Cirrhosis

On this page

Overview

Cirrhosis
Cirrhosis
Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage.  The scar tissure prevents the liver working properly.
 
Cirrhosis is sometimes called end-stage liver disease because it happens after other stages of damage from conditions that affect the liver, such as hepatitis.
 
Your liver may keep working even when you have cirrhosis. However, cirrhosis can eventually lead to liver failure, and you can get serious complications, which can be life threatening.
 
Treatment may be able to stop cirrhosis from getting worse.
 

Symptoms

 
You may not have any symptoms during the early stages of cirrhosis. As your liver becomes more damaged, you may:
  • feel very tired and weak
  • feel nauseous
  • lose your appetite
  • lose your sex drive

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 (odema) or tummy (ascites) from a build-up of fluid
  • loss of sex drive (libido).

See your GP if you think you may have 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, felxibile tube with a light and camera at the end (an endoscope) is passed down your throat and into your stomach, imahes 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 cur down on or stop drinking alcohol, or lose weight if you are 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.

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

Cirrhosis can also be caused by a problem affecting your bile ducts (such as primary biliary cholangitis) or immune system (such as autoimmune hepatitis), some inherited conditions, and the long-term use of certain medicines.

Alcohol consumption

Drinking to 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 man, 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 difficulat to cut down the amount of alcohol you drink.

Protect yourself from hepatitis

Hepatitis B and C are infections in the liver caused by a virus.

The hepatitis B virus is spread in blood and body fluids. The hepatitis C virus is usually spread in blood.

Common ways of spreading these viruses include having sex with an infected person without using a condom, or close contact with an infected person's blood, such as sharing their toothbrush or sharing needles to inject drugs.

Vaccination for hepatitis B is part of the NHS childhood vaccination schedule. The vaccine is also available to anyone who has an increased chance of getting hepatitis B.

There is no vaccine for hepatitis C at the moment.

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.

The liver

The liver is an important organ that carries out hundreds of jobs vital for sustaining life.

For example, it:

  • stores glycogen, a carbohydrate that produces short-term energy
  • makes bile, which helps digest fats
  • makes substances that clot the blood
  • processes and removes alcohol, toxins or drugs
  • helps the body fight infections

Your liver is very tough. It'll keep working even if badly damaged, and can continue to repair itself until it's severely damaged.

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:

  • tiredness and weakness
  • nausea
  • loss of appetite resulting in weightloss
  • reduced sex drive
  • red patches on your palms and small, spider-like blood vessels on your skin (spider angiomas) above waist level

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 (odema), 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

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 talking 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
  • practice good hygiene to reduce your chances of developing infections
  • speak to your GP or pharmacist if you're talking 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 it's 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 reduce high blood pressure in your portal vein, the main vein that transports blood from the gut to the liver
  • creams to reduce itching

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 duretic 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 severly 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 Organ Donation Wales website has more information.

Cirrhosis and diabetes

Your diabetes may get worse if you have type 2 diabetes and develop cirrhosis.

This is because cirrhosis can increase your resistance to insulin, a hormone produced by the body to control blood sugar levels.

If this happens, you should discuss the implications with your GP.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 05/07/2021 13:32:34