Cirrhosis of the liver

What is cirrhosis?

Cirrhosis is permanent scarring of the liver caused by many liver diseases and conditions, such as hepatitis and alcohol abuse.

The liver is a vital organ that performs many important functions for keeping your body healthy, including:

• removing toxins from your blood
• storing vitamins, extra glucose and iron
• making and breaking down hormones and proteins

Although cirrhosis can’t be cured, early diagnosis and treatment can stop or delay its progress. This can minimise damage and reduce the chance of developing complications.

Cirrhosis happens when the liver is permanently damaged, causing scar tissue to replace healthy tissue. It usually develops slowly over many years, and can eventually stop the liver from working properly.

If cirrhosis becomes very serious it causes the liver to fail and can be life-threatening.

What are the symptoms of cirrhosis?

Symptoms of cirrhosis usually start slowly and progress as the liver becomes more damaged and stops working properly. Not everyone experiences the same symptoms. They can include:

• loss of appetite and/or weight loss
• weakness
• increased sensitivity to medicines and drugs
• confusion
• drowsiness
• slurred speech

They can also include visible symptoms including:

• bruising and bleeding easily
• yellowing of skin and whites of the eyes (jaundice)
• fluid build-up in abdomen (ascites)
• skin conditions, such as liver spots (solar lentigo), spider veins and rashes
• swelling in legs (oedema)
• red palms of the hands

What causes cirrhosis?

Anything that damages the liver can cause cirrhosis, but the most common causes are:

• hepatitis B and hepatitis C infection
• drinking too much alcohol over many years (chronic alcohol abuse)
• being overweight or having a build-up of excess fat in the liver (fatty liver), which is associated with obesityand diabetes

Less common causes include:

• autoimmune liver disease, such as primary biliary cholangitis (previously known as primary biliary cirrhosis), where the bile ducts in the liver are slowly destroyed by the immune system
• inherited liver diseases (such as haemochromatosis)

How is cirrhosis diagnosed?

If your doctor suspects you have cirrhosis, they will ask about your symptoms, examine you and refer you for some tests.

Tests that help to diagnose cirrhosis include:

• blood tests, including liver function tests
• urine tests
• imaging tests, including ultrasound, CT scansor MRI scans
• liver biopsy (taking a small piece of tissue from the liver so that it can be tested)

When should I see my doctor?

You should see your doctor if you have symptoms of cirrhosis, especially if you have risk factors for liver problems.

If your doctor has diagnosed you with cirrhosis, seek urgent medical attention if you experience:

• new or worsening yellowing of your skin or the whites of your eyes (jaundice)
• blood in your stools, or stools that are black and tar-like
• vomit that contains fresh blood, or looks like ‘coffee grounds’
• confusion
• fever

How is cirrhosis treated?

Treatment depends on the cause and stage of your cirrhosis. Cirrhosis has no cure. However, it is possible to manage the symptoms and any complications, and slow its rate of progression.

Your doctor may recommend that you:

• stop drinking alcohol permanently (support groups like Alcoholics Anonymous Australiaand SMART Recovery)
• lose weight, if you are above a healthy weight range
• maintain a healthy diet
• stay physically active
• take any medicines prescribed to treat any underlying causes (such as hepatitis C, autoimmune disease, inherited liver disease)

Very advanced cirrhosis can cause the liver to fail. In this case, a liver transplant is the only treatment option.

If you have liver cirrhosis, it’s important you avoid drinking alcohol to prevent further liver damage.

Reduce your chance of catching infections by washing your hands properly and ensuring your vaccinations are up to date. Talk to your doctor or pharmacist before you use over-the-counter medications, and tell them you have liver disease.

Can cirrhosis be prevented?

To help reduce your chance of developing liver diseases including cirrhosis:

• eat a balanced diet
• take care with how much alcohol you drink, and know your limit
• exercise regularly

Hepatitis infections can increase your chance of developing liver problems.

You can reduce your chance of catching hepatitis by:

• getting vaccinated against hepatitis B
• practising safe sex
• use safe needle practices (for example, don’t share needles)

You can reduce the risk of fatty liver by:

• exercising regularly
• eating healthily
• losing weight

What are the complications of cirrhosis?

Without treatment, cirrhosis of the liver can lead to serious and life-threatening problems including:

• primary liver cancer — the most common type of cancer that cirrhosis causes is hepatocellular carcinoma
• liver failure
• fluid build-up in the abdomen, which can become infected
• osteoporosis (brittle bones)
• encephalopathy, which can cause changes in mood and behaviour, confusion or coma