Cirrhosis of the liver

Cirrhosis is scarring of the liver caused by long-term liver damage. The scar tissue prevents the liver from working properly, which can lead to the need for long term treatment or a liver transplant.

You may experience symptoms of liver cirrhosis when your liver stops working as it should. However, cirrhosis of the liver can be quite advanced before any symptoms are spotted. 

Liver cirrhosis is managed by treating the symptoms it’s causing and helping people tackle the main cause of it. 

For example, one common cause of cirrhosis is regularly drinking too much alcohol.

Liver cirrhosis is becoming more common in the UK, so if you think you might have it, book a scan or blood test to get your liver checked.

What does the liver do?

Your liver is the largest individual organ inside your body and performs hundreds of important jobs. These include:

• Cleaning your blood and getting rid of harmful chemicals (toxins), including alcohol
• Storing minerals, vitamins and glycogen
• Breaking down red blood cells that are over a certain age
• Producing bile, a liquid that helps you digest fat in your intestines
• Producing various blood proteins, including those that make your blood clot and are important for wound healing

In the UK, the vast majority of cases of liver cirrhosis are due to:

Too much alcohol

Just over half of all the cases of liver cirrhosis are due to people drinking too much alcohol over a long period.

Chronic viral hepatitis

The hepatitis B and hepatitis C viruses both cause liver cirrhosis, though hepatitis A does not. Hepatitis C is more common than hepatitis B in the UK. Hepatitis C is usually transmitted through one person’s blood making contact with another person’s blood. 

This usually occurs through the sharing of needles, getting a tattoo or having your hair shaved with a blade that is infected. Rarely is hepatitis C passed on through sex.

Other causes of liver cirrhosis include:

Primary biliary cirrhosis

A rare type of liver disease that is more common in women than in men.

Autoimmune chronic active hepatitis

A rare condition that happens when your body’s immune system starts to attack and destroy liver cells.

Drugs and chemicals

A number of drugs and chemicals can cause liver damage, but only a few cause cirrhosis of the liver.

Inherited metabolic disorders

A number of metabolic conditions can cause chronic liver disease, which leads to cirrhosis of the liver. The most common of these are haemochromatosis and Wilson’s disease.

Cirrhosis of the liver can go undetected for many years. You may show no symptoms at all, even though your liver has stopped working properly in many different ways. Signs of cirrhosis of the liver include:

• Abdominal pain
• Not being able to think clearly (this is called hepatic encephalopathy)
• Loss of interest in sex 
• Men not being able to get an erection (impotence)
• An increase in breast tissue in men (gynecomastia) 
• Nausea and vomiting
• Nosebleeds 
• Bleeding gums
• Small, red spider-like blood vessels on the skin
• Swollen legs (oedema) 
• Build-up of fluid in the belly (ascites) 
• Pale or clay-coloured poo (stools), which shows you’re not producing enough bile 
• Dark urine
• Vomiting blood
• Blood in your poo
• General weakness
• Weight loss

Cirrhosis of the liver can go undetected for many years. You may show no symptoms at all, even though your liver has stopped working properly in many different ways. By themselves, these symptoms may not be caused by cirrhosis of the liver. 

But if you experience several of these symptoms together, you need to check the health of your liver and see if cirrhosis is a possible cause. You can do this by seeing a doctor and getting a scan or a blood test done.

If your doctor thinks you have cirrhosis of the liver, you may have the following tests at The London Clinic to confirm your diagnosis:

• Blood tests
• Scans, such as an ultrasound, CT scan, MRI scan, or a FibroScan
• A liver biopsy, were a fine needle is used to remove a sample of liver cells so they can be examined under a microscope

If tests show you have cirrhosis of the liver, you may be referred to see a doctor who specialises in liver problems (hepatologist).

Chronic alcoholic liver disease can be divided into four stages:

Stage 1

Most heavy drinkers develop a fatty liver because if the liver is damaged it can’t break down fat properly. This stage usually produces no symptoms and gets better if the person reduces the amount of alcohol they drink.

Stage 2 

The liver becomes swollen and painful (inflamed). This is called steatohepatitis. In severe cases jaundice may develop. A diagnosis of acute alcoholic hepatitis is made at this point.

Stage 3

Scar tissue (fibrosis) begins to form on the liver. Again, this cannot be detected by blood tests or routine scans.

Stage 4 

Liver cirrhosis is advanced fibrosis. The liver stops looking smooth and purple, taking on a pale grey, knobbly appearance that has been described as toad-like. The liver also stops functioning properly in many different ways.

Once liver cirrhosis develops, the future outcomes for a person depend heavily on whether they continue to drink alcohol or not.