Cirrhosis

Cirrhosis is a serious condition that destroys healthy tissue, leaving scar tissue, which blocks the flow of blood through an organ. It is usually associated with the liver, but can also affect other organs in the body.

The liver carries out many important functions. It stores glycogen, breaking it down into glucose that is then released into the bloodstream, providing energy. It also processes fats and proteins from digested food, produces essential blood clotting substances, removes poisons and toxins, such as alcohol, from the body, and produces bile that passes into the gut and helps digest fats.

Cirrhosis progresses slowly, and gradually causes a decline in the function of the liver. In the early stages of the disease, there may not be any symptoms, but as the condition of the liver deteriorates, serious problems can develop. For example, the liver will fail to control infection and blood clotting, and prevent bile from passing into the small intestine.

In the UK, heavy alcohol consumption and hepatitis C are the most common causes of cirrhosis.

There are many different causes of cirrhosis, but in the UK, drinking alcohol and the hepatitis C infection are the most common causes.

Alcohol-related cirrhosis

The liver breaks down toxins and poisons, such as alcohol, but too much alcohol can damage the cells of the liver. If you are a heavy drinker, your chances of developing cirrhosis are increased. However, cirrhosis of the liver is not just a condition that affects alcoholics. If you are a heavy social drinker, you can also develop cirrhosis.

Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking, and affects about 10% of heavy drinkers. Some people are more susceptible to liver cell damage than others, although the reasons for this are unknown. Women who drink heavily are more susceptible to liver damage than men.

Hepatitis C-related cirrhosis

Hepatitis C is a blood-borne infection that can cause damage to the liver which, over time, may develop into cirrhosis. Other forms of the infection, hepatitis B and D, can also cause cirrhosis.

Other causes

A number of other conditions and inherited diseases that prevent healthy liver function can also lead to cirrhosis. For example:

- Heart failure - if you have had several instances of heart failure, it can cause high blood pressure and congestion in the liver.
- Autoimmune hepatitis - normally, the immune system makes antibodies to attack bacteria and viruses. However, if you have an autoimmune disease, such as autoimmune hepatitis, your immune system will make antibodies which attack healthy organs of the body, such as the liver.
- Some rare, genetic conditions such as Haemochromatosis (an excess build up of iron in the liver and other parts of the body), and Wilsons Disease (an excess 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 and cancer of the pancreas.
The use of certain drugs and exposure to certain environmental poisons and toxins can also cause cirrhosis.

If you have type 2 diabetes and you develop cirrhosis, your diabetes may get worse. In this type of diabetes, the body's cells do not use insulin (a hormone produced by the pancreas) properly. This is known as insulin resistance. Cirrhosis can increase your resistance to insulin even more. If you have diabetes and you develop cirrhosis, you should discuss the implications with your GP.

In the early stages of cirrhosis, there are often no symptoms. You will usually only become aware of the problem when scar tissue has built up sufficiently to cause an obstruction. As healthy liver tissue is destroyed and scar tissue builds up, the liver will start to lose its ability to function properly. Symptoms may include:

- tiredness and weakness,
- loss of appetite, feeling sick, and vomiting,
- a build up of fluid in the bloodstream, legs (oedema) and abdomen (ascities),
- weight loss (although weight may be put back on through fluid retention),
- tendency to bruise and bleed easily,
- jaundice (yellow skin colour) due to a build up of bilirubin, a substance that is produced by the body when old red blood cells are broken down,
- itchiness, due to a build up of toxins, and
- changes in your personality and behaviour due to toxins in the bloodstream affecting your brain. For example, you may become confused, forgetful, and have difficulty concentrating. Severe changes in your mental state can also lead to a loss of consciousness, coma, and death.
As cirrhosis develops, the build up of scar tissue will restrict the flow of blood through your liver. The pressure in the vein that transports blood from the gut to the liver will increase, leading to hypertension (high blood pressure). This can cause the veins in the lining of the oesophagus (gullet) and stomach to swell. These swellings, known as varices, often bleed into the gut and, if they do, you may vomit blood, or pass blood in your stools (faeces).

IIf, from your symptoms, your GP suspects that you have cirrhosis, s/he will carry out a physical examination and refer you for a number of further tests. If your liver feels enlarged or harder than usual, you may have liver damage.

A blood test will highlight any abnormal liver function. An ultrasound examination, or CT scan, may be carried out to diagnose problems in your liver. To confirm a diagnosis, a biopsy will be performed. This involves a small sample of liver cells being taken for examination under a microscope. The outcome may also provide further information about the underlying cause of your cirrhosis.

Cirrhosis cannot be cured, but treatment can be provided to slow the progress of the condition. Cirrhosis tends to get progressively worse if the underlying cause persists. The way that cirrhosis is treated may depend on the underlying cause.

If you have cirrhosis, you should not drink alcohol because doing so increases the rate that the condition progresses, regardless of the cause. You should talk to your GP or pharmacist if you are taking over-the-counter or prescription medicines as some medications are processed in the liver.

Treatment for underlying causes may include:

- medicines to treat autoimmune diseases that cause liver damage for example, removing copper from the body will help ease cirrhosis that occurs as a result of Wilsons Disease,
- medication, such as Interferon, to treat hepatitis, and
- regularly removing blood (approximately one pint) to reduce the high level of iron which occurs in Haemochromatosis.
There are also a number of treatments that are available to ease the symptoms of cirrhosis. For example, a low-sodium (low salt) diet, or water tablets, will help reduce the amount of fluid in your body. Also, medication to reduce high blood pressure (hypertension) and medicines and creams to reduce itching.

If you have bleeding from swellings (varices) in your oesophagus or gut, it is a medical emergency. You should see your GP, or go to A&E immediately, if you vomit blood, or pass blood in your faeces. Surgery can be used to stop the bleeding, and reduce the risk of it happening again.

If, as a result of long-term cirrhosis, your liver is extremely damaged by scarring, it may stop functioning altogether. In this situation, a liver transplant is the only option.

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Alcohol consumption

Heavy alcohol consumption is one of the most common causes of cirrhosis of the liver. Therefore, the best way to prevent alcohol-related cirrhosis developing is to stick to the recommended limits. These are as follows:

men up to 21 units per week (3-4 units a day),
women up to 14 units per week (2-3 units a day), and
pregnant women one or two alcoholic drinks (1-2 units) once or twice a week, is unlikely to harm your unborn baby. However, the amount of alcohol that is definitely safe during pregnancy is unknown, so many women decide not to consume any while pregnant. NHSDEC07