Cirrhosis is a condition in which scar tissue replaces healthy liver tissue and over time prevents the liver from working properly. Alcohol-induced cirrhosis (also known as alcoholic cirrhosis) is the term used to describe cirrhosis that has been caused by drinking excessive amounts of alcohol, usually over many years.
In cirrhosis, the healthy cells of the liver are gradually replaced by scar tissue in a process called fibrosis. If this happens, the liver tissue that should be smooth becomes lumpy (nodular) and hard. Alcohol-induced cirrhosis refers specifically to cirrhosis caused by drinking alcohol. Cirrhosis can also be caused by liver infections, such as hepatitis B and C, and by some inherited liver diseases.
Cirrhosis is the most severe form of a range of alcoholic-related liver diseases. If you drink excessive amounts of alcohol, you can develop a condition such as fatty liver disease or hepatitis (inflammation of the liver). Simple, uncomplicated fatty liver disease can usually be reversed by stopping drinking. People who continue to drink excessively are at risk of developing a more severe type of liver disease, such as hepatitis or cirrhosis.
Cirrhosis is classed as either compensated or decompensated. If you have compensated cirrhosis, your liver is usually able to cope with the damage and continue to carry out most of its important functions. Most people with compensated cirrhosis have few or no symptoms. However, without treatment you're likely to develop decompensated cirrhosis (although this may take many years). If you have decompensated cirrhosis, you will usually have severe symptoms and complications.
Symptoms
You may not have any symptoms in the early stages of cirrhosis and your doctor could only have picked up signs of liver damage from a routine blood test. Early symptoms can include:
- - a loss of appetite
- - feeling sick and vomiting
- - itchy skin
- - weight loss
However, as the condition progresses, your symptoms may include:
- - a yellowing of your skin and/or the whites of your eyes (this is called jaundice)
- - swelling in your abdomen (tummy) and legs
- - muscle wasting
- - having spider-like blood vessels on your skin
- - bruising and bleeding easily
- - vomiting blood or having blood in your faeces (which may appear black and tarry and have an unpleasant smell)
- - feeling confused or having a poor memory
- - a high temperature (fever) because of an infection – you're more likely to get certain infections if you have cirrhosis
- - sexual changes – if you are a man you may notice you have less body hair, smaller testicles (testicular atrophy) and more breast tissue (gynaecomastia) and if you are a woman you may have irregular periods
These symptoms aren't always caused by cirrhosis but if you have them, see your doctor.
If you're vomiting blood, have black stools or develop a fever, you should seek urgent medical attention.
Complications
Scar tissue can restrict the flow of blood to the liver, causing a build up of pressure in the vein that takes blood from the gut to the liver (the portal vein). This is known as portal hypertension. As the pressure increases, the blood tries to find another way back to the heart without going through the liver and expands the veins in the lining of the stomach and oesophagus. These expanded veins (called varices) may bleed slowly, causing anaemia (a condition where there are too few red blood cells or not enough haemoglobin in the blood). There is also a risk that the varices can bleed severely and require emergency treatment.
Cirrhosis can lead to liver failure. This is where the liver is no longer able to function as it should. It can also lead to kidney failure (hepatorenal syndrome) and brain damage (encephalopathy).
If you have cirrhosis, you're more likely to get liver cancer.
Causes
One of the liver's many functions is to process the alcohol drunk. The liver can handle a certain amount of alcohol, but if one is a regular heavy drinker, this can put strain on it.
The liver is usually able to repair and renew itself. But if the cells become too badly damaged, the liver tissue can become permanently scarred. As scar tissue builds up, the liver cannot function as efficiently. It will then become less able to process chemicals and drugs, which can cause harmful substances (toxins) to build up in the body. The damage to the liver builds up gradually over many years until eventually it stops working properly.
Alcohol-induced cirrhosis is usually caused by many years of heavy drinking. There is no specific amount of alcohol that will cause cirrhosis; the amounts that can cause liver damage vary from person to person. In general, the more alcohol you drink, the higher your chance of developing alcohol-induced cirrhosis. It doesn't only affect people who have an alcohol addiction. If you're a heavy social or binge drinker, you also have a higher chance of developing cirrhosis.
Diagnosis
Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. He or she may refer you to a hepatologist – a doctor who specialises in conditions of the liver.
You may need to have one or more of the following tests.
- - Blood tests, including a liver function test to see how well your liver is working.
- - Scans, such as an ultrasound, CT scan or MRI scan.
