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Health Maintenance in Liver Disease and Cirrhosis

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Liver Disorders

Abstract

Patients with liver disease are at an increased risk of worsening of their underlying liver disease by contracting viral hepatitis and should be vaccinated for hepatitis A and B. Patients with cirrhosis in particular have an increased risk of worsening liver function from influenza or pneumococcal infection and thus should be vaccinated. Cirrhotics should avoid live vaccines if feasible due to the potential risk of developing infection.

The majority of patients with liver disease should be evaluated with bone densitometry for low bone density. There is a high prevalence of bone disease in patients with liver disease. This is particularly true in cholestatic liver disease such as primary biliary cirrhosis, alcohol-related liver disease, or cirrhosis of any etiology. Additionally, fat-soluble vitamin levels such as vitamin D are often low, which can contribute to osteopenia and osteoporosis.

Coffee has been shown to be beneficial in many types of liver disease. Increased coffee consumption reduces mortality, decreases progression of nonalcoholic fatty liver disease (NAFLD), decreases the rate of scarring in the liver and progression to cirrhosis, decreases rate of liver cancer development, and increases treatment response to hepatitis C antiviral interferon-based therapy.

Pain management is challenging in cirrhotic patients. In general nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids should be avoided. Acetaminophen at doses less than 2–3 g/day or tramadol are more appropriate choices for pain management.

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References

  1. Keeffe EB. Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases? Am J Gastroenterol. 1995;90(2):201–5.

    CAS  PubMed  Google Scholar 

  2. Vento S et al. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med. 1998;338(5):286–90.

    Article  CAS  PubMed  Google Scholar 

  3. Xavier S, Anish K. Is hepatitis A vaccination necessary in Indian patients with cirrhosis of liver? Indian J Gastroenterol. 2003;22(2):54–5.

    PubMed  Google Scholar 

  4. Jacobs RJ, Koff RS, Meyerhoff AS. The cost-effectiveness of vaccinating chronic hepatitis C patients against hepatitis A. Am J Gastroenterol. 2002;97(2):427–34.

    PubMed  Google Scholar 

  5. Lee SD et al. Safety and immunogenicity of inactivated hepatitis A vaccine in patients with chronic liver disease. J Med Virol. 1997;52(2):215–8.

    Article  CAS  PubMed  Google Scholar 

  6. Arguedas MR, McGuire BM, Fallon MB. Implementation of vaccination in patients with cirrhosis. Dig Dis Sci. 2002;47(2):384–7.

    Article  PubMed  Google Scholar 

  7. Smallwood GA et al. Can patients awaiting liver transplantation elicit an immune response to the hepatitis A vaccine? Transplant Proc. 2002;34(8):3289–90.

    Article  CAS  PubMed  Google Scholar 

  8. Feray C et al. Hepatitis C virus RNA and hepatitis B virus DNA in serum and liver of patients with fulminant hepatitis. Gastroenterology. 1993;104(2):549–55.

    Article  CAS  PubMed  Google Scholar 

  9. Benvegnu L et al. Specificity and patterns of antibodies to hepatitis C virus in hepatocellular carcinoma. Hepatology. 1991;14(5):959.

    Article  CAS  PubMed  Google Scholar 

  10. Lemon SM, Thomas DL. Vaccines to prevent viral hepatitis. N Engl J Med. 1997;336(3):196–204.

    Article  CAS  PubMed  Google Scholar 

  11. Jacobs RJ, Meyerhoff AS, Saab S. Immunization needs of chronic liver disease patients seen in primary care versus specialist settings. Dig Dis Sci. 2005;50(8):1525–31.

    Article  PubMed  Google Scholar 

  12. Poland GA. Hepatitis B immunization in health care workers. Dealing with vaccine nonresponse. Am J Prev Med. 1998;15(1):73–7.

    Article  CAS  PubMed  Google Scholar 

  13. Duchini A et al. Hepatic decompensation in patients with cirrhosis during infection with influenza A. Arch Intern Med. 2000;160(1):113–5.

    Article  CAS  PubMed  Google Scholar 

  14. Song JY et al. Clinical impact of influenza immunization in patients with liver cirrhosis. J Clin Virol. 2007;39(3):159–63.

    Article  PubMed  Google Scholar 

  15. Kyaw MH et al. The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults. J Infect Dis. 2005;192(3):377–86.

    Article  PubMed  Google Scholar 

  16. Bouza E et al. Nosocomial bloodstream infections caused by Streptococcus pneumoniae. Clin Microbiol Infect. 2005;11(11):919–24.

    Article  CAS  PubMed  Google Scholar 

  17. Collier J. Bone disorders in chronic liver disease. Hepatology. 2007;46(4):1271–8.

    Article  CAS  PubMed  Google Scholar 

  18. Venu M et al. High prevalence of vitamin A deficiency and vitamin D deficiency in patients evaluated for liver transplantation. Liver Transpl. 2013;19(6):627–33.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peris P et al. Vertebral fractures and osteopenia in chronic alcoholic patients. Calcif Tissue Int. 1995;57(2):111–4.

