Cirrhosis Of The Liver

Overview

Cirrhosis is a long-term liver condition. Healthy liver tissue is replaced by scar tissue. This scar tissue can block blood flow and stop the liver from working as well. The liver has many jobs, such as cleaning the blood, helping digestion, and storing energy. Cirrhosis can be mild at first, but over time it can lead to serious problems. It is not contagious.

Cirrhosis is not one of the most common conditions, but the liver diseases that lead to it are common and increasing worldwide.

Anyone can get cirrhosis. It is more likely in adults with long-term heavy alcohol use, chronic hepatitis B or C, fatty liver disease, or inherited liver conditions. Children can get it too, but it is rare and often has a different cause.

Symptoms

Common symptoms

• Feeling very tired or weak
• Losing weight without trying
• Poor appetite or feeling sick
• Swelling in the belly or legs
• Yellow skin or eyes (jaundice)
• Itchy skin
• Easy bruising or bleeding
• Red palms or small spider-like blood vessels on the skin
• Confusion, poor concentration, or sleep problems

Symptoms in children

• Poor growth or poor weight gain
• Yellow skin or eyes
• Itchy skin
• Swollen belly
• Bleeding or bruising easily

Symptoms in older adults

• Confusion or memory problems that may be mistaken for ageing
• Falls or weakness
• Poor appetite and muscle loss
• Swelling in the legs or belly
• Infections that happen more often

Causes

Main causes

• Long-term heavy alcohol use
• Chronic hepatitis B or C (long-term viral infections of the liver)
• Fatty liver disease linked to weight, diabetes, and metabolic health
• Autoimmune liver diseases, where the body's immune system attacks the liver
• Inherited conditions that make the body store too much iron or copper, or process other substances poorly
• Diseases of the bile ducts, the tubes that carry bile away from the liver
• Some medicines, herbal products, or toxins, but this is less common

Risk factors

• Long-term heavy alcohol use
• Obesity or type 2 diabetes
• Chronic hepatitis B or C
• Family history of liver disease
• Using shared needles or unsterile equipment for tattoos or piercings
• Taking some medicines or herbal products that can harm the liver

When to see a doctor

See a doctor urgently if:

• You are vomiting blood or have black, tarry stools
• You have new confusion, unusual sleepiness, or trouble waking up
• You have severe belly pain with fever and swelling
• You have trouble breathing or feel faint
• Your skin or eyes are yellow and getting worse

Book a routine appointment if:

• You feel very tired for weeks and do not know why
• Your skin or eyes look yellow
• Your belly or legs are swelling
• You bruise or bleed more easily
• You have itchy skin that does not settle
• You have a liver condition or risk factors and want a check-up

Diagnosis

Your doctor will ask about your symptoms, alcohol use, medicines, health history, and family history. They will do a physical exam. They may use blood tests and scans to check your liver. Cirrhosis is scarring, so scans can show a stiff or bumpy liver. Sometimes a small sample of liver tissue is needed to be sure.

Tests that may be done

• Blood tests to check liver function and look for causes
• Ultrasound scan of the liver
• A special scan that measures liver stiffness
• Endoscopy to check for swollen veins in the food pipe and stomach
• Liver biopsy, where a small sample is taken with a needle
• Tests for hepatitis B and C and other causes

What to expect at your appointment

Tests are done step by step. Many are simple and can be done at a clinic or hospital. You may be referred to a liver specialist. The results help your team find the cause, check how much scarring there is, and plan your care.

Treatment

Cirrhosis cannot usually be reversed, but treatment can slow damage, manage problems, and help you feel better. Care focuses on treating the cause, protecting the liver, and checking for complications.

Self-care at home

• Stop drinking alcohol completely. This is one of the most important steps if alcohol is a cause.
• Eat a balanced diet. A dietitian can help you make a plan.
• Limit salt if your doctor advises it, especially if you have swelling.
• Stay active in ways that suit you.
• Ask your doctor or pharmacist before taking any medicine, herbal remedy, or supplement.
• Keep up with recommended vaccines and check-ups.
• Avoid smoking and illegal drugs.
• Get enough rest and sleep.

Medical treatments

Treatment aims to slow damage, treat the cause, and manage complications. Your team may treat the underlying liver disease, help you stop alcohol, or manage fatty liver disease. They may prescribe medicines for complications, use procedures to remove extra fluid, treat bleeding veins, or give nutrition support. Some people are assessed for a liver transplant. Regular check-ups are important.

When is surgery considered?

Surgery is not a cure for most causes of cirrhosis. A liver transplant is the main surgical option for advanced liver failure in suitable patients. Other procedures may be used to control complications such as bleeding or fluid buildup.

Living with this condition

You may need regular blood tests and scans. Keep a list of your medicines and ask before starting anything new. Notice changes in your weight, belly size, swelling, confusion, or bleeding, and tell your care team. Plan rest breaks if fatigue is a problem.

Lifestyle tips

• Avoid alcohol completely.
• Do not smoke.
• Keep to a healthy weight if possible.
• Ask for help with sleep, stress, and mood.
• Keep appointments and screening scans.
• Do not share needles, razors, or toothbrushes.

Diet and exercise

Eat regular meals with plenty of vegetables, fruit, whole grains, and protein. If you have swelling, your team may ask you to reduce salt. A dietitian can make a plan for you. Gentle activity, like walking, can help strength and mood. Ask your doctor what is safe if you feel very tired or have lots of swelling.

Mental health and emotional wellbeing

It is common to feel worried, sad, or overwhelmed. Fatigue and changes in thinking can also affect mood. Talk to your care team; mental health support is part of good liver care. If you ever have thoughts of harming yourself, call your local emergency number or a local crisis line right away.

Prevention

Often the risk can be lowered. Not all causes can be prevented, but treating liver disease early and avoiding further damage can prevent or slow cirrhosis.

Vaccines

Ask your healthcare provider which vaccines are recommended. Vaccines that protect against hepatitis and routine seasonal vaccines can be important for people with liver disease.

Screening programmes

If you have risk factors, ask about blood tests for hepatitis B and C and tests for liver health. People with cirrhosis may need regular ultrasound scans to check for liver cancer.

Complications

If left untreated

• Bleeding from swollen veins in the food pipe or stomach
• Buildup of fluid in the belly (ascites) or legs
• Infections, including in the fluid in the belly
• Confusion and sleepiness from toxins building up (hepatic encephalopathy)
• Kidney problems
• Liver cancer
• Liver failure

Long-term outlook

Cirrhosis is a serious long-term condition, but many people live for many years with treatment and regular care. Stopping further liver damage, treating the cause, and managing complications can help people feel better and live longer. A liver transplant can be an option for some people with advanced disease. Support is available.

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