Cirrhosis is a serious condition that replaces normal liver tissue by scar tissue (fibrosis). It tends to progress slowly and often causes no symptoms in its early stages. However, as liver function gradually becomes worse, serious problems can develop. In the UK, the two most common causes of cirrhosis are alcohol abuse and hepatitis C infection Treatments may vary, depending on the cause. If cirrhosis becomes severe, a liver transplant may be the only option.
On this page
- What does the liver?
- What is cirrhosis?
- What causes cirrhosis?
- How common is cirrhosis?
- What are the symptoms of cirrhosis?
- How is cirrhosis diagnosed?
- What is the treatment for cirrhosis?
- Cirrhosis can be prevented?
- What is the outlook (prognosis)?
- More help and information
What does the liver?
The liver in the right upper abdomen. It has many features including:
- Glycogen storage (fuel for the body) made from sugars. When required, the glycogen is broken down into glucose that is released into the bloodstream.
- Helping to process fats and proteins from digested food.
- The production of proteins that are essential for blood clotting (coagulation factors).
- Processing many medicines you can take.
- Helping to remove or process alcohol, poisons and toxins from the body.
- Making bile which passes from the liver to the intestine to help digest fats.
What is cirrhosis?
Cirrhosis is a condition in which normal liver tissue replaced by scar tissue (fibrosis).
Scarring is usually a gradual process. The scar tissue affects the normal structure and regeneration of liver cells. Liver cells are damaged and die as scar tissue develops gradually. Therefore, the liver gradually loses its ability to function well. Scar tissue may also affect the flow of blood through the liver that can cause back pressure in the blood vessels that carry blood towards the liver. This counter is called portal hypertension.
What causes cirrhosis?
There are many causes of cirrhosis. In the UK the most common causes are excessive alcohol consumption and infection with hepatitis C.
Liver cells metabolize alcohol, but excess alcohol can damage the liver cells. As a general rule, the heavier your drinking, the more their risk of developing cirrhosis. However, alcoholic cirrhosis is not only a condition of alcoholics. People who are social drinkers also may develop cirrhosis.
Around 1 in 10 heavy drinkers will eventually develop cirrhosis. It tends to occur after 10 or more years of heavy drinking. It is unclear why some people are more prone to liver cells damaged by alcohol and the development of cirrhosis. There may be a genetic tendency. Women who drink excessively seem more prone to cirrhosis than men.
Hepatitis C and cirrhosis
Chronic (persistent) infection with the hepatitis C virus causes a prolonged inflammation in the liver. This eventually can lead to scarring of the liver and cirrhosis. Up to 1 in 5 people with chronic hepatitis C develop cirrhosis, but this usually takes about 20 years or longer since the initial infection.
Other causes of cirrhosis
Less common causes include:
- Chronic infection with hepatitis B. Worldwide, this is the most common cause of cirrhosis (but alcohol and hepatitis C are the most common in the UK).
- Autoimmune hepatitis. The immune system normally makes antibodies to attack bacteria, viruses and other germs. In people with autoimmune diseases, the immune system produces antibodies against the part (s) of the body. Something triggers the immune system to trigger these autoantibodies but not known. In autoimmune hepatitis, immune system produces antibodies against liver cells, which can lead to damage and cirrhosis.
- The diseases that cause blockage of the bile ducts can cause back pressure and damage to the liver cells. For example, primary biliary cirrhosis, sclerosing cholangitis, and congenital bile duct.
- Nonalcoholic steatohepatitis (NASH). This is a condition that causes the accumulation of fat in the liver. This can lead to scarring and cirrhosis. Overweight / obesity increases the risk of developing NASH.
- Severe reactions to certain drugs.
- Some poisons and environmental toxins.
- Certain infections caused by bacteria and parasites that are normally found only in tropical countries.
- Severe heart failure can cause the pressure of the blood and liver congestion.
- Some rare inherited diseases that can cause damage to the liver cells. For example:
- Hemochromatosis. This is a condition that causes an abnormal accumulation of iron in the liver and other body parts.
- Wilson's Disease. This is a condition that causes an abnormal accumulation of copper in the liver and other body parts.
- Other rare disorders.
How common is cirrhosis?
An estimated 30,000 people living with cirrhosis in the UK and at least 7,000 new cases diagnosed each year. The number of people living with both alcoholic cirrhosis and cirrhosis related to alcohol seem to be increasing.
