What Is Cirrhosis

Cirrhosis is a relatively common condition that claims many lives every year and as many of the common causes of this condition are preventable, it is important to know about cirrhosis and how serious it is. Awareness of the risk factors and the symptoms is key as the quicker it is diagnosed the better the outlook will be.

The condition of cirrhosis occurs when the liver has been damaged over a long period of time by alcohol, drugs, viruses or rarer causes which will be discussed shortly. Scarring known as ‘fibrosis’ develops in the liver and prevents it carrying out its normal functions, eventually, without treatment, liver function is greatly impaired and liver failure is the end stage of this process.

From reading this article on cirrhosis you will learn the causes, risk factors, symptoms of this condition and the way it is diagnosed and treated. Cirrhosis is the 11th most common cause of death worldwide.¹

Overview

Causes of cirrhosis

Alcohol is the most common cause of cirrhosis in the West, ² in terms of the world as a whole viral infections are the biggest cause of this disease. As you can see from the list below, alcohol and hepatitis are the main causes of cirrhosis but there are many other potential causes, some of which are very rare.

Common causes of cirrhosis:

• Alcohol
• Hepatitis B, D
• Hepatitis C
• Other viruses

Other causes of cirrhosis:

• Primary biliary cirrhosis
• Secondary biliary cirrhosis
• Autoimmune hepatitis
• Hereditary haemochromatosis
• Hepatic venous congestion 
• Budd - Chiari syndrome
• Wilson's disease
• Drugs
• Cystic fibrosis
• Non-alcoholic fatty liver disease

Signs and symptoms of cirrhosis

In the early stages of the disease there may not be any signs or symptoms that cirrhosis is present as the liver continues to function even when damaged.

• Tiredness and weakness
• Feeling sick - nausea, appetite loss and weight loss
• Red patches on palms of the hands
• Visible blood vessels on the skin - spider angiomas
• Yellowing skin and whites of eyes - jaundice 
• High temperature and shivering 
• Vomiting blood
• Pale stools 
• Itchy skin 
• Painful and swollen stomach - ascites 
• Dark urine
• Tarry poo
• Easy bruising and bleeding 
• Swelling of lower limbs such as legs, ankles and feet - oedema
• Personality changes including memory loss, confusion, problems concentrating or hallucinations
• Abnormal periods
• Enlarged breasts

Management and treatment for cirrhosis

Once cirrhosis has begun in the liver, the changes that begin to occur are irreversible but disease progress can be halted by protecting the liver from further damage, this all depends on the cause of the cirrhosis. Where drugs or alcohol are the cause then stopping these is vitally important. 

How the disease may progress will depend on the cause and if any complications have developed. Treatment will depend on the cause and how far the disease has progressed and what if any complications are occurring. Often cirrhosis is managed rather than treated.

In some cases a liver transplant can be performed but the main problem is a shortage of donors and preventing rejection of the transplanted liver and other complications.

Diagnosis of cirrhosis

If cirrhosis is suspected then liver function will be investigated to assess how severe the disease is. Various blood tests will be performed to find out which type of cirrhosis is present such as tests looking for viruses. Ultrasound examination can assess the changes occurring in the liver to its structure and blood flow. A CT scan may be performed or a MRI scan. Sometimes endoscopy and colonoscopy are performed to look for complications. A biopsy may be necessary in some cases.

Risk factors

As discussed earlier there are some rare causes of cirrhosis, below are the most common risk factors. It is worth noting that having the risk factors does not mean cirrhosis will definitely develop - 

• Alcohol abuse - drinking too much alcohol is a risk factor for cirrhosis
• Obesity - being very overweight can increase the risk of developing non-alcoholic liver disease
• Viral infection with hepatitis

Other less common risk factors include having autoimmune disorders, genetic tendency and long term use of some medications. 

Complications

There are many complications associated with cirrhosis depending on how much damage has already occurred to the liver and the effect on its functions.

• Portal hypertension - this vein can become blocked and the pressure can build to the point where hemorrhage can occur in the gastrointestinal system or upper digestive system such as varices 
• Fluid can build in the tummy area leading to a very swollen stomach, this is called ascites and this can lead to further complications of infection in the area or peritonitis
• Portosystemic encephalopathy - toxic substances normally removed by a functioning liver pass to the brain and cause neuropsychiatric symptoms affecting mood, personality and intellect
• Renal failure - the complications of cirrhosis can affect kidney function due to disturbed fluid and sodium balance in the body
• Hepatopulmonary syndrome - with advanced cirrhosis oxygen levels in the body can be disturbed resulting in low oxygen levels in the blood known as hypoxemia

FAQs

How can I prevent cirrhosis?

Limit alcohol consumption by sticking to the guidelines. Make sure you are vaccinated against hepatitis, practice safe sex and never share needles to reduce the risk of getting this virus. Maintain a healthy weight and eat a healthy diet. Exercise regularly and avoid toxic substances and excessive medication use. Be aware about your liver health and any symptoms that may indicate problems.

How common is cirrhosis?

Cirrhosis is quite common particularly where high levels of alcohol consumption exist and is responsible for 1.3 million deaths worldwide (WHO) each year. 

Is cirrhosis a cancer?

Cirrhosis is not a cancer but can increase the risk of developing liver cancer which is known as hepatocellular carcinoma. 

Is cirrhosis hereditary?

The development of cirrhosis can be influenced by genetic factors such as the genetic disorder hemochromatosis,however most cases of cirrhosis are caused by lifestyle factors rather than genetic factors. 

Can cirrhosis be reversed?

Cirrhosis cannot be reversed but can be halted in its progression by getting treatment and stopping any factors- such as drinking alcohol, that are contributing to its development.

When should I see a doctor?

Make sure to see a doctor if you notice any symptoms that may indicate that your liver function is impaired so that your function can be tested. If you know you are indulging in behaviour that increases your risk of developing cirrhosis such as excessive alcohol intake or drug use involving sharing needles then seek help from a medical professional to work to address your addictions.

Summary

Liver cirrhosis is a complex and progressive disease caused by excessive alcohol consumption and hepatitis. Signs and symptoms to look out for are tiredness and weakness, nausea, appetite loss and weight loss, red patches on palms of the hands, spider angiomas, jaundice, high temperature and shivering, vomiting blood, pale stools, iItchy skin, painful and swollen stomach, dark urine, tarry poo, easy bruising and bleeding, oedema, personality changes including memory loss, confusion, problems concentrating or hallucinations, abnormal periods and enlarged breasts. You should see a doctor if you notice any of these symptoms for adequate diagnosis and treatment.