Cirrhosis is a serious condition where normal liver tissue is replaced by scar tissue (fibrosis). It tends to progress slowly and often does not cause symptoms in its early stages. However, as the function of the liver gradually becomes worse, serious problems can develop. In the UK, the two common causes of cirrhosis are heavy alcohol drinking and hepatitis C infection. Treatments may vary, depending on the cause. If cirrhosis becomes severe, a liver transplant may be the only option.
The liver is in the upper right part of the abdomen. It has many functions which include:
Cirrhosis is a condition where normal liver tissue is replaced by scar tissue (fibrosis).
The scarring tends to be a gradual process. The scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. Therefore, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver which can cause back pressure in the blood vessels which bring blood to the liver. This back pressure is called portal hypertension.
There are many causes of cirrhosis. In the UK the most common causes are heavy alcohol drinking and infection with the hepatitis C virus.
Your liver cells break down alcohol, but too much alcohol can damage the liver cells. As a rule, the heavier your drinking, the more your risk of developing cirrhosis. However, alcoholic cirrhosis is not just a condition of alcoholics. People who are social heavy drinkers can also develop cirrhosis.
About 1 in 10 heavy drinkers will eventually develop cirrhosis. It tends to occur after 10 or more years of heavy drinking. It is not clear why some people are more prone to their liver cells becoming damaged by alcohol and to developing cirrhosis. There may be a genetic tendency. Women who are heavy drinkers seem to be more prone to cirrhosis than men.
Chronic (persistent) infection with the hepatitis C virus causes long-term inflammation in the liver. This can eventually lead to liver scarring and cirrhosis. Up to 1 in 5 people with chronic hepatitis C develop cirrhosis but this usually takes about 20 years or even longer from the initial infection.
Less common causes include:
There are an estimated 30,000 people living with cirrhosis in the UK and at least 7,000 new cases being diagnosed each year. The numbers of people living with both alcoholic cirrhosis and non-alcohol-related cirrhosis seem to be rising.
In the early stages of the condition, often there are no symptoms. You can get by with a reduced number of working liver cells. However, as more and more liver cells die, and more and more scar tissue builds up, the liver:
Therefore, the symptoms that may develop include:
Also, the scar tissue restricts the flow of blood through the liver. As the cirrhosis becomes worse, this causes back pressure in the portal vein (known as portal hypertension). The portal vein is the vein that takes blood from the gut to the liver - it contains digested foods. Increased pressure in this vein can cause swellings (varices) to develop in the branches of the vein in the lining of the oesophagus (gullet) and stomach. These varices have a tendency to bleed easily into the gut. If a bleed occurs, you may vomit blood, or pass blood with your stools (faeces).
A doctor may suspect, from your symptoms and a physical examination, that you have cirrhosis. (For example, a doctor may detect that your liver is enlarged, or that you are retaining fluid.) A doctor may especially think of cirrhosis as a cause of your symptoms if you have a history of heavy alcohol drinking or have had a previous episode of hepatitis.
Blood tests may show abnormal liver function. (See separate leaflet called 'Blood Test - Liver Function Tests' for more details.) An ultrasound scan (or a CT or MRI scan) may show that you have a damaged liver. To confirm the diagnosis, a biopsy (small sample) of the liver may be taken to be looked at under the microscope. (See separate leaflet called 'Biopsy - Liver' for more details.) The scarring of the liver and damage to liver cells can be seen on a biopsy.
If the underlying cause of the cirrhosis is not clear, then further tests may be done to clarify the cause. For example, to check for antibodies to hepatitis viruses, to check for autoantibodies that may have attacked your liver cells, to look in a blood sample for excess iron or copper, etc.
Cirrhosis tends to get progressively worse if the underlying cause persists and is not treated. In general, once the damage is done the scarring is not able to reverse. Therefore, the aim of treatment is, if possible, to prevent further liver scarring, or to slow the progression of the scarring process. Treatments that may be advised include the following.
Whatever the cause of cirrhosis, you should stop drinking alcohol completely. Drinking alcohol will increase the rate of progression of cirrhosis from whatever cause.
Always tell your doctor or pharmacist that you have cirrhosis if you take any prescribed or over-the-counter medicines. Some medicines that are processed in the liver may need their dose adjusted if you have liver problems, or even should not be used at all.
Some of the underlying causes of cirrhosis can be treated. This may slow down, or halt, the progression of cirrhosis. For example:
Various treatments may be advised, depending on the severity of the cirrhosis and the symptoms that develop. For example:
A bleed from varices (described above) is a medical emergency. Seek medical help immediately if you have cirrhosis and you vomit blood, or pass blood in your faeces, or if your faeces become black. Various surgical techniques can be used to stop the bleeding and to help reduce the risk of further bleeds.
In severe cases, where the scarring is extensive and the liver can barely function, then a liver transplant may be the only option.
Up until recently the scarring process of cirrhosis was thought to be irreversible. However, recent research has led to a greater understanding of the scarring process. Some research suggests that medicines may be able to be developed that can reverse the scarring process. Stem-cell or liver cell transplantation aimed at restoring liver function is also being investigated. This research continues.
The most common cause of cirrhosis in the UK is heavy alcohol drinking. The most important way to prevent cirrhosis from developing is to drink within the recommended safe limits. That is:
Where do these recommendations come from?
In general, the more you drink above these limits, the more harmful alcohol is likely to be.
A unit of alcohol is about equal to:
Note: using the above guide, it is easy to underestimate how much alcohol is in a drink. This is because many beers are now strong, and wines are often served in 175 ml glasses. Many wines are also stronger than standard (some contain 12-14% alcohol by volume).
But, you should not drink alcohol at all if you have already developed early cirrhosis or you have chronic hepatitis or certain other liver problems.
Some causes of cirrhosis are due to infectious diseases which can often be prevented. For example, people who inject street drugs are at risk of hepatitis B and C if they use unclean needles or other injection equipment. These infections may also be passed on through unprotected sex. Hepatitis B can be prevented by immunisation which is offered to those at risk such as healthcare workers, drug users and people with multiple sexual partners.
The outlook depends on factors such as the underlying cause, how early the condition is diagnosed, and how early treatment is given. Many people who have cirrhosis which is not too extensive live a normal life for a number of years. In some cases, the progression of the cirrhosis can be halted or slowed by treatment. The outlook is not so good if there is a lot of liver damage, especially if you have alcoholic cirrhosis and do not stop drinking.
Cirrhosis can cause death due to bleeding from varices, or by going into a coma from liver failure. People with cirrhosis are also at increased risk of developing serious infections.
If you have cirrhosis, you have an increased risk of developing cancer of the liver (hepatocellular carcinoma). The risk varies according to the cause of cirrhosis. The greatest risk is with cirrhosis caused by hepatitis C infection, followed by cirrhosis caused by hereditary haemochromatosis. The risk of developing liver cancer is lower in those with alcoholic cirrhosis. If you have cirrhosis, you should have regular checks to make sure that there are no signs of liver cancer developing.
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