Liver cirrhosis — end-stage scarring

Cirrhosis is advanced hepatic fibrosis — regenerative nodules surrounded by scar — disrupts blood flow and function.

Compensated — Child-Pugh A, minimal symptoms

Decompensated — ascites, varices, encephalopathy, jaundice — median survival falls sharply

Causes in the UK

  1. Alcohol-related liver disease (ARLD)
  2. NAFLD/NASH — obesity epidemic
  3. Hepatitis C — declining with direct-acting antivirals
  4. Hepatitis B, autoimmune, PBC, PSC

See fatty liver disease and hepatitis — treat before cirrhosis when possible

Clinical features

Stigmata of chronic liver disease:

  • Spider naevi
  • Palmar erythema
  • Gynaecomastia
  • Clubbing (HCC)
  • Caput medusae

Decompensation events:

  • Ascites
  • Variceal haemorrhage
  • Hepatic encephalopathy
  • Hepatocellular carcinoma

Monitoring

6-monthly ultrasound + AFP — HCC surveillance

Endoscopy — varices — beta-blocker or band ligation

FibroScan/elastography — non-invasive fibrosis staging

Management

Cause removal:

  • Alcohol abstinence — support services
  • Weight loss — NAFLD
  • Antivirals — HBV suppression, HCV cure

Complications:

  • Ascites — salt restriction, spironolactone/furosemide, paracentesis
  • SBP prophylaxis — selected patients
  • Encephalopathy — lactulose, treat precipitants
  • Bleeding — terlipressin, antibiotics, urgent endoscopy

Transplant assessment — tertiary hepatology

Heavy drinker with new ankle swelling — liver bloods + ultrasound — cirrhosis manageable years if alcohol stops today.

Common questions about liver cirrhosis

What causes liver cirrhosis?
Alcohol-related liver disease — commonest in UK historically. Non-alcohol fatty liver disease linked to obesity and diabetes — rising fast. Chronic hepatitis B and C. Autoimmune hepatitis, primary biliary cholangitis, haemochromatosis, Wilson disease — less common. Multiple causes can coexist.
What are the symptoms of cirrhosis?
Early — none or fatigue, weight loss, itchy skin. Advanced — jaundice, ascites, leg oedema, spider naevi, palmar erythema, muscle wasting, gynaecomastia, hepatic encephalopathy (confusion, day-night reversal), easy bruising. Decompensation marks turning point in prognosis.
Can cirrhosis be reversed?
Scar tissue in established cirrhosis does not fully reverse — but stopping alcohol, weight loss in NAFLD, and curing hepatitis C can stabilise liver and improve function — some downstage from decompensated with sustained change. Early fibrosis before cirrhosis can regress significantly.
What is hepatic encephalopathy?
Brain dysfunction from liver failure — ammonia and toxins not cleared. Graded confusion, sleep reversal, personality change, flapping tremor (asterixis). Triggers — infection, constipation, bleeding, sedatives. Treated with lactulose and rifaximin — reduce gut ammonia production.
When is liver transplant needed?
End-stage liver failure when MELD score high or recurrent decompensation despite treatment — refractory ascites, recurrent encephalopathy, hepatorenal syndrome. Transplant waiting list — alcohol-related disease requires 6 months abstinence in most UK centres. Living donor partial transplant rare in UK.

Sources