Quick answer

What is liver cirrhosis?

Cirrhosis is advanced scarring of the liver — usually from long-term alcohol misuse, non-alcohol fatty liver disease (NAFLD), or chronic viral hepatitis. Early cirrhosis (compensated) may have no symptoms — picked up on blood tests or scan. Decompensated cirrhosis causes jaundice, ascites (fluid belly), leg swelling, confusion (hepatic encephalopathy), and vomiting blood. Stopping alcohol and treating underlying cause can stabilise some cases. See a GP if you have liver disease risk factors with fatigue, jaundice, or swelling — urgent same-day for vomiting blood or confusion.

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

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