Cirrhosis
Also known as: liver cirrhosis, end-stage liver disease
Scarring of the liver from long-term damage, in which nodules of regenerating cells are surrounded by fibrous bands that distort blood flow and impair function.
Overview
Years of injury from alcohol, fatty liver disease or viral hepatitis replace liver tissue with scar. The result is failure of the liver's jobs (jaundice, bleeding, confusion) and high pressure in the portal vein (varices, fluid in the abdomen, an enlarged spleen). Cirrhosis is irreversible, but stopping the cause halts progression.
Causes
- Alcohol
- Metabolic dysfunction-associated (fatty) liver disease
- Hepatitis B and C
- Autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
- Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency
Risk factors
- Heavy drinking
- Obesity and type 2 diabetes
- Unprotected sex or injected drug use (viral hepatitis)
- Family history of liver disease
Symptoms
What a clinician may find
- Jaundice, spider naevi, red palms
- Enlarged spleen, ascites
- Muscle wasting, bruising
- Confusion and a flapping tremor (encephalopathy)
Complications
- Bleeding oesophageal varices
- Ascites and spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Liver cancer (hepatocellular carcinoma)
- Kidney failure (hepatorenal syndrome)
Diagnosis
Liver function tests, clotting and platelet count; ultrasound or elastography (FibroScan) measuring stiffness; tests for the cause (hepatitis viruses, iron, autoantibodies); endoscopy for varices; six-monthly ultrasound for cancer surveillance.
Treatment
Remove the cause: complete abstinence from alcohol, weight loss, antivirals for hepatitis B and C. Diuretics for ascites, beta blockers or banding for varices, lactulose for encephalopathy, nutrition, vaccination. Liver transplantation for decompensated disease.
Prevention
Drink within recommended limits or not at all, keep a healthy weight, vaccinate against hepatitis B, never share needles, treat hepatitis C.
When to seek care
Emergency care for vomiting blood, black stools, confusion or drowsiness, a rapidly swelling abdomen with fever, or deepening jaundice.