C, which enhances iron absorption when consumed with food. Or, you should only take vitamin C four hours before or after a meal.

Alcohol enhances iron absorption, which is one reason you should avoid it or consume it only in moderate amounts. Another reason is that it can cause additional liver damage beyond that caused by hemochromatosis.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Primary Sclerosing Cholangitis (PSC)

Primary sclerosing cholangitis (PSC) is a liver disease that causes inflammation and scarring in the bile ducts, making them shrink over time. (Bile ducts are small tubes that bile flows through from within the liver to the gallbladder and intestines). This inflammation results from immune cells attacking the bile ducts. PSC is called “primary” because the cause is unknown, “sclerosing” because of the scarring, and “cholangitis” because the inflammation occurs in the bile ducts.

Bile is a yellow-green fluid produced by your liver to aid digestion. When bile ducts are damaged by inflammation and scarring (cholangitis), bile and other substances collect in the liver, which in turn damages liver cells.

PSC may sometimes be confined to the bile ducts within the liver, but most often it also attacks the large bile ducts outside the liver. The disease affects both sexes, but it’s more common in men. It occurs in people mostly between the ages of 30 and 50.

Symptoms

The progression of PSC is unpredictable and not well understood. A person can have the disease for many years before symptoms show. The most common symptoms include:

  • Chronic fatigue. This can range from mild to disabling.
  • Itching. Known medically as pruritus, itching can range from mild to intense. It can be relentless, disrupting sleep and quality of life. This itching usually attacks the whole body and may be the result of the liver’s inability to process bile.
  • Jaundice. This refers to yellowing of the skin and eyes.
  • Episodes of fever, chills, and abdominal pain. These may be signs of an infection within the bile ducts. Any patient with PSC who has fever and chills should go to the nearest hospital emergency room immediately.

In its advanced stages, PSC may lead to extensive scarring in the bile ducts and eventually, liver failure.

As liver damage progresses in PSC, other symptoms may appear. These can affect parts of your body outside your liver. These symptoms are the same as for advanced liver disease from any cause.

Diagnosis

Because people with PSC may have no symptoms for many years, PSC is often diagnosed when patients show abnormal results from standard blood tests. Additional diagnostic tests such as MRI (magnetic resonance imaging) or ERCP (endoscopic retrograde cholangiopancreatography) may be necessary to confirm PSC.

ERCP combines the use of X-ray and an endoscope, which is a long, flexible tube. Through this form of endoscopy, your doctor can see inside your stomach and duodenum and inject dyes into your bile ducts. This creates a high-quality X-ray that can show strictures (narrowing) caused by inflammation in your bile ducts.

Treatment

There is no specific treatment for slowing the advance of PSC. Unfortunately, PSC is relentless over time. It leads to liver failure and the need for liver transplant with almost all patients.

However, doctors can treat PSC symptoms with varying success using antibiotics, vitamins, and medications.

To help relieve itching (pruritus), a common symptom, your doctor may prescribe various medications such as cholestyramine, antihistamines, or other drugs such as naltrexone or rifampicin. For patients with extreme itching, doctors will occasionally prescribe ultraviolet light therapy.

Sometimes, doctors will use ERCP to dilate a stricture or insert a stent in the bile ducts. This may alleviate jaundice and other symptoms over the short term.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. Canadian Liver Foundation
Last reviewed March 15, 2021