Cirrhosis

Cirrhosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Cirrhosis Cirrhosis About cirrhosis Symptoms of cirrhosis Causes of cirrhosis Diagnosing cirrhosis Treating cirrhosis Preventing cirrhosis About cirrhosis Cirrhosis is scarring of the liver caused by continuous, long-term liver damage. Scar tissue replaceshealthy tissue in the liver and prevents the liver from working properly. The damage caused by cirrhosis cant be reversed and can eventually become so extensive that your liver stops functioning. This is called liver failure. Cirrhosis can be fatal if the liver fails. However, it usuallytakesyears forthe conditionto reach this stage and treatment can help slow its progression. Each year inthe UK, around 4,000 people die from cirrhosis and 700 people with the condition need a liver transplant to survive. Signs and symptoms There are usually few symptoms in the early stages of cirrhosis. However, as your liver loses its ability to function properly, youre likely to experience a loss of appetite, nausea anditchy skin. In the later stages, symptoms can include jaundice, vomiting blood, dark, tarry-looking stools, and a build-up of fluid in the legs (oedema) and abdomen (ascites). Read more about the symptoms of cirrhosis. When to see your GP As cirrhosis doesnt have many obvious symptoms during the early stages, its often picked up during tests for an unrelated illness. See your GP if you have any of the following symptoms: fever and shivering shortness of breath vomiting blood very dark or black, tarry stools (faeces) periods of confusion or drowsiness Read more about diagnosing cirrhosis . What causes cirrhosis? Inthe UK, the most common causes of cirrhosis are: drinking too much alcohol ( alcohol misuse ) over many years beinginfected with the hepatitis C virus for a long time acondition called non-alcoholic steatohepatitis (NASH) that causes excess fat to build up in the liver NASH is on the rise in the UK, due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Less common causes of cirrhosis include hepatitis B infection and inherited liver diseases, such as haemochromatosis. Read more about the causes of cirrhosis . Treating cirrhosis Theres currently no cure for cirrhosis.However, its possible to managethe symptomsand any complications, and slowits progression. Treating underlying conditions that may be the 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 or stop drinking alcohol, or to lose weight if youre overweight.A widerange of alcohol support services are available. In its more advanced stages, the scarring caused by cirrhosis can make your liver stop functioning. In this case, a liver transplant is the only treatment option. Read more about treating cirrhosis . Preventing cirrhosis Notexceedingthe recommended limits for alcohol consumption is the best way of preventing alcohol-related cirrhosis. 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 developing hepatitis B and C. A vaccine forhepatitis B is available, but theres currently no vaccine for hepatitis C. Read more about preventing cirrhosis . Symptoms of cirrhosis There are usually few symptoms during the early stages of cirrhosis. Noticeable problems tend to develop as the liver becomes more damaged. Inearly stage cirrhosis, the liver is able to function properly despite being damaged. As the condition progresses, symptoms tend to develop when functions of the liver are affected. Symptoms of cirrhosiscan include: tiredness and weakness loss of appetite weight loss and muscle wasting feeling sick(nausea) and vomiting tenderness or pain around the liver area tiny red lines (blood capillaries) on the skin above waist level very itchy skin yellowing of the skin and the whites of the eyes (jaundice) a tendency to bleed and bruise more easily, such as frequent nosebleeds or bleeding gums hair loss fever and shivering attacks swelling in the legs, ankles and feet due to a build-up of fluid (oedema) swelling in your abdomen (tummy), due to a build-up of fluid known as ascites (severe casescan make you look heavily pregnant) You mayalso notice changes in your personality, problems sleeping ( insomnia ), memory loss, confusion and difficulty concentrating. This is known as encephalopathy andoccurs when toxins affect your brain because your liver is unable to remove them from your body. Late-stage symptoms In the later stages of cirrhosis, you may vomit blood or have tarry, black stools. This is because blood cant flow through the liver properly, which causes an increase in blood pressure in the vein that carries blood from the gut to the liver (portal vein). The increase in blood pressure forces blood through smaller, fragile vessels that line your stomach and gullet (varices). These can burst under high blood pressure, leading to internal bleeding, which is visible in vomit and/or stools. Over time, the toxins that would normally be removed from the body by a healthy liver can cause multiple organ failure, followed by death. When toseek medical help You should see your GP if you have persistent signs and symptoms of cirrhosis. Seek immediate medical help if you develop the following symptoms, particularly if youve been previously diagnosed with cirrhosis: fever and shivering attacks shortness of breath vomiting blood very dark or black tarry stools periods of mental confusion or drowsiness Causes of cirrhosis There are many different causes of cirrhosis. In the UK, the most common causes are drinking excessive amounts of alcohol and long-term hepatitis C infections. Insome cases, no specific cause is identified. Alcohol consumption The liver breaks down toxins (poisons), such as alcohol, but too much alcohol can scar and damage the livers cells. Men and women who drink more than 14units of alcohol a week are considered to be drinking too much. If youre a heavy drinker, your chances of developing cirrhosis are increased. However, its important to realise that cirrhosis of the liver isnt just a condition that affects people dependent on alcohol. If youre a heavy social drinker, you can also develop cirrhosis. Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking. For unknown reasons, some people are more susceptible to liver cell damage than others. Women who drink heavily are more susceptible to liver damage than men, partly because of their different body size and build. Stages of alcoholic liver damage People who drink excessively and continue to drink heavily develop cirrhosis in 3separate stages. The first stage of alcohol-related liver disease is known as fatty liver, which almost all excessive drinkers develop. Its a side effect of the liver breaking alcohol down and disappears when you drink less. The second stage of alcohol-related liver disease is alcoholic hepatitis. Around 20% to 30% of people who continue to drink heavily develop alcoholic hepatitis. During this stage, the liver becomes inflamed. If alcoholic hepatitis deteriorates into its most extreme form (liver failure) it can lead to death. About 10% of heavy drinkersdevelop cirrhosis, which is the third stage of alcohol-related liver disease. This risk of developing cirrhosis, along with the risk of alcoholic hepatitis, is one of the main reasons the government recommends that men and women should not regularly drink more than 14 units a week. If you do drink as much as 14 units a week, it is advised that you spread your drinking over 3 or more days. A unit of alcohol is roughly equivalent to half a pint of normal-strength lager or a single measure (25ml) of spirits. A small glass of wine (125ml) is about 1.5 units. Read more about alcohol units . Your GP can give you help and advice if youre finding it difficult to cut down the amount you drink. Hepatitis Hepatitisisinflammationof the liver. Left untreated, it can damage the liver over many years, eventually resulting in cirrhosis. Inthe UK, hepatitis C isthe most common form of hepatitis. The hepatitis Cvirusis usually transmitted through blood-to-blood contact,most commonly by sharing needles used to inject drugs. Two other types of hepatitis infection, hepatitis B and D, can also cause cirrhosis. Non-alcoholic steatohepatitis Non-alcoholic steatohepatitis (NASH) is a severe liver condition that can lead to cirrhosis. As with alcohol-related liver disease, the early stage of NASH is the build-up of excess fat in the liver. This fat is associated with inflammation and scarring, which could lead to cirrhosis. NASH can develop in peoplewho areobese, have diabetes , havehigh levels of fat in the blood ( high cholesterol ) and high blood pressure . Most people with NASH feel well and arent awarethey have a problem until cirrhosis occurs and liver function is affected. NASH is on the rise in the UK due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Other causes There are a number of other conditions that can prevent the liver functioning healthily and can lead to cirrhosis. These include: autoimmuneliver disease  the immune system usually makes antibodies to attack bacteria and viruses; however, if you have an autoimmune disease, such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis (PSC),your immune system will make antibodies that attack healthy organs some rare, genetic conditions  such as haemochromatosis (a build-up of iron in the liver and other parts of the body) and Wilsons disease (a build-up of copper in the liver and other parts of the body) any condition that causes the bile ducts to become blocked  such as cancer of the bile ducts or pancreatic cancer Budd-Chiari syndrome  caused by blood clots blocking the veins that carry blood from the liver Less commonly, the use of certain medications, such as amiodarone and methotrexate, can also cause cirrhosis. Diagnosing cirrhosis If your GP suspects cirrhosis, theyll check your medical history and carry out a physical examination to look for signs of chronic liver disease. If your GP suspects your liver is damaged, youll be referred for tests to confirm the diagnosis. Tests You may have a number of different tests. Blood tests Blood tests can measure your liver function and the amount of liver damage. A blood test may be used to measure the levels of the liver enzymes alanine transaminase (ALT) and aspartate transferase (AST) in your blood, as these will be raised if you have inflammation of the liver (hepatitis). Scans An ultrasound scan ,transient elastography scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be carried out on your liver. Atransient elastography scan is similar to an ultrasound scan carried out during pregnancy (its sometimes known as a Fibroscan). These scans can produce detailed images of your liver or check liver stiffness to identify any scarring. The Lab Tests Online UK website hasmore information about ALT and AST measurements. Liverbiopsy A liver biopsy is where afine needle is inserted into your body (usually between your ribs) to removea small sample of liver cells. The sample is sent to a laboratory so it can be examined under a microscope. The biopsy is usually carried out under local anaesthetic , as a day case or with an overnight stay in hospital. The outcome of the biopsy will confirm a diagnosis of cirrhosis and may provide more information about the cause.However, transient elastography is increasingly being used as an alternative to a biopsy in the diagnosis of cirrhosis. Endoscopy Anendoscopy is where an endoscope (a thin, long, flexible tube with a light and video camera at the end) is passed down your throat and into your stomach. Images of your oesophagus (tube from your throat to your stomach) and stomach are transmitted to an external screen where any varices (swollen vessels),which are a sign of cirrhosis, can be seen. Grading There are several different grading systems for cirrhosis according to how serious it is. One system is theChild-Pugh score which, based on your examination and laboratory tests, grades cirrhosis from A (relatively mild) to C (severe). An alternativesystem calledmodel of end-stage liver disease (MELD) uses the results of a blood test to help identifypeople who need an urgent liver transplant. Treating cirrhosis Cirrhosis cant be cured, so treatment aims to manage the symptoms and any complications and stop the condition getting worse. Its usually not possible to reverseliver damage thats already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause of the liver damage can be successfully treated. Treatment is likely to take place at a hospital with a specialist hepatology unit, which treats disorders of the liver, gall bladder and biliary ducts. Stoppingcirrhosis getting worse Taking medication to treatthe underlying cause of the liver damageand making healthy lifestyle changes can help stop cirrhosis getting worse and reduce your risk of