- - Liver biopsy, in which a tiny piece of your liver is taken using a fine needle and examined under a microscope to see whether the tissue is damaged.
If your doctor thinks you have developed varices in your oesophagus or stomach, you may need to have a gastroscopy. This is a test that allows your doctor to look at your oesophagus and stomach using a narrow, flexible, tube-like telescopic camera called an endoscope.
Treatment
Self-help
Liver damage from cirrhosis cannot be reversed but you can prevent further damage. The best way to do this is to stop drinking alcohol. If you find it difficult to stop drinking, speak to your doctor. Your doctor may advise you on your diet and appropriate nutritional supplementation as it’s important to prevent malnutrition.
Medicines
Your doctor can give you medicines to help relieve the symptoms. For example, if you have portal hypertension, you may be given a beta-blocker to reduce the risk of bleeding. Or if you have abdominal swelling, he or she may prescribe a diuretic (water tablet) to help remove the fluid from your abdomen. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Surgery
If you have liver failure, a transplant may be an option. This is a major operation to remove your diseased liver and replace it with a healthy liver from a donor. Your doctor will be able to advise you whether this is a suitable option. If you have a liver transplant, you must not drink alcohol for the rest of your life.
Prevention
The best way to reduce your chance of getting alcohol-induced cirrhosis is to limit the amount of alcohol you drink, or not drink at all. Stopping drinking alcohol can also prevent cirrhosis progressing if you already have it.
The current guidelines for sensible drinking are:
- - women shouldn’t regularly drink more than two or three units of alcohol per day
- - men shouldn’t regularly drink more than three to four units of alcohol per day
It can be easy to underestimate how many units you're drinking. The following examples should help you track the amount you're drinking. Keep them in mind to make sure you stay within the sensible drinking limits.
- - One pint of cider at 6% alcohol by volume (abv) is around 3.4 units.
- - One pint of lager at 5% abv is around 2.8 units.
- - A standard glass of wine (175ml) at 13% abv is 2.3 units.
- - A large glass of wine (250ml) at 12% abv is 3 units.
- - One measure of spirits at 40% abv is 1 unit.
Common Questions Published by Bupa’s Health Information Team, October 2011.
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
What will happen if I have alcohol-induced cirrhosis and continue to drink?
If you have alcohol-induced cirrhosis and continue to drink, your condition will progressively get worse and can be fatal. If you’ve been diagnosed with alcohol-induced cirrhosis this means your liver is likely to be severely damaged. Your liver cannot recover if it has been badly affected, but you can help prevent any further damage by not drinking alcohol. If you have cirrhosis and stop drinking alcohol, you can almost double your chances of survival. But if you continue to drink, you will cause further damage to your liver and reduce your chance of survival.
I have alcohol-induced cirrhosis, but am finding it difficult to stop drinking – how can I help myself?
If you have alcohol-induced cirrhosis, it's important that you stop drinking to reduce any further damage to your liver. But if you're finding it difficult to give up, contact your doctor. Talking to your doctor can help to address any underlying problems, such as anxiety or depression. He or she may be able to recommend support groups, such as Alcoholics Anonymous. These types of group can help you while you give up. They give ongoing help to prevent you becoming dependent on alcohol again by sharing personal experiences and advice with others who are dependent on alcohol.
You may also find it helpful to speak to family or friends.
It is very unlikely that you will be offered a liver transplant if you continue to drink alcohol. A liver transplant is a major operation to remove your diseased liver and replace it with a healthy liver from a donor. A liver transplant is usually only recommended if other treatments for cirrhosis haven't worked and your life is at risk. You will usually be considered for a liver transplant after a period of abstinence (not drinking), usually for six months. If you continue to drink alcohol it’s very unlikely that you will be considered for a transplant.
If you have a liver transplant you will be expected not to drink alcohol for the rest of your life. This is because drinking alcohol will put strain on your new liver. You will usually be asked to sign an agreement, which states that you won't drink alcohol after your transplant and you will take part in regular follow-up assessments, including routine blood tests to check that you haven’t had any alcohol.
Drinking over eight units for men and six units for women in one session is classed as binge drinking. Binge drinking is generally thought of as heavy drinking over a short period of time (usually one evening). Drinking heavily over such a short period quickly increases the amount of alcohol in your blood. This can lead to drunkenness and reckless behaviour. Rarely, binge drinking can cause you to stop breathing or stop your heart.
Drinking eight or more units per day for men and six or more for women is regarded as binge drinking. These levels are twice the recommended daily allowance of three to four units per day for men and two to three units a day for women.