Cirrhosis of the liver

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1 Cirrhosis of the liver Fighting liver disease

2 Cirrhosis of the liver The liver Your liver is your body s factory, carrying out hundreds of jobs that are vital for life. You only have one liver, but it is very tough. It keeps on going when badly damaged and can repair itself. Your liver has about 500 different roles. Importantly, it: makes quick energy when the body needs it helps fight infections makes bile to help breakdown food in the gut stores sugars, vitamins and minerals, including iron destroys and deals with poisons and drugs filters and cleans the blood controls the amount of cholesterol makes and controls the amount of hormones makes the chemicals - proteins and enzymes - that keep our body working. Right hepatic duct Left hepatic duct Hepatic vein Liver Contents What are the signs and symptoms?...4 What causes cirrhosis?...6 How is cirrhosis diagnosed?...7 How is cirrhosis treated?...7 Is cirrhosis reversible?...8 Alcohol and cirrhosis...8 What is cirrhosis? Cirrhosis is the medical term to describe excessive development of scar tissue (fibrosis) within a liver, irrespective of the underlying cause. Usually when the liver is acutely damaged, some of the liver cells die and the organ then regenerates itself without scarring. If, however, a chronic or repeated disease process damages the liver, then scarring starts to develop. This process usually starts slowly and progresses over many years without causing any symptoms. Eventually excess scar tissue builds up and this begins to interfere with some of the vital functions of the liver. At this point, the liver is no longer able to regenerate itself sufficiently. Cystic duct Gallbladder Portal vein Common bile duct Pancreatic ducts emptying into duodenum Spleen Pancreas Pancreatic duct Symptoms can develop at any stage, but usually occur relatively late on in the scarring process. Many of the symptoms are caused by the complications of cirrhosis when the liver is failing. 2 Fighting liver disease 3

3 What are the signs and symptoms? There are very few specific symptoms to suggest the onset of cirrhosis. Many cirrhotic patients have no symptoms - they are found to have cirrhosis by physical examination and laboratory tests performed in the course of investigations for an unrelated illness. Alternatively, one or more of the symptoms listed on the opposite page may occur. If you have recently been diagnosed as having cirrhosis, you should particularly watch out for those symptoms in italics. If these occur, you should seek medical help, as specific (and sometimes urgent) treatments are needed. Symptoms can include: Loss of appetite. Lethargy and a general feeling of ill-health or malaise (tired all the time). Nausea and vomiting. Jaundice - yellow discolouration of the skin and whites of the eyes because bile pigment can no longer be removed by the liver. Itching. Swelling of the abdomen (ascites) and legs (peripheral oedema) due to build up of fluid. If this occurs there may be a dramatic increase in body weight. Sometimes this swelling can be painful, particularly if the fluid becomes infected with bacteria. Vomiting of blood - this may occur from swollen ruptured veins that burst in the lower end of the gullet (oesophageal varices) or the top end of the stomach (gastric varices). This occurs because blood passing from the gut cannot pass easily through the scarred liver. This raises the pressure in the system (portal hypertension) and leads to swelling of the veins. Dark black tarry stools - when blood passes through the bowel, it becomes partly digested giving it this characteristic appearance and a very offensive smell. Fever, which may be accompanied by shivering attacks can occur during an infection. The type of infection can take many forms, but patients with cirrhosis are more prone to developing infection in the skin (cellulitis), abdominal fluid (spontaneous bacterial peritonitis), or bloodstream (septicaemia). Episodes of confusion may occur due to the liver s inability to clear body poisons adequately (hepatic encephalopathy). Initally there may be subtle mental changes such as uncharacteristic patterns of behaviour or poor memory. If encephalopathy becomes advanced, patients may progress into coma. Weight loss and loss of muscle bulk from the body - often noticed as thinning of the upper arms. Enlargement of the liver, felt underneath the right side of the ribs. Increased sensitivity to drugs and alcohol - due to the liver s inability to process them. 4 Fighting liver disease 5