What are the symptoms of cirrhosis?
In the initial stages of the disease, often there are no symptoms. You can get by with a small number of liver cells work. However, as more and more liver cells die and scar tissue accumulates increasingly, liver:
- Not obtain enough protein such as albumin that help regulate the composition of the fluid in the bloodstream and body.
- Fails to make enough chemicals necessary for blood clotting.
- Is able to process less waste chemicals in the body, such as bilirubin. Thus, they can accumulate in the body.
- Is less able to process drugs, toxins and other chemicals, which may then accumulate in the body.
Therefore, symptoms may develop include:
- Tiredness and weakness.
- Fluid leaking from the bloodstream and accumulates in the legs (edema) and abdomen (ascites).
- Loss of appetite, nausea and vomiting.
- Weight loss (although it can gain weight if you retain much liquid).
- The tendency to bleed and bruise easily.
- Jaundice (yellowing leaves) due to a buildup of bilirubin.
- Itching due to an accumulation of toxins.
- Mental health changes may develop in severe cases as toxins accumulate in the bloodstream and affect the brain. This can cause changes in personality and behavior, confusion, forgetfulness and difficulty concentrating. Over time it can lead to unconsciousness and hepatic coma. These changes are known as hepatic encephalopathy.
Moreover, scar tissue restricts the flow of blood through the liver. As cirrhosis worse, this causes the pressure in the portal vein (known as portal hypertension). The portal vein is the vein that carries blood from the intestine to the liver – it contains digested food. Increased pressure in this vein can cause inflammation (varices) to develop the branches of the vein in the lining of the esophagus (gullet) and stomach. These veins have a tendency to bleed easily in the gut. If bleeding occurs, may vomit blood or pass blood in the stool (feces).
How is cirrhosis diagnosed?
A doctor may suspect your symptoms and a physical examination, you have cirrhosis. (For example, a doctor may find that your liver is enlarged, or that you are retaining fluid.) A doctor might consider cirrhosis as the cause of your symptoms if you have a history of alcohol abuse or have had an episode prior hepatitis.
Blood tests may show abnormal liver function. (See separate leaflet called 'Blood – liver function tests. For details) ultrasound (or CT scan or MRI) can show that you have a damaged liver. To confirm the diagnosis, a biopsy (small sample) of the liver can be taken for examination under a microscope. (See separate leaflet called 'Biopsy – Liver. for details) The liver scarring and damage to the liver cells can be seen in a biopsy.
If the underlying cause of cirrhosis is not clear, then other tests may be done to clarify the cause. For example, to test for antibodies against hepatitis virus, to test for antibodies that can be targeted to liver cells, to search a blood sample to excess iron or copper, etc.
What is the treatment for cirrhosis?
Cirrhosis tends to progressively worsen if the underlying cause persists and untreated. In general, once the damage is done healing can not invest. Therefore, the objective of treatment is, if possible, to prevent subsequent scarring liver, or slow the progression of the healing process. The treatments may be advised include the following.
Stop drinking alcohol
Whatever the cause of cirrhosis, stop drinking alcohol completely. Alcohol consumption increases the rate of progression of cirrhosis from any cause.
Be careful when taking medications
Always tell your doctor or pharmacist if you have cirrhosis you take prescription drugs or over the counter. Some medications that are processed in the liver may be necessary to adjust the dose if you have liver problems, or even not be used at all.
The treatment of the underlying causes
Some of the underlying causes of cirrhosis can be treated. This can slow or stop the progression of cirrhosis. For example:
- Do not drink alcohol if alcohol is the cause.
- Interferon and other medicines may be used to treat viral hepatitis.
- Steroid medicines or other immunosuppressive drugs can be used to treat autoimmune diseases that cause liver damage.
- Regular elimination half-liter or less of the blood can remove excess iron that occurs in hemochromatosis.
Treatment to relieve symptoms and prevent complications
Several treatments may be advised, depending on the severity of cirrhosis and symptoms that develop. For example:
- Adequate food intake (including calories and protein) and regular exercise are important to avoid excessive weight loss and muscle wasting.
- A low-sodium diet or diuretics (tablets) to reduce the accumulation of fluid in the body.
- Medications to reduce itching.
- Zinc deficiency is common in cirrhosis and zinc supplements can be used.
