Liver Cirrhosis
Advanced scarring of the liver from chronic injury, with serious systemic complications.
Overview
Cirrhosis is the end result of progressive liver injury, with fibrosis replacing normal architecture. It is often silent until decompensation occurs (ascites, varices, encephalopathy, jaundice). Early identification and treatment of the underlying cause can halt or reverse damage.
Symptoms
- • Often asymptomatic in compensated disease
- • Fatigue, poor appetite, weight loss
- • Jaundice, itching
- • Abdominal swelling (ascites), leg oedema
- • Easy bruising or bleeding
- • Confusion or drowsiness (hepatic encephalopathy)
Risk factors
- • Heavy or prolonged alcohol use
- • Obesity, type 2 diabetes
- • Chronic viral hepatitis
- • Unprotected sex, injection drug use
- • Family history of liver disease
Causes
- • Alcohol-related liver disease
- • Chronic hepatitis B and C
- • Non-alcoholic fatty liver disease (MASLD/MASH)
- • Autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
- • Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency
🚨 Red flags — seek urgent care
- • Vomiting blood or passing black tarry stool — variceal bleed, emergency
- • Severe confusion or drowsiness
- • Rapidly enlarging abdomen with fever — possible spontaneous bacterial peritonitis
- • Deepening jaundice
When to seek care
- • Persistent fatigue, weight loss or abdominal swelling
- • Abnormal liver tests on routine bloods
- • Risk factors plus any new symptoms
Diagnosis
- • Liver tests, INR, albumin, platelet count
- • Ultrasound and transient elastography (FibroScan)
- • Aetiological screen: viral hepatitis, autoimmune, iron studies, ceruloplasmin
- • Liver biopsy in selected cases
- • Screen for varices (endoscopy) and HCC (6-monthly ultrasound)
Treatment
- • Treat the underlying cause (alcohol abstinence, antivirals, weight loss, immunosuppression)
- • Vaccinate against hepatitis A & B, pneumococcus, influenza, COVID-19
- • Manage complications: diuretics for ascites, lactulose/rifaximin for encephalopathy, beta-blockers and band ligation for varices
- • Avoid NSAIDs and hepatotoxic drugs; review prescriptions
- • Liver transplantation for decompensated disease meeting criteria
Prevention
- • Limit alcohol; abstinence in established liver disease
- • Treat viral hepatitis early; vaccinate against hepatitis B
- • Maintain healthy weight; manage diabetes
- • Safe sex and injection practices
Complications
- • Variceal bleeding
- • Ascites and spontaneous bacterial peritonitis
- • Hepatic encephalopathy
- • Hepatocellular carcinoma
- • Hepatorenal and hepatopulmonary syndromes
Prognosis
Compensated cirrhosis has 10-year survival above 80%; decompensated disease has 1–2 year survival of 50% without transplant. Removing the cause (e.g. alcohol abstinence, hepatitis C cure) can markedly improve outcomes.
Education & self-care
Cirrhosis is serious but often modifiable. Identifying and removing the cause early prevents complications and may reverse damage.
Frequently asked questions
Can cirrhosis be reversed?
Fibrosis can regress if the cause is removed early (e.g. hepatitis C cure, alcohol abstinence, weight loss). Advanced cirrhosis is largely irreversible.
Is it safe to drink alcohol with cirrhosis?
No. Complete abstinence is recommended in any established liver disease.
Can cirrhosis be reversed?
Early fibrosis can regress when the underlying cause is removed (alcohol, hepatitis B/C, weight loss in NAFLD). Established cirrhosis usually does not fully reverse, but progression can be halted.
Why are vaccinations important?
People with cirrhosis are at higher risk of severe infection. Hepatitis A and B, pneumococcal, annual flu and COVID-19 vaccines are routinely recommended.
When is liver transplant considered?
Decompensated cirrhosis (ascites, encephalopathy, variceal bleeding) or early liver cancer in cirrhosis triggers a transplant assessment based on the UKELD or MELD score.