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Cirrhosis is scarring of the liver as a result of long term liver damage.

What causes Cirrhosis?

You can develop cirrhosis as a result of:

  • Alcoholic liver disease damage to the liver caused by excessive amounts of alcohol over an extended period of time.
  • Non-alcoholic liver disease usually due to obesity and a high fat diet
  • Chronic infection with Hepatitis B or Hepatitis C if the virus has not been treated effectively the liver may become progressively damaged over a period of 20-30 years.
  • Autoimmune Hepatitis

In advanced cirrhosis, the only treatment that can relieve symptoms is a complete liver transplant. Sometimes it is difficult to find a donor who matches in time, so treatment of advanced liver disease and liver failure focuses on relieving symptoms.

Diagnosing cirrhosis of the liver

Today we usually pick up signs of fibrosis, the forerunner of cirrhosis, non-invasively using the FibroScan® technology that we have at The London Clinic. We can also use contrast enhanced imaging to visualise liver nodules in a patient with cirrhosis to investigate how extensive the liver damage has become.

Liver function tests involve testing the blood for the levels of various components such as:

  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These indicate the degree of inflammation because they leak into the blood when liver cells are damaged. ALT is more specific to liver damage than AST, which could be due to damage in other tissues, such as muscles.
  • Bilirubin. This greenish pigment should be excreted in bile. Raised levels of one particular chemical form of bilirubin indicate that jaundice is due to a liver or bile duct problem; if this occurs in someone with viral hepatitis or a history of excessive alcohol use, this can mean that cirrhosis has developed.
  • Albumin. A vital protein that helps keep fluid pressures stable and carries many substances in the body. Low albumin levels suggest chronic liver disease, particularly if someone’s health is declining.

A liver biopsy may also be taken. This is a small sample of liver cells taken using a needle that is inserted into the liver (usually through the space between the lower ribs on the right side of the body). Analysis can show healthy liver cells, or the onset of fibrosis/cirrhosis. 

Our Liver Consultants will also ask about all the symptoms that a patient may have. Cirrhosis of the liver can result in several serious complications:

  • An excess of fluid in the tissues: this is called ascites when it builds up in the abdomen and peripheral oedema when it accumulates in the legs.
  • Swollen veins around the oesophagus due to portal hypertension known as varices,  they are the result of the body trying to re-route blood around the damaged liver. These large veins are fragile and bleed easily, causing blood to be lost in faeces or in vomit.
  • Poor brain function: cirrhosis prevents the liver dealing with toxins and these can build up in the blood causing hepatic encephalopathy, a condition which results in mood swings, drowsiness, confusion and distress.

Managing patients with cirrhosis

Prevention of further damage, if that is possible, is the first step and we will encourage lifestyle changes if your liver disease is due to alcohol abuse or obesity to try to reduce the pressure on the liver.

If you are diagnosed with infection with hepatitis B or hepatitis C, drug treatment to try to limit the virus or even to clear the virus from your body will be started immediately.

Treating the complications of cirrhosis

Excess fluid can be drained from the abdomen if it is severe. You can also take diuretic ‘water’ tablets to increase urine excretion and you will be encouraged to follow a low-salt diet to limit fluid accumulation. Swollen blood vessels around the oesophagus can be treated to prevent bleeding using two main techniques:

  • Banding and sclerotherapy: an endoscope passed down the oesophagus is used to place a band around the most fragile blood vessels to support them and prevent bleeding. A substance may also be injected to block them. Once treated, they wither away over the next few months.
  • TIPSS: a Transjugular Intrahepatic Portosystemic Stent Shunt can be put in place if banding or sclerotherapy does not work. This is an endovascular operation that involves introducing a catheter into the jugular vein and under the direction of image guidance placing a stent between the two main veins in the liver, which lowers the pressure and prevents blood being diverted into the collateral vessels.

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