4 What causes cirrhosis? A number of conditions can lead to cirrhosis. The list below is not intended to be complete, but highlights common causes (many are often seen in liver clinics): excessive intake of alcohol chronic hepatitis C virus infection non alcoholic fatty liver disease (sometimes called NASH or non-alcoholic steatohepatitis) autoimmune chronic active hepatitis primary biliary cirrhosis and other chronic diseases of the bile ducts such as sclerosing cholangitis, or biliary atresia in children chronic hepatitis B virus infection inherited diseases: - haemochromatosis - abnormal - processing of iron by the body - wilson s disease - abnormal processing of copper by the body - glycogen or lipid storage diseases prolonged exposure to some drugs and toxins diseases of blood vessels e.g. Budd Chiari syndrome. It can be seen from this list that there are many causes of cirrhosis that have nothing to do with excess alcohol use. How is cirrhosis diagnosed? A doctor will first take a careful medical history, performing a physical examination and arrange for further tests and imaging, which will include: Liver function tests - a blood test to measure the activity of liver enzymes. Imaging - which can be by X-ray, ultrasound, CT or MRI scan. Biopsy - a liver biopsy is a small sample of tissue taken for examination under a microscope by a pathologist. It is usually taken under local anaesthetic, either as a day case or with an overnight stay in hospital. Please see our fact sheet guides to liver function tests, liver biopsy and liver ultrasound. How is cirrhosis treated? Treatment depends on the type and stage of the cirrhosis. It aims at stopping the progress of the cirrhosis if at all possible, reversing the damage that has already occurred, and treating complications that are disabling or life threatening (for instance treating variceal bleeding in hospital). In some patients liver transplantation may be appropriate. Discuss any concerns you may have regarding your suitability for treatment with your specialist nurse or doctor. In everyday life however, the term cirrhosis has tended to become linked with alcoholic cirrhosis. This commonly held mistaken belief leads to some degree of confusion about liver disease and cirrhosis in the general public. 6 Fighting liver disease 7

5 Is cirrhosis reversible? Until very recently most liver specialists thought that cirrhosis was irreversible. This is usually the case, largely because the underlying disease is chronic (long-term) and most liver diseases are difficult to treat in terms of curing the underlying cause. However, recent research has shown that in some liver diseases that have been treated effectively (e.g. antiviral drugs in chronic viral hepatitis B or C) there can be very significant reversal of liver scarring with some reports of reversal of cirrhosis. These relatively early reports may be encouraging and may lead to the prospect of understanding how this occurs and to the possible development of new drugs to combat the process of scarring in the liver. However, more research still needs to be done before anything becomes widely available. Alcohol and cirrhosis While almost everyone who drinks excessive amounts of alcohol develops some liver damage, this does not necessarily develop into cirrhosis. Of those people who drink to excess up to 90% will develop simple fatty liver (please see our fact sheet on Fatty liver) and about one in ten will develop cirrhosis. In general the more often you drink the more likely cirrhosis will develop. A poor diet may also be a contributing factor. For information on diet please see our leaflet Diet and liver disease. All types of alcoholic drinks can lead to liver disease. Sensible drinking Drinking within sensible limits of alcohol intake can minimise your risk of developing alcoholic liver disease or the risk of progression to cirrhosis in people with other liver diseases. The recommended safe limits for alcohol consumption (as adopted by the Department of Health) are: 14 units per week for women. 21 units per week for men. For information on units of alcohol, please see our leaflet on Alcohol and liver disease. Women are more susceptible to alcoholic liver damage than men, in part because of their different body size and build. Importantly, not all patients with alcoholic cirrhosis are dependent on alcohol or considered to be alcoholics. Individuals who drink alcohol socially may develop alcoholic liver damage, including cirrhosis. Individual tolerance of alcohol varies considerably and is worse in people with chronic liver disease of all types. Please see our leaflet called Alcohol and liver disease. Further information This is one of a series of leaflets, other titles include: Alcohol and liver disease, Hepatitis B, Hepatitis C, Primary biliary cirrhosis. 8 Fighting liver disease 9

6 Support the British Liver Trust We raise funds from many sources and a large proportion is donated by voluntary contributions. For the British Liver Trust to continue its support, information and research programme, we need your help. If you can send a donation, it will enable us to keep providing the services that people need. If you would like to help, please fill in the form on the page opposite. If you wish to help us further with our work by participating in a fundraising event or becoming a Friend of the British Liver Trust please contact: British Liver Trust Portman House, 44 High Street, Ringwood, BH24 1AG Tel: Fax: I enclose a cheque/postal order made payable to the British Liver Trust I wish to pay by credit card: MasterCard Visa CAF CharityCard Please debit my card with the sum of... Card No... Expiry date... Name... Address......Postcode Signature...Date... I am a tax payer and authorise the charity to reclaim the tax on my donation* Please send me your next newsletter Please send me a list of information leaflets I am interested in leaving the Trust a legacy. Please send me more information Special thanks Professor Michael J P Arthur DM FRCP FMedSci; Professor of Medicine Southampton General Hospital. Professor Chris Day MA PhD MD FRCP; Professor of Liver Medicine, Centre for Liver Research, University of Newcastle-upon-Tyne. * You must pay an amount of income tax and/or capital gains tax equal to the amount the British Liver Trust will reclaim on your donation: which is equal to 28p for every 1 you donate. Your name and address will be added to our computer database ensuring you are sent the latest information. If you do not wish to receive further information, please tick here. 10 Fighting liver disease 11

7 This leaflet is for information only. Professional, medical or other advice should be obtained before acting on anything contained in the leaflet as no responsibility can be accepted by the British Liver Trust as a result of action taken or not taken because of the contents. British Liver Trust Portman House, 44 High Street, Ringwood, BH24 1AG Tel: Fax: Web site: Registered Charity No British Liver Trust 2005 CIL/05

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