Cirrhosis

Cirrhosis is severe, long-term damage to the liver. Over years, scar tissue replaces healthy liver tissue. The scarring is permanent, and as it spreads the liver cannot do its many jobs, such as making proteins, fighting infection and cleaning the blood.

Many people feel well for years. Treating the cause can slow the damage, and complications can be treated. Without care, the liver can eventually fail.

There may be no symptoms at first. Later they can include:

• Tiredness and weakness
• Poor appetite, weight loss, nausea or vomiting
• Discomfort in the upper right of the tummy
• Itchy skin
• Easy bruising or bleeding
• Yellow skin and eyes (jaundice) and dark urine
• Swelling of the tummy (ascites), legs, ankles or feet
• Confusion, poor concentration or changes in sleep

See a doctor soon if your skin or eyes turn yellow, your tummy, legs or ankles swell, you bruise or bleed easily, your skin itches, or you have lasting tiredness, poor appetite or weight loss. If you drink heavily or have hepatitis B, hepatitis C, fatty liver disease or diabetes, ask about a liver check even if you feel well.

Cirrhosis follows long-term damage to the liver. The most common causes are:

• Long-term heavy alcohol use
• Chronic hepatitis B or hepatitis C infection
• Fatty liver disease, more common with being overweight or having type 2 diabetes

Less common causes include autoimmune liver disease, bile duct diseases, inherited conditions such as Wilson disease and haemochromatosis, long-term use of certain medicines, and long-standing heart failure.

• Drinking heavily over many years
• Hepatitis B or hepatitis C infection
• Being overweight or having type 2 diabetes
• Inherited liver conditions
• Long-term use of some medicines

Cirrhosis can lead to serious problems, which is why regular follow-up matters:

• Fluid in the tummy (ascites) and swollen legs
• Enlarged veins in the food pipe and stomach (varices), which can burst and bleed heavily
• Confusion and drowsiness, when toxins that the liver cannot clear affect the brain
• Infections, kidney problems, poor nutrition and weak bones
• Liver cancer and liver failure

Not every case can be prevented, but the main causes can often be tackled:

• Avoid heavy drinking, or stop drinking if you already have liver disease
• Keep a healthy weight with a balanced diet and regular activity
• Get tested for hepatitis B and C, and have them treated if present
• If you have cirrhosis, keep vaccinations up to date and avoid raw or undercooked shellfish, fish and meat

A doctor asks about alcohol, other conditions, medicines and herbal products, and looks for signs of liver disease such as yellow eyes, swelling and a tremor of the hands. Tests may include:

• Blood tests, to check how the liver is working and look for causes such as hepatitis B or C
• Ultrasound, CT or MRI scans of the liver
• Elastography, a scan that measures liver stiffness, which rises with scarring
• A liver biopsy, using a needle, when other tests are unclear

Cirrhosis cannot be cured and scarring cannot be removed, but treatment can slow it or stop it getting worse. First the cause is treated: stopping alcohol completely, weight loss for fatty liver disease, antiviral medicines for hepatitis B or C, and medicines that calm the immune system for autoimmune hepatitis.

Complications are treated as they arise: water tablets (diuretics) and less salt for fluid build-up, medicines to lower pressure in the veins and reduce bleeding, endoscopy for bleeding veins, antibiotics for infections, and medicines to reduce the toxins that cause confusion. Regular blood tests and scans look for liver cancer early.

Avoid alcohol and illegal drugs. Take pain relief such as paracetamol or anti-inflammatory painkillers, and any herbal product or supplement, only if a doctor says it is safe. A liver transplant is considered when the liver fails and other treatments no longer work.