Cirrhosis

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Introduction

Cirrhosis

Cirrhosis is scarring of the liver caused by long-term liver damage. The scar tissue prevents the liver working properly.

Cirrhosis can eventually lead to liver failure, where your liver stops working, which can be fatal.

But it usually takes years for the condition to reach this stage and treatment can help slow its progression.

This page covers:

Symptoms

Diagnosis

Treatment

Causes

Prevention

Symptoms

You may not have any symptoms during the early stages of cirrhosis. As your liver becomes more damaged, you may:

As the condition gets worse, further symptoms can include:

  • yellowing of the skin and whites of the eyes (jaundice)
  • vomiting blood
  • itchy skin
  • dark, tarry-looking poo
  • a tendency to bleed or bruise more easily
  • swollen legs (oedema) or tummy (ascites) from a build-up of fluid 

See your GP if you think you may have cirrhosis.

Read more about the symptoms of cirrhosis.

Diagnosing cirrhosis

If your GP suspects cirrhosis, they'll check your medical history and carry out a physical examination to look for signs of long-term liver disease.

You may have tests to confirm the diagnosis. Tests include:

  • blood tests
  • scans - an ultrasound scan, transient elastography scan, CT scan, or MRI scan
  • liver biopsy - a fine needle is used to remove a sample of liver cells so they can be examined under a microscope
  • endoscopy - a thin, flexible tube with a light and camera at the end (an endoscope) is passed down your throat and into your stomach; images of your oesophagus and stomach can show swollen veins (varices), which are a sign of cirrhosis

Treating cirrhosis

There's currently no cure for cirrhosis. But it's possible to manage the symptoms and any complications, and slow its progression.

Treating the underlying cause, such as using anti-viral medication to treat a hepatitis C infection, can also stop cirrhosis getting worse.

You may be advised to cut down on or stop drinking alcohol, or lose weight if you're overweight. A wide range of alcohol support services are available.

If your liver is severely scarred, it can stop functioning. In this case, a liver transplant is the only treatment option.

Read more about treating cirrhosis.

What causes cirrhosis?

In the UK, the most common causes of cirrhosis are:

  • drinking too much alcohol over many years
  • being infected with hepatitis for a long time, particularly hepatitis C
  • non-alcoholic steatohepatitis - a more severe form of non-alcoholic fatty liver disease, where the liver becomes inflamed as the result of a build-up of excess fat

Alcohol consumption

Drinking too much alcohol can damage the liver's cells.

Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking.

Women who drink heavily are more likely to get liver damage than men, partly because of their different size and build.

Preventing cirrhosis

Limit alcohol

The best way of preventing alcohol-related cirrhosis is to drink within the recommended limits:

  • men and women shouldn't regularly drink more than 14 units of alcohol a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

You should stop drinking alcohol immediately if you have alcohol-related cirrhosis. Alcohol speeds up the rate at which cirrhosis progresses, regardless of the cause.

Your GP can give you help and advice if you're finding it difficult to cut down the amount you drink. 

Read more about alcohol units and alcohol misuse.

Protect yourself from hepatitis

Hepatitis B and C are infections you can get by having unprotected sex or sharing needles to inject drugs.

Using a condom during sex and not injecting drugs will reduce your risk of getting hepatitis B and C.

A vaccine for hepatitis B is available, but there's currently no vaccine for hepatitis C.

Aim for a healthy weight

To reduce your risk of developing non-alcoholic fatty liver disease, which can lead to cirrhosis, try to maintain a healthy weight by having a healthy, balanced diet and exercising regularly.

Symptoms

Symptoms

You may not have any symptoms when you first develop cirrhosis.

In the early stages, the liver can function normally despite being damaged.

You tend to get noticeable symptoms as the liver becomes more severely damaged.

The main symptoms include:

As the condition progresses, you may also have:

  • yellowing of the skin and whites of the eyes (jaundice)
  • fever and shivering attacks
  • vomiting
  • diarrhoea 
  • itchy skin
  • stomach pain, or a swollen or bloated stomach
  • dark, tarry-looking poo
  • a tendency to bleed or bruise easily
  • tiny red lines (blood capillaries) on the skin above waist level
  • swelling in the legs, ankles and feet caused by a build-up of fluid (oedema), which can cause breathing problems
  • difficulty maintaining weight
  • personality changes, confusion, difficulty concentrating, memory loss, or hallucinations
  • in women, abnormal periods
  • in men, enlarged breasts, a swollen scrotum (the loose sac of skin that contains the testicles) or shrunken testicles

See your GP if you think you may have cirrhosis.

