Liver cirrhosis

What is liver cirrhosis?

Liver cirrhosis is an advanced stage of long-term damage and inflammation to your liver. It’s when scar tissue (also known as fibrosis) has built up, and your liver forms abnormal tissue (nodules).

Liver cirrhosis is one of the last stages of liver damage and can eventually lead to liver failure. The good news is there are ways to manage liver cirrhosis to stop it from getting worse.

You can check your liver health at home by using a liver blood test (formerly known as a liver function blood test or LFT). It’s important to note that this test can’t formally rule out or diagnose liver disease without more medical context or further investigation from your GP. This test might be helpful if you are at risk of liver disease and have ongoing symptoms, like fatigue and nausea.

What are the causes of liver cirrhosis?

The main causes that lead to liver damage and cirrhosis are:

• alcohol-related liver disease  — caused by binge drinking in a harmful way in a harmful way, or being dependent on alcohol
• hepatitis B or C infection — a viral infection
• non-alcoholic fatty liver disease (NAFLD) — usually caused by carrying excess weight and insulin resistance
• problems affecting your bile ducts — like primary biliary cirrhosis (PBC)
  

Alcohol-related liver disease is the most common cause of liver cirrhosis in Europe. The process of breaking down alcohol can cause damage to your liver, which can prevent it from breaking down fats. If you continue drinking alcohol, too much fat in your liver can cause inflammation and scarring occur — leading to liver cirrhosis. 

Find out more about the effects of alcohol on your body.

Liver cirrhosis stages

Liver cirrhosis severity is scored on a scale of 1 to 4, but clinically there are only 2 stages, including:

1. compensated cirrhosis — your liver still functions relatively well despite its damage so you might not have any symptoms. Your liver can function with as little as 20% of it intact. 

2. decompensated cirrhosis — your liver can’t function well enough, so you might experience symptoms of confusion as well as complications like a swollen abdomen (ascites) and gastrointestinal bleeding.

What are the symptoms of liver cirrhosis?

As the damage to your liver progresses, the main symptoms experienced include:

• loss of appetite
• nausea
• tiredness
• spider-like blood vessels on the skin above your waist
• red blotches on your palms

When liver cirrhosis becomes more advanced, symptoms include:

• yellowing of your skin and eyes (jaundice)
• dark-coloured urine
• pale stools
• swelling of your legs (oedema) and abdomen (ascites)
• confusion, difficulty concentrating, and memory loss

These are all signs that your liver isn’t working properly. If you have these symptoms, it’s important to see your GP.

Liver cirrhosis treatment

While there’s no cure for liver cirrhosis, there are treatment options to help manage your symptoms and slow down or stop its progression. This depends on the severity and cause of cirrhosis.

In cases of severe cirrhosis or life-threatening complications, you might be referred to a specialist for a liver transplant. There were 942 liver transplants in the UK in 2019 and they're usually very successful — 93 out of 100 people are alive 1 year after their transplant, while 83 out of 100 people go on to live another 5 years. But you can avoid a liver transplant by getting the correct treatment at the right time. 

How to prevent liver cirrhosis

Stopping or slowing down liver cirrhosis is done by treating the underlying liver disease that’s caused it. This might involve treating hepatitis B or C with antiviral medications and cutting alcohol from your diet for alcohol-related cirrhosis.

Improve your diet  

Changing your diet is an essential part of liver cirrhosis management. Between 25 to 60% of people with liver cirrhosis are malnourished, increasing the chances of complications and even death. 

Everyone with liver cirrhosis will have different requirements, depending on your level of cirrhosis, underlying cause, and other health conditions. It's vital to work with your doctor or dietitian to develop a plan that suits your needs.

Eat nutrient-dense foods 

When you have liver cirrhosis, your body might struggle to absorb zinc and fat-soluble vitamins like vitamin A, vitamin D, vitamin E, and vitamin K. 

You should eat a range of nutrient-dense foods and consider a supplement to avoid nutrient deficiencies.

Nutritious foods to eat include:

• almonds
• leafy green vegetables
• whole grains

Eat enough calories and protein

You need enough calories and protein in your diet to prevent malnourishment. If you have cirrhosis, your liver stores less energy in the form of glycogen than a healthy liver. This means you break down more protein — increasing how much protein you need from your diet.

In general, if you have liver cirrhosis, aim for:

• 30-35 calories per 1 kg of body weight each day
• 1.2 -1.5g protein per 1 kg of body weight each day 

If you weigh 70kg, this equates to consuming 2,100-2,450 calories and 84 to 105g of protein each day.

Eating a protein-rich snack before bed is an effective way to increase the amount of dietary protein your body holds on to.

But if you’re overweight or obese, it's advised to reduce the number of calories you eat and increase physical activity.

Eat small meals frequently

Keep the time between eating as small as possible — as a cirrhotic liver doesn’t store energy well. Aim for 3-5 smaller meals and a late evening snack.

Reduce your salt intake

If your cirrhosis is causing swelling of the abdomen, reduce your salt intake to a moderate level. This reduces your body holding onto water and helps lower blood pressure — high blood pressure can cause further damage to your liver.

Is cirrhosis reversible?

In the past, liver cirrhosis was thought to be irreversible, but your liver has remarkable powers of regeneration. Current treatment focuses on regaining the function of your liver and not making scarring any worse. 

Recent experimental research provides evidence that the scarring that leads to cirrhosis might be reversible. Much more research is needed to understand this fully and for it to become part of standard treatment. 

If you see any signs of your liver not functioning properly — seek advice and diagnosis from your doctor.