Cirrhosis

Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver working properly.

Cirrhosis is sometimes called end-stage liver disease because it happens after other stages of damage from conditions that affect the liver, such as hepatitis.

Your liver may keep working even when you have cirrhosis. However, cirrhosis can eventually lead to liver failure, and you can get serious complications, which can be life threatening.

Treatment may be able to stop cirrhosis from getting worse.

Symptoms of cirrhosis

You may not have any symptoms during the early stages of cirrhosis.

As your liver becomes more damaged, you may:

• feel very tired and weak
• feel sick (nausea)
• lose your appetite
• lose weight and muscle mass
• get red patches on your palms and small, spider-like blood vessels on your skin (spider angiomas) above waist level

If cirrhosis gets worse, some of the symptoms and complications include:

• yellowing of the skin and whites of the eyes (jaundice)
• vomiting blood
• itchy skin
• dark pee and tarry-looking poo
• bleeding or bruising easily
• swollen legs (oedema) or tummy (ascites) from a build-up of fluid
• loss of sex drive (libido)

See a GP if you think you may have cirrhosis.

Diagnosing cirrhosis

If a GP suspects cirrhosis, they'll check your medical history and do a physical examination to look for signs of long-term liver disease.

You may have tests to confirm the diagnosis, such as:

• blood tests
• scans, such as an ultrasound, CT, MRI, or transient elastography scan
• a liver biopsy, where a fine needle is used to remove a sample of liver cells so they can be examined under a microscope

If tests show that you have cirrhosis, a GP should refer you to see a doctor who specialises in liver problems (hepatologist).

If you have complications from cirrhosis, or a high chance of getting complications, you may be referred to a specialist liver centre.

Treating cirrhosis

There's no cure for cirrhosis at the moment. However, there are ways to manage the symptoms and any complications and slow its progression.

Treating the problem that led to cirrhosis (for example, using anti-viral medicines to treat hepatitis C) can stop cirrhosis getting worse.

You may be advised to cut down or stop drinking alcohol, or to lose weight if you're overweight. 

A GP can help you get support if you need help to stop drinking or to lose weight.

If your liver is severely damaged, a liver transplant may be the only treatment option.

What causes cirrhosis

In the UK, the most common causes of cirrhosis are:

• drinking too much alcohol over many years
• being infected with hepatitis for a long time, particularly hepatitis B or hepatitis C
• a severe form of non-alcoholic fatty liver disease (NAFLD), called non-alcoholic steatohepatitis, where the liver becomes inflamed from a build-up of excess fat

Cirrhosis can also be caused by a problem affecting your bile ducts (such as primary biliary cholangitis) or immune system (such as autoimmune hepatitis), some inherited conditions, and the long-term use of certain medicines.

Alcohol-related liver disease

Drinking too much alcohol damages the liver. Over time, this can lead to alcohol-related liver disease.

Cirrhosis is the final stage of alcohol-related liver disease. It usually happens after many years of heavy drinking.

How to prevent cirrhosis

The best way to prevent alcohol-related cirrhosis is to drink within the recommended limits.

The guidelines recommend:

• men and women should not regularly drink more than 14 units of alcohol a week
• you should spread your drinking over 3 days, or more, if you drink as much as 14 units a week

Stop drinking alcohol immediately if you have alcohol-related cirrhosis. Drinking alcohol speeds up the rate at which cirrhosis progresses, regardless of the cause.

A GP can offer help and advice if you're finding it difficult to cut down the amount you drink. 

Read more about where to get alcohol support.

Protect yourself from hepatitis

Hepatitis B and C are infections in the liver caused by a virus.

The hepatitis B virus is spread in blood and body fluids. The hepatitis C virus is usually spread in blood.

Common ways of spreading these viruses include having sex with an infected person without using a condom, or close contact with an infected person's blood, such as sharing their toothbrush or sharing needles to inject drugs.

Vaccination for hepatitis B is part of the NHS childhood vaccination schedule. The vaccine is also available to anyone who has an increased chance of getting hepatitis B.

There is no vaccine for hepatitis C at the moment.

Aim for a healthy weight

To reduce your chance of getting non-alcoholic fatty liver disease (NAFLD), which can lead to cirrhosis, make sure you're a healthy weight by eating a healthy, balanced diet and exercising regularly.

The liver

The liver is an important organ that does hundreds of jobs that are vital for sustaining life.

For example, the liver:

• stores glycogen, a type of fuel the body needs for energy
• makes bile, which helps us digest fats
• makes substances that help blood to clot and repair damaged tissues
• processes and removes alcohol, toxins or medicines from the blood
• helps the body fight infections

Your liver is very tough. It'll keep working even when it's damaged and can continue to repair itself until it's severely damaged.