People with cirrhosis may develop jaundice (yellowing of the skin, eyes, and tongue), itching, and extreme tiredness.

In this article, we explain the symptoms, causes, and treatments of liver cirrhosis, including information about complications.

What is liver cirrhosis?

Cirrhosis is a progressive disease, developing slowly over many years. If it is allowed to continue, the build up of scar tissue can eventually stop liver function (liver failure).

For cirrhosis to develop, long-term, continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and replaced by scar tissue, the condition becomes serious, because it can start blocking the flow of blood through the liver.

The liver carries out several essential functions; it helps to remove harmful substances from the body. It also purifies the blood and manufactures vital nutrients.

If cirrhosis is mild, the liver can make repairs and continue functioning properly. If the cirrhosis is advanced, and more and more scar tissue forms in the liver, the damage is irreparable. The liver tissue is replaced by fibrous scar tissue. Regenerative nodules may also form; these are lumps that appear as the liver tries to heal the damage.

Causes of cirrhosis

Common causes of cirrhosis are

• long-term alcohol abuse
• hepatitis B and C infection
• fatty liver disease
• toxic metals
• genetic diseases

Of those, hepatitis B and C together are said to be the leading cause of cirrhosis. We will take a look at each of these causes in detail below.

Drinking too much alcohol

Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too high, the liver will be overworked and liver cells can eventually become damaged.

Heavy, regular, long-term drinkers are much more likely to develop cirrhosis, compared with other, healthy people. Typically, heavy drinking needs to be sustained for at least 10 years for cirrhosis to develop.

There are generally three stages of alcohol-induced liver disease:

1. Fatty liver – this involves a build-up of fat in the liver.
2. Alcoholc hepatitis – around 35 percent of those who continue drinking heavily will go on to develop alcoholic hepatitis where the cells of the liver swell.
3. Approximately 10 percent of heavy drinkers will subsequently develop cirrhosis.

Hepatitis

Hepatitis C, a blood-borne infection, can damage the liver and eventually lead to cirrhosis. Hepatitis C is a common cause of cirrhosis in Western Europe, North America, and many other parts of the world. Cirrhosis can also be caused by hepatitis B and D.

Non-alcoholic steatohepatitis (NASH)

NASH, in its early stages, begins with the accumulation of too much fat in the liver. The fat causes inflammation and scarring, resulting in possible cirrhosis later on.

NASH is more likely to occur in people who are obese, diabetes patients, those with high blood lipid (fat) levels, and people with hypertension (high blood pressure).

Autoimmune hepatitis

The person’s own immune system attacks healthy organs in the body as though they were foreign substances. Sometimes the liver is attacked. Eventually, the patient can develop cirrhosis.

Some genetic conditions

• Hemochromatosis – iron accumulates in the liver and other parts of the body.
• Wilson’s disease – copper accumulates in the liver and other parts of the body.

Blockage of bile ducts

Some conditions and diseases, such as cancer of the bile ducts, or cancer of the pancreas, can block the bile ducts, increasing the risk of cirrhosis.

Budd-Chiari syndrome

There is thrombosis (blood clots) in the hepatic vein, the blood vessel that carries blood from the liver. This leads to liver enlargement and the development of collateral vessels.

Other diseases and conditions that can contribute to cirrhosis include:

• Cystic fibrosis.
• Primary sclerosing cholangitis – hardening and scarring of the bile ducts.
• Galactosemia – inability to process sugars in milk.
• Schistosomiasis – a parasite commonly found in some developing countries.
• Biliary atresia – badly formed bile ducts in babies.
• Glycogen storage disease – problems in the storage and energy release vital for cell function.

