Cirrhosis of the liver: symptoms, causes and treatment

The NHS says many people with cirrhosis do not have symptoms, especially early on. Liver UK says it usually takes many years to develop and most people feel nothing while it happens; it may be found by accident during other health checks, or when they become very unwell.

Early symptoms the NHS lists are listed first below, followed by those that can appear as cirrhosis gets worse.

Cirrhosis is the late stage of scarring (fibrosis) of the liver. Liver UK says it is a later stage in many types of liver disease, and is usually diagnosed using blood tests and scans.

Liver UK describes two stages. Compensated cirrhosis is when the liver has permanent scarring but is working OK, the body is coping, and you may not feel ill; people can live for years with it. Decompensated cirrhosis is when the body is no longer coping and the liver cannot function properly, with complications affecting other parts of the body that often need urgent treatment. Liver UK says it is often possible to slow compensated cirrhosis to stop it becoming decompensated, usually by stopping or treating the cause, and that it is also possible to reverse decompensation.

The NHS says cirrhosis is caused by long-term damage to the liver. You may be more likely to have it if you have any of the following.

• You regularly drink a lot of alcohol: the NHS gives over 50 units a week for men and over 35 units a week for women.

• You have hepatitis B or hepatitis C.

• You live with obesity or have type 2 diabetes.

• You have non-alcoholic fatty liver disease (NAFLD).

• You have an autoimmune liver condition such as autoimmune hepatitis, primary biliary cholangitis or primary sclerosing cholangitis.

• You have a genetic condition such as haemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency or cystic fibrosis.

The NHS says cirrhosis cannot be cured, but there are treatments that can help slow it down or stop it getting worse. This usually involves treating the cause, for example antivirals for hepatitis B or C, plus treatment to prevent and treat complications.

Treatments the NHS lists include laxative medicine to help remove toxins, beta blockers to reduce bleeding, medicine to make you pee more and reduce swelling, antibiotics to treat or prevent infections and treat internal bleeding, treatment for weakened bones and, if cirrhosis is very severe, a liver transplant. Healthy lifestyle changes are strongly recommended, including stopping drinking alcohol.

Care usually involves a group of professionals: a liver specialist (hepatologist), a gastroenterologist, dietitians and alcohol support services.

The NHS suggests the following to help stop cirrhosis getting worse and to stay healthy.

• Have a healthy, balanced diet, exercise regularly and try to keep to a healthy weight.

• Check with a pharmacist or doctor before taking any medicines, including herbal medicines, because they may not be suitable.

• Stay up to date with vaccinations such as the flu and pneumococcal vaccines.

• Do not drink alcohol and do not smoke.

The NHS says how serious cirrhosis is depends on the cause and how early it is diagnosed and treated. Many people can feel well and live for many years, but it can cause serious or life-threatening complications.

These include malnutrition, weakened and fragile bones (osteoporosis), infections such as urinary tract infections and pneumonia, sepsis, jaundice, ascites (fluid in the tummy), confusion caused by changes in the brain, internal bleeding, liver failure, a blood clot in the vein that brings blood to the liver, and liver cancer. Liver UK says many people with cirrhosis will not die from it.

If you have been diagnosed with cirrhosis, the NHS says to ask for an urgent GP appointment or get help from NHS 111 if your skin or the whites of your eyes look yellow, you are more short of breath than usual, or you have a swollen tummy, legs, ankles or feet.

Call 999 or go to A&E if you are vomiting blood, your poo is very dark or black, or you suddenly become confused or have slurred speech. Do not drive yourself.

Cirrhosis is usually diagnosed after blood tests and scans arranged through a GP or hospital liver clinic. NHS care is led by liver specialists, with access to transplant assessment when needed. Private hepatology clinics offer assessments and scans; ask what is included, and keep your NHS team informed if you use both.