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Cirrhosis is long-term, non-reversible damage to the liver. The delicate, metabolically active liver cells die and become replaced with connective or ‘scar’ tissue.
How common is cirrhosis of the liver?
It is estimated that there are 30,000 people living with cirrhosis in the UK, with at least 7,000 new cases being diagnosed each year, and it’s on the increase.
Symptoms occur due to loss of liver function, but cirrhosis of the liver can be quite advanced before there are any symptoms at all. The condition is managed by reducing the underlying cause, usually excessive long-term alcohol consumption, and treating the symptoms.
Cirrhosis and liver function
The liver is the largest individual organ inside the body and is responsible for hundreds of different chemical functions which, overall, control the composition of the blood. The liver plays a central role in keeping conditions constant within the body.
Liver functions include:
- Storage of minerals, vitamins and glycogen.
- Breaking down red blood cells that are over a certain age.
- Producing bile, a fluid that helps us digest fat.
- Production of various blood proteins including those that make blood clot.
- Removal and breakdown of toxins, including alcohol.
The liver is a remarkably tough organ that repairs itself throughout your lifetime. Old worn-out cells are replaced by healthy new ones very readily. So what happens with liver cirrhosis? Why can’t the liver simply repair itself?
The problem arises when all the liver cells are under severe stress. This can happen when the body comes under heavy viral attack, or when we experience self-imposed high blood alcohol levels over a long period of time. If the damage is severe, liver cells die and become replaced by tough fibrous connective tissue; this pattern of scarring is called cirrhosis. In addition to doing nothing useful, the tough scar tissue actually restricts blood flow to the healthy parts or the organ.
What causes cirrhosis of the liver?
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 have long-term excessive alcohol consumption as the cause.
- 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, and is usually transmitted through blood to blood contact. This usually occurs through sharing needles; sexual transmission is rare.
Other causes include:
- Type 2 diabetes and/or obesity, leading to non-alcoholic fatty liver disease. This leads to fat accumulation in the liver, inflammation and in some people, to progressive scarring, leading to cirrhosis. With increasing obesity around the world, this is becoming more common.
- Primary biliary cirrhosis: this is a rare disease mainly affecting women.
- Autoimmune chronic active hepatitis: another uncommon condition that results in the body's immune system attacking and destroying liver cells.
- Drugs and chemicals: a number of drugs and chemicals can cause liver damage but few cause liver cirrhosis.
- Inherited metabolic disorders: several rare conditions that usually arise due to a missing enzyme can cause a metabolic imbalance in the liver that leads to liver cirrhosis. The most common are haemochromatosis, which causes excess deposits of iron in the liver and Wilson’s disease, which causes too much copper to build up.
What are the symptoms of cirrhosis of the liver?
Cirrhosis of the liver can go undetected for many years. Most people show no symptoms despite a large percentage fall in their liver function.
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 and/or impotence.
- Breast development (gynecomastia) in men.
- Nausea and vomiting.
- Nosebleeds or bleeding gums.
- Pale or clay-coloured stools (indicating a lack of bile production) and dark urine.
- Small, red spider-like blood vessels on the skin.
- Swollen legs (oedema) and/or abdomen (ascites) due to fluid retention.
- Vomiting blood or blood in stools.
- General weakness.
- Weight loss.
- Jaundice: a yellow colour in the skin, mucus membranes or eyes.
Individually, these symptoms can be due to other causes but when several occur together, further tests must be done to check on the health of the liver to see if cirrhosis is a possible cause.
The steps towards cirrhosis of the liver
Chronic alcoholic liver disease can be divided into 4 stages:
- Most heavy drinkers will develop a fatty liver as a result of the breakdown of alcohol. This stage usually produces no symptoms and gets better if alcohol consumption is reduced.
- The liver becomes inflamed. This is called steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis is made at this point.
- Fibrosis – the laying down of scar tissue – begins. Again, this cannot be detected by blood tests or routine scans.
- Liver cirrhosis is advanced fibrosis. The normally soft liver tissue is divided into thousands of pea-sized pockets, wrapped in fibrosis. The liver stops looking smooth and purple, taking on a pale grey, knobbly appearance that has been described as toad-like. Liver function is drastically reduced. Once liver cirrhosis develops, the prognosis partly depends on whether or not someone continues to drink.
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