- Vaccination to protect against hepatitis A, influenza and pneumococcal infections.
- Osteoporosis may occur and thus the prevention and treatment of osteoporosis is important.
- Medications can help reduce portal hypertension.
- The drainage of liquid which accumulates on the abdomen (ascites).
Treatment of bleeding varices
Variceal hemorrhage (described above) is a medical emergency. Seek medical help immediately if you have cirrhosis and vomit blood or pass blood in the stool, or if your stools become black. Various surgical techniques can be used to stop bleeding and to help reduce the risk of further bleeding.
In severe cases, where the scar is wide and liver can function only after a liver transplant may be the only option.
Until recently the healing process was thought cirrhosis irreversible. However, recent research has led to a greater understanding of the healing process. Some research suggests that the drugs may be able to develop that can reverse the process of healing. Stem cells or liver cells aimed at restoring liver function is also being investigated. This investigation continues.
Cirrhosis can be prevented?
The most common cause of cirrhosis in the United Kingdom is the excessive consumption of alcohol. The most important way to prevent the development of cirrhosis is drinking within recommended safe limits. That is:
- Men should not drink more than 21 units of alcohol per week, no more than four units in a single day, and have at least two alcohol-free days a week.
- Women should not drink more than 14 units of alcohol per week, no more than three units in a single day, and have at least two alcohol-free days a week.
- Pregnant women. Advice from the Department of Health states that … "Pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimize the risk to the baby should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk. "
Where are these recommendations?
- The Department of Health recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. "Regularly" means drinking every day or most days of the week. And if you do drink more than that on any day, within 48 hours without alcohol after to let your body recover.
- The Royal College of Physicians (RCP) recommends no more than 21 units per week for men and 14 units per week for women. But also, have 2-3 days off alcohol a week to allow time for the liver to recover after drinking anything but the smallest amount of alcohol. A quote from the RCP … "In addition to quantity, safe limits alcohol also should consider the frequency. There is an increased risk of liver disease for those who drink daily or near-daily compared with those who drink periodically or intermittently."
- The House of Commons Science and Technology Committee advised that people should have at least two alcohol-free days a week.
- Some might argue that the upper limits of the recommendations are too high. For example, one study found that more than two units a day for men and more than one unit per day for women significantly increases the risk of developing certain cancers.
In general, the more you drink above these limits, alcohol is more harmful it can be.
One unit of alcohol is approximately equal to:
- A pint of normal beer strength, cider or beer.
- As pub liquor (25 ml), or fortified wine, sherry as (50 ml).
- A small glass (125 ml) of wine containing 8% alcohol by volume.
Note: Using the above guide is easy to underestimate the amount of alcohol in a drink. This is because many are now strong beers, and wines are often served in 175 ml glasses. Many wines are also stronger than the standard (some contain 12-14% alcohol by volume).
However, you should not drink alcohol at all if you have already developed cirrhosis early or have chronic hepatitis and other liver problems.
Some causes of cirrhosis are due to infectious diseases that can be prevented. For example, people who inject illegal drugs are at risk for hepatitis B and C if they use dirty needles or injection equipment. These infections can also be transmitted through unprotected sex. Hepatitis B is preventable through immunization offered to those at risk, such as health workers, drug users and people with multiple sexual partners.
What is the outlook (prognosis)?
The prognosis depends on factors such as the underlying cause, how early the condition is diagnosed, and how early treatment is given. Many people with cirrhosis that is not too long to live a normal life for a number of years. In some cases, the progression of cirrhosis can be stopped or slowed by treatment. The outlook is not so good if there are a lot of liver damage, especially if you have alcoholic cirrhosis and non stop drinking.
Cirrhosis can cause death from variceal bleeding, or entering a coma from liver failure. People with cirrhosis are also at increased risk of developing serious infections.
If you have cirrhosis, you have a higher risk of developing liver cancer (hepatocellular carcinoma). The risk varies according to the cause of cirrhosis. The greatest risk is cirrhosis caused by hepatitis C, followed by cirrhosis caused by hereditary hemochromatosis. The risk of developing liver cancer is lower in those with alcoholic cirrhosis. If you have cirrhosis, should have regular checkups to make sure there are no signs of developing liver cancer.
More help and information
British Liver Trust
2 Southampton Road Ringwood BH24 1HY
Free Help: 0800 652 7330 Web: www.britishlivertrust.org.uk