Treatment

Treatment

Cirrhosis can't be cured, so treatment aims to manage the symptoms and any complications, and stop the condition getting worse.

Stopping cirrhosis getting worse

Making healthy lifestyle changes and taking medicine to treat the underlying cause of the liver damage can help stop cirrhosis getting worse. It can also reduce your risk of developing further health problems.

Lifestyle changes

There are a number of things you can do to help stay healthy and reduce your chances of developing further problems:

  • avoid alcohol if your liver problems are alcohol-related
  • lose weight if you're overweight or obese
  • take regular exercise to reduce muscle wasting
  • practise good hygiene to reduce your chances of developing infections
  • speak to your GP about vaccinations you may need, such as the annual flu vaccine or travel vaccines
  • speak to your GP or pharmacist if you're taking over-the-counter or prescription medications, as cirrhosis can affect the way some medicines work

Dietary changes

Malnutrition is common in people with cirrhosis, so it's important you have a balanced diet to help you get all the nutrients you need.

Cutting down on salt can help reduce your risk of developing swelling in your legs, feet and tummy caused by a build-up of fluid.

The damage to your liver can also mean it's unable to store glycogen, which provides short-term energy.

When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. This means you may need extra calories and protein in your diet.

Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat three or four small meals a day, rather than one or two large meals.

Medication

The medication you need will depend on the specific cause of the damage to your liver. For example, if you have viral hepatitis, anti-viral medication may be prescribed.

Easing symptoms

Treatments to ease the symptoms of cirrhosis include:

  • a low-salt diet or tablets called diuretics to reduce the amount of fluid in your body
  • tablets to reduce high blood pressure in your portal vein, the main vein that transports blood from the gut to the liver
  • creams to reduce itching

Managing complications

If you have advanced cirrhosis, complications caused by the condition may need treatment.

Swollen veins in the oesophagus

If you vomit blood or have blood in your poo, the veins in your oesophagus (gullet), the tube that carries food from the throat to the stomach, may be swollen and leaking blood. These are known as oesophageal varices.

You need urgent medical attention if you have oesophageal varices. See your GP or go to your nearest accident and emergency (A&E) department immediately.

An endoscopy is used to help diagnose oesophageal varices. A number of treatments can also be carried during the procedure to stop the bleeding and reduce the swelling.

The Chesterfield Royal Hospital has more information about treating oesophageal varices (PDF, 360kb).

You may also be given a type of medication called a beta-blocker, such as propranolol or carvedilol, to reduce the risk of bleeding.

Fluid in the tummy and legs

A build-up of fluid around your stomach area or legs and ankles is a common complication of advanced cirrhosis.

The main treatments are cutting salt in your diet and taking diuretic tablets, such as spironolactone or furosemide.

If the fluid around your stomach becomes infected, you may need antibiotics. In severe cases, you may need to have the fluid drained from your tummy with a tube.

Encephalopathy

People with cirrhosis can sometimes develop problems with their brain function (encephalopathy).

Symptoms include confusion, drowsiness and problems concentrating. This happens because the liver isn't clearing toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative and helps clear the toxins that have built up. Resistant cases may be treated with a special type of antibiotic called Rifaximin.

Bleeding

Cirrhosis can affect the liver's ability to make the blood clot, leaving you at risk of severe bleeding if you cut yourself.

In emergencies, vitamin K and a blood product called plasma can be given to treat bleeding. You'll need to apply pressure to any cuts that bleed.

You should get specialist advice before having medical procedures, including any dental work.

Liver transplant

Your liver may stop functioning if it's severely damaged by scarring. In this situation, a liver transplant is the only option.

This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver.

You'll probably have to wait a long time for a liver transplant as there are more people waiting for a transplant than there are donors.

You won't be able to have a liver transplant if you're still drinking excessive amounts of alcohol.

The NHS Blood and Transplant Organ Donation website has more information about transplants and joining the Organ Donor Register.