developing further health problems. Medication The medication you need will depend on the specific cause of the damage to your liver. For example, if you have viralhepatitis you may be prescribed anti-viral medications. If you have autoimmune hepatitis you may be given steroid medication ( corticosteroids ) or medication to suppress your immune system (immunosuppressants). Lifestyle changes There are a number of things you can do to help yourself stay healthy and reduce your chances of developing further problems if you have cirrhosis, including: completely avoid alcohol , regardless of the cause of your cirrhosis, asalcohol consumption increases the rate at which the condition progresses lose weight if youre overweight or obese regular exercise toreduce muscle wasting practisegood hygiene to reduce your chances of developing infections speak to your GP about vaccinations you may need, such as the annual flu vaccine ortravel vaccines speak to your GP or pharmacist ifyoure taking over-the-counter or prescription medications, as cirrhosis can affect the way your body processes some medicines Malnutrition is common in people with cirrhosis, so its important to ensure you have a balanced diet to help you get all the nutrients you need. Avoiding salty foods andnot adding salt to foods you eat can helpreduce your risk of developing swelling in yourlegs, feet and abdomen (tummy) caused by a build up of fluid. Seetips for a lower salt diet for more information. The damage to your liver can alsomean itsunable to store glycogen,a carbohydrate that 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. Therefore, youmay 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 3or 4small meals a day, rather than 1or 2large meals. Easing symptoms A number of treatments can ease the symptoms of cirrhosis, including: a low-sodium (salt) diet ortablets called diureticsto 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) and prevent or treat any infection creams to reduce itching Managing complications of advanced cirrhosis In cases of advanced cirrhosis, complications caused by the condition mayneed treatment. Swollen varices If you vomit blood or pass blood in your stools, you probably have swollen veins in your oesophagus (the long tube that carries food from the throat to the stomach). These are known as oesophageal varices. In these cases,urgent medical attention is required. This means seeing your GP or going to theaccident and emergency (A&E) department of your nearest hospital immediately. Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as: banding  anendoscopy is carried out (a thin, flexible tube is passed down your throat) and a small band is placed around the base of the varices to help control the bleeding injection glue therapy  following an endoscopy, a type of medical super glue is injected into the varices to make the blood clot, which helps to stop the bleeding a Sengstaken tube with a balloon on the end  a specialtube is passed down your throat into your stomach and the balloon is inflated; thisputs pressure on the varices and helps stop the bleeding and youll be heavily sedated during the procedure a transjugular intrahepatic portosystemic stent shunt (TIPSS)  a metal tube called a stent is passed across your liver to join 2 large veins (the portal vein and hepatic vein); this creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices You may also be given a type of medication called a beta-blocker , such as propanolol, to reduce the risk of bleeding or reduce the severity of any bleed thatdoes occur. Fluid in thetummy and legs Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. Theyll need to be addressed as soon as possible. You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The main treatments for ascites and oedema are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide. If thefluid around your stomach becomes infected, you may need to be treated with antibiotics . Alternatively, antibiotics may be used on a regular basisto prevent infection in people at high risk. In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks. Encephalopathy People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isnt clearing toxins properly. The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used. Bleeding Cirrhosis can affect the livers ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. Youll need to apply pressure to any cuts that bleed. Therefore,you should seek specialist advice before having medical procedures, including any dental work. Liver transplant Your liver may stop functioning if its 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. However, youll probably have to wait a long time for a liver transplant because there are more people waiting for a transplant than there are donors. The NHSBT Organ Donation website has more information about transplants and joining the Organ Donor Register . Preventing cirrhosis You can reduce your chances of developing cirrhosis by limiting your alcohol consumption and protecting yourself from a hepatitis infection. Limiting your alcohol consumption Heavy alcohol consumption is one of the most common causes of cirrhosis of the liver.One of the best ways to avoid thisis to keep withinrecommended limits. men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3days or more if you drink as much as 14 units a week If you have cirrhosis, you should stop drinking alcohol immediately because it speeds up the rate at which the condition progresses, regardless of the cause. Read more about alcohol misuse . Protect yourself from hepatitis Cirrhosis can be caused by infectious conditions, such as hepatitis B and C. Hepatitis B and C can be caught through having unprotected sex or by sharing needles to inject drugs. Using a condom when having sex will help you avoid the risk of getting hepatitis, as will avoiding injecting drugs. Anyone whos at risk of getting hepatitis B, such as police officers and social care workers, can be protected by being vaccinated against the condition. However, theres currently no vaccine for hepatitis C . People born in areas of the world where hepatitis B and C are widespread, such as parts of South Asia and Africa, need to be screened for hepatitis, as early treatment can help prevent the onset of cirrhosis. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? 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