Liver cirrhosis

Liver cirrhosis is most commonly caused by alcohol abuse or hepatitis viruses. The liver is initially enlarged (“fatty liver”), but there are no specific symptoms.

Medical professionals

1 May 2021 | 5 Min. Reading Time

Overview

Liver cirrhosis is most commonly caused by alcohol abuse or hepatitis viruses. The liver is initially enlarged (“fatty liver”), but there are no specific symptoms. In later stages, the liver shrinks and becomes cirrhotic. Functional impairment and blood flow problems occur. Moderate alcohol consumption is the most important preventive measure.

Symptoms

Initial stage: there are often no symptoms for many years

Symptoms usually only occur when cirrhosis is advanced:

Fatigue, feeling unwell, reduced performance and slightly elevated temperature
Nausea, pressure and feeling of fullness in upper abdomen (mostly on the right side)
- Thereafter: loss of appetite and weight loss
Skin changes
- Spider veins close to the surface of the skin around the nostrils and on the backs of the hands
- Very red palms and soles of the feet
Itching
Hormonal deficiencies in men
- Testicular shrinkage
- Feminisation (e.g. loss of hair on chest or stomach or in the armpits)
- Enlarged mammary glands
- Potency disorders and loss of libido
Hormonal deficiencies in women
- Menstrual disorders, usually periods stop.
Dupuytren’s contracture, common for cirrhosis caused by alcohol abuse

Complications

Jaundice
Enlarged veins in the oesophagus (oesophageal varices) and in the stomach
- Caused by impaired flow of blood in the sick liver
- Can lead to massive bleeding, with a high mortality rate
Impaired blood clotting ability
- Generally increased tendency to bleed
- Gastric bleeding, nosebleeds
Thrombosis and high blood pressure in portal vein
- Higher incidence of spider veins around the navel
- External haemorrhoids
Ascites (“abdominal dropsy”)
- Accumulation of fluid in the abdomen
- Increasing abdominal girth
- Bulging and tense abdominal wall
Increased susceptibility to infections owing to immune deficiency (e.g. pneumonia, urinary tract infections)
Neurological symptoms: sleepiness, tremors, disturbances in movement (ataxia), confusion, etc.
Tissue nodes and ongoing transformation processes mean there is a higher risk of liver cancer
Final stage
- Liver stops functioning (liver failure)
- Growing sleepiness which ends in a coma (liver coma)
- Reduction in urinary output
- Death is possible due to multiple organ failure

Prognosis

Alcohol-related liver cirrhosis: early cirrhosis can be reversed through complete alcohol abstinence
Complication-related cirrhosis that is diagnosed late: prognosis is rather bad; patients die from liver failure, variceal haemorrhage or liver cell carcinoma

Causes and treatment

Causes

Liver cirrhosis = final stage of many chronic liver diseases
Damage and death of individual liver cells or parts of the liver owing to a number of different causes (see below)
Overlapping processes of connective tissue repair
Formation of lobules of new liver tissue (regenerative pseudo-lobules)
Regenerative pseudo-lobules and scars can impair blood flow in the liver and the flow of bile

Liver cells are damaged by:

Alcohol abuse: (Co-)responsible in 50 to 70% of cases
Hepatitis B and C: Around 45% of cases, chronic inflammation with liver cirrhosis is possible
Infrequent causes (around 5%):
- Metabolic disorders (including genetic disorders)
- Chemical damage (e.g. solvents)
- Autoimmune disorders
- Cholestasis (blocked bile flow), caused by chronic inflammation of the bile duct (cholangitis), bile duct stones, cancer of the pancreas or cancer of the bile duct
- Various medicines (particularly if high doses are taken over a longer period of time, such as many painkillers, tranquillisers and medication for Parkinson’s, some antibiotics)

Further treatment by your doctor / in hospital

Possible tests

Blood test (liver function, coagulation levels, etc.)
Abdominal ultrasound
CT scan (computed tomography), if necessary
Removal of liver tissue samples
Oesophagoscopy and gastroscopy (suspicion of varicose veins in the oesophagus and bowel)
Regular check-ups are advised if liver cirrhosis has been diagnosed
- Ultrasound and blood tests every 6 months
- Early diagnosis of liver cancer

Possible therapies

Protect the still functional liver tissue, prevent further progression of the disease (secondary measures)
- Vitamin-rich diet which is well balanced with regard to carbohydrates, fat and protein
- Elimination or replacement of medication that can damage the liver
- Alcohol abstinence is essential
- Blockage of bile duct by gallstones: operation, if necessary
Treatment of complications such as bleeding, infections, ascites (“abdominal dropsy”), renal insufficiency, metabolic disorders
Treatment of an underlying disease
- E.g. anti-viral medication (against viruses) for chronic hepatitis B and C
Operation/intervention
- Insertion of a shunt (to reduce pressure in portal vein)
- Liver transplant (as a last resort)

What can I do myself?

If a chronic liver disease has been diagnosed (regardless of its cause)
- Complete alcohol abstinence (elimination of damaging factors can help the liver to recover before reaching the stage of cirrhosis)
- Diet rich in calories and vitamins (careful: healthy people should not take vitamin preparations for a lengthy period)
Prevention: moderate consumption of alcohol or complete abstinence
- Risky alcohol consumption: > 24g/day (men), > 12g/day (women)
- 24g alcohol equals approx. 500 ml of beer, 12g would be, for example, 100 ml of wine
- Individual capacity differs greatly and depends on genetic factors, among others
Vaccination against hepatitis B
- Urgently recommended for people with a higher risk (e.g. medical staff)
- Recommended basic vaccination according to Swiss Vaccination Schedule
Follow the safer sex rules (protection against hepatitis B, C and D)
- Always use a condom or femidom during sexual intercourse
- Don't get sperm or blood (including menstrual blood) in your mouth, and don’t swallow