Cirrhosis

Cirrhosis is a term describing severe scarring of the liver. It has many causes including alcohol, fatty liver, viral hepatitis, haemochromatosis, autoimmune hepatitis and lots more rarer ones.

 Scarring occurs as part of the livers natural wound healing response (just like if you cut or burn yourself), but when the condition injuring the liver is repetitive eg. due to alcohol, or constant eg. due to a virus, fatty liver or autoimmune disease, the scar tissue accumulates. When there is so much scar tissue that it cris-crosses the liver causing a nodular appearance, this is what we call cirrhosis.

The best way to diagnose cirrhosis is by liver biopsy (taking a small piece of the liver with a needle under local anaesthetic). This also has the advantage of telling us what the cause of the cirrhosis is as well. Sometimes biopsy is not needed because the diagnosis is fairly obvious from scans and physical examination for example. We are increasingly using blood tests and special scans to avoid liver biopsy especially where we know the cause of the underlying liver disease.

Cirrhosis is not always obvious and a person with it can often appear to be completely healthy (compensated cirrhosis). 

It is important to diagnose cirrhosis because of the potential complications.

Blood from the intestines must pass through the liver on its way back to the heart. When the liver develops cirrhosis it becomes stiff and holds up this blood flow like a dam. Eventually the blood pressure in the veins coming from the intestines builds up (we call this portal hypertension) and can lead to complications with the development of large veins in the gullet and stomach which can bleed (varices). Portal hypertension can also lead to swelling of the abdomen (belly) with fluid known as ascites.

Other complications of cirrhosis include, hepatocellular carcinoma (liver cancer)  and decompensation (liver failure).

Once a diagnosis of cirrhosis is made regular ultrasound screening is performed to look out for hepatocellular carcinoma, becasue if found it is often treatable. Likewise we will recommend endoscopy to look for varices, because if found, we can treat them before they start bleeding.

If the underlying cause can be identified and treated it is usually possible for the liver to recover somewhat, although the cirrhosis doesnt usually go away.

Whatever the cause of the cirrhosis, stopping alcohol and avoiding being over weight are important things that you can do to help your liver.

If you are diagnosed with cirrhosis it is important that your care is coordinated by a Liver specialist. At GI choice we can provide the specialist endoscopy and ultrasound investigations you require for your follow up.