Symptoms of cirrhosis

Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates, the liver’s ability to function properly is undermined. The following signs and symptoms may occur:

• blood capillaries become visible on the skin on the upper abdomen.
• fatigue
• insomnia
• itchy skin
• loss of appetite
• loss of bodyweight
• nausea
• pain or tenderness in the area where the liver is located
• red or blotchy palms
• weakness

The following signs and symptoms may appear as liver cirrhosis progresses:

• abdomen fills up with fluid, giving the patient a large tummy (ascites).
• accelerated heartbeat
• altered personality (as blood toxins build up and affect the brain)
• bleeding gums.
• body and upper arms lose mass
• body finds it harder to process alcohol
• body finds it harder to process drugs
• confusion
• dizziness
• fluid buildup on ankles, feet, and legs (edema)
• hair loss
• higher susceptibility to bruising
• jaundice (yellowing of the skin, whites of the eyes, and tongue)
• loss of libido (sex drive)
• memory problems
• more frequent fevers (susceptibility to infections)
• muscle cramps
• nosebleeds
• pain on the right shoulder
• panting (breathlessness)
• stools become black and tarry, or very pale.
• urine becomes darker.
• vomiting blood
• walking problems (staggering)

Diagnosis of cirrhosis

Because there are rarely symptoms early on in the condition, cirrhosis is often diagnosed when the patient is being tested for some other condition or disease.

Anybody who has the following symptoms should see their doctor immediately:

• Fever with shivering.
• Panting (shortness of breath).
• Vomiting blood.
• Dark or tarry stools (as if covered with tar).
• Episodes of drowsiness or confusion.

A doctor will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about their medical history and lifestyle, including drinking.

The following tests may also be ordered:

• Blood test – to measure how well the liver is functioning. If levels of ALT (alanine transaminase) and AST (aspartate transaminase) are high, the patient may have hepatitis.
• Imaging tests – ultrasound, CT, or MRI scans. Apart from seeing whether the liver is enlarged, the doctor will also be able to detect any scarring or nodules.
• A biopsy – a small sample of liver cells are extracted and examined under a microscope. The biopsy can confirm cirrhosis and its cause.
• Endoscopy – a long, thin tube with a light and video camera at the end goes down the patient’s foodpipe (esophagus) and into their stomach. The doctor looks out for swollen blood vessels (varices), a hallmark sign of cirrhosis.

Treatments for cirrhosis

If the cirrhosis is diagnosed early enough, damage can be minimized by treating the underlying cause. Alcohol dependency (alcoholism) treatment – it is important for the patient to stop drinking if their cirrhosis was caused by long-term, regular heavy alcohol consumption. In many cases, the doctor will recommend a treatment program for alcoholism.

Medications – the patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C.

Complications of liver cirrhosis

Ascites or edema – ascites (accumulation of fluid in the abdomen) or edema (fluid retention in the legs) can be treated with a low-sodium (salt) diet and water pills. In severe cases, the fluid may have to be drained repeatedly. Sometimes surgery is required.

Pressure in the portal vein – blood can “back up” in the portal vein that supplies the liver with blood, causing hypertension (high blood pressure) in the portal vein. Drugs are usually prescribed to control the increasing pressure in other blood vessels; the aim is to prevent severe bleeding. Signs of bleeding can be detected via an endoscopy.

Swollen varices – if the patient vomits blood or passes bloody stools, they probably have esophageal varices (in the food pipe). Urgent medical attention is required. The following procedures may help:

Banding – a small band is placed around the base of the varices to control bleeding.

Injection sclerotherapy – after an endoscopy, a substance is injected into the varices which triggers a blood clot and scar tissue to form; this helps stem the bleeding.

A Sengstaken-Blakemore tube with a balloon – the balloon is at the end of the tube. If endoscopy does not stop the bleeding a tube goes down the patient’s throat and into their stomach. The balloon is inflated; this places pressure on the varices and stops the bleeding.

TIPSS (transjugular intrahepatic portosystemic stent shunt) – if the above-mentioned therapies do not stem the bleeding, a stent (metal tube) is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces the pressure that was causing the varices.

Infections – the patient will be given antibiotics, and some other treatments.

Screening for liver cancer – patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.

Hepatic encephalopathy (high blood toxin levels) – drugs can help treat excessive blood toxin levels. The signs and symptoms need to be explained to the patient so that they know what to look out for.

Liver transplant – if the cirrhosis is advanced and there is liver failure (liver does not function) the patient may need a liver transplant.