    Article  CAS  PubMed  Google Scholar 

  20. Lindor KD et al. Bone disease in primary biliary cirrhosis: does ursodeoxycholic acid make a difference? Hepatology. 1995;21(2):389–92.

    CAS  PubMed  Google Scholar 

  21. Chapman R et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology. 2010;51(2):660–78.

    Article  CAS  PubMed  Google Scholar 

  22. Solaymani-Dodaran M et al. Fracture risk in people with primary biliary cirrhosis: a population-based cohort study. Gastroenterology. 2006;131(6):1752–7.

    Article  PubMed  Google Scholar 

  23. Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002;50 Suppl 1:i1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Leslie WD, Bernstein CN, Leboff MS. AGA technical review on osteoporosis in hepatic disorders. Gastroenterology. 2003;125(3):941–66.

    Article  PubMed  Google Scholar 

  25. Lindor KD et al. Primary biliary cirrhosis. Hepatology. 2009;50(1):291–308.

    Article  PubMed  Google Scholar 

  26. Guichelaar MM et al. Bone mineral density before and after OLT: long-term follow-up and predictive factors. Liver Transpl. 2006;12(9):1390–402.

    Article  PubMed  Google Scholar 

  27. Sokhi RP et al. Bone mineral density among cirrhotic patients awaiting liver transplantation. Liver Transpl. 2004;10(5):648–53.

    Article  PubMed  Google Scholar 

  28. Martin P, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the AASLD and the American Society of Transplantation. 2013; http://www.aasld.org/sites/default/files/guideline_documents/evaluationadultltenhanced.pdf.

  29. Ninkovic M et al. Incidence of vertebral fractures in the first three months after orthotopic liver transplantation. Eur J Gastroenterol Hepatol. 2000;12(8):931–5.

    Article  CAS  PubMed  Google Scholar 

  30. Tanaka K et al. Coffee consumption and decreased serum gamma-glutamyltransferase and aminotransferase activities among male alcohol drinkers. Int J Epidemiol. 1998;27(3):438–43.

    Article  CAS  PubMed  Google Scholar 

  31. Ruhl CE, Everhart JE. Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2005;128(1):24–32.

    Article  CAS  PubMed  Google Scholar 

  32. Modi AA et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010;51(1):201–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ruhl CE, Everhart JE. Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States. Gastroenterology. 2005;129(6):1928–36.

    Article  PubMed  Google Scholar 

  34. Klatsky AL, Armstrong MA, Friedman GD. Coffee, tea, and mortality. Ann Epidemiol. 1993;3(4):375–81.

    Article  CAS  PubMed  Google Scholar 

  35. Klatsky AL et al. Coffee, cirrhosis, and transaminase enzymes. Arch Intern Med. 2006;166(11):1190–5.

    Article  PubMed  Google Scholar 

  36. Freedman ND et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009;50(5):1360–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Freedman ND et al. Coffee consumption is associated with response to peginterferon and ribavirin therapy in patients with chronic hepatitis C. Gastroenterology. 2011;140(7):1961–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Birerdinc A et al. Caffeine is protective in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2012;35(1):76–82.

    Article  CAS  PubMed  Google Scholar 

  39. Montella M et al. Coffee and tea consumption and risk of hepatocellular carcinoma in Italy. Int J Cancer. 2007;120(7):1555–9.

    Article  CAS  PubMed  Google Scholar 

  40. Kurozawa Y et al. Dietary habits and risk of death due to hepatocellular carcinoma in a large scale cohort study in Japan. Univariate analysis of JACC study data. Kurume Med J. 2004;51(2):141–9.

    Article  PubMed  Google Scholar 

  41. Kurozawa Y et al. Coffee and risk of death from hepatocellular carcinoma in a large cohort study in Japan. Br J Cancer. 2005;93(5):607–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Wakai K et al. Liver cancer risk, coffee, and hepatitis C virus infection: a nested case-control study in Japan. Br J Cancer. 2007;97(3):426–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This review did not receive financial support from a funding agency or institution, and Veronica Loy, DO, has no conflict of interests to declare.

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Authors and Affiliations

  1. Division of Hepatology, Loyola University of Chicago, 2160 S First Avenue, Maywood, IL, 60153, USA

    Veronica Loy D.O.

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  1. Veronica Loy D.O.
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Correspondence to Veronica Loy D.O. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Kia Saeian

  2. Division of Gastroenterology and Hepatology, Medicine Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Reza Shaker

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© 2017 Springer International Publishing Switzerland

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Loy, V. (2017). Health Maintenance in Liver Disease and Cirrhosis. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_7

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  • DOI: https://doi.org/10.1007/978-3-319-30103-7_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30101-3

  • Online ISBN: 978-3-319-30103-7

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