Liver cirrhosis is the result of continuous damage to the liver.1 The damage leads to scarring where irregular bumps (nodules) replace the smooth liver tissue, leaving it unable to function properly.2 Since cirrhosis is caused by long-term damage, it is often referred to as end-stage liver disease. This simply means that it comes after the other stages of liver damage, including inflammation, fatty deposits, increased stiffness and scarring.1
Liver cirrhosis has many causes, but is commonly caused by alcohol [link to K15], hepatitis viruses and non-alcoholic fatty liver disease (NAFLD). NAFLD can be caused by conditions such as high cholesterol, high blood pressure and obesity.3
The symptoms of liver cirrhosis may vary, depending on the severity of the disease, but usually they are quite general. Symptoms may include (amongst others): low energy, weight loss, loss of appetite, itching of the skin, yellowing of the skin (known as jaundice), the formation of spider-like veins, and easy bruising. Patients may also develop fluid build-up in the abdomen (known as ascites) or confusion as toxins build up in the blood.3
If liver disease is suspected, there are several tests and investigations that can be done to help with diagnosis. The healthcare team may take a blood sample to check liver function. The team may also use the blood sample to check if your blood is still able to clot as normal.3
The healthcare team may organize scans to visualize the liver and look for any abnormalities. Scans that are useful in assessing liver disease are CT scans, MRI scans, and ultrasound. A liver biopsy may also be necessary. A biopsy involves taking a small tissue sample from your liver, which will then be looked at by specialists under a microscope.3
Although alcohol is a common cause of liver disease, there are many other causes, meaning you can develop liver disease even if you do not drink alcohol. Causes may include viral infections, inherited conditions, autoimmune disease, certain blood vessel diseases, and exposure to certain drugs and toxins.1
The aims of cirrhosis treatments are typically focused on treating the underlying cause to prevent or delay further damage, and on preventing or managing complications that arise. Your healthcare professional may also advise you to change your lifestyle, like eating a healthy diet and avoiding alcohol.4
People with cirrhosis often become malnourished, so it is important to eat a nutritious diet. Dietary recommendations will be different for every individual, but there are some general recommendations for patients with liver cirrhosis:5
- Avoid alcohol completely
- Reduce foods with high fat, sugar, or salt content
- Avoid any raw or undercooked seafood or meat
To craft the best plan for you, you should discuss your nutrition plan with your healthcare team.5
Hepatic encephalopathy is a major complication of liver cirrhosis6 in which brain function becomes impaired.7 The liver is responsible for the breakdown and excretion of toxins such as ammonia. When the liver is damaged it is unable to breakdown these toxins.8 These toxins can build up in the bloodstream and if they enter the brain, they can lead to hepatic encephalopathy, which leads to both physical symptoms and reduces mental function.6
Hepatic encephalopathy can cause mild mental function changes such as difficulty concentrating, changes in personality, or forgetfulness. As it worsens, it can cause more severe symptoms, such as extreme confusion and seizures. These symptoms may develop slowly but can have a rapid onset.6
The brain relies on normal liver functioning. The liver removes toxic substances from the blood that can be harmful to brain cells. When liver disease causes liver cell damage, the cells may become unable to detoxify the blood, and these toxins may reach the brain.9
It is possible to stop or delay liver damage, and even reverse or improve it, if the underlying cause is managed. Examples of this might include treating the underlying infection or abstaining from alcohol.3
Lifestyle changes may also help slow down disease progression. The goal of treatment is to prevent cirrhosis from worsening, reverse any liver damage if possible, and manage any complications.1
References
- British Liver Trust. Cirrhosis of the liver. Available at: https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/cirrhosis/#info (Last accessed October 2020)
- NHS Inform. Cirrhosis. Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/cirrhosis (Last accessed October 2020)
- University of Rochester Medical Centre Health Encyclopedia. Chronic Liver Disease/Cirrhosis. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00662 (Last accessed October 2020)
- John Hopkins Medicine. Chronic Liver Disease/Cirrhosis. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-liver-disease-cirrhosis (Last accessed October 2020)
- Daniel, C. Verywell health. What to Eat When You Have Cirrhosis. Available at: https://www.verywellhealth.com/what-is-the-best-diet-for-cirrhosis-1760062 (last accessed: September 2020) (Last accessed November 2020)
- British Liver Trust. Hepatic Encephalopathy (HE). Available at: https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/hepatic-encephalopathy/ (Last accessed October 2020)
- Ferenci P, Gastroenterology Report. 2017;5(2):138–147
- Starr S, American Family Physician. 2011;84(12):1353-1359
- R Butterworth, Alcohol Research & Health. 2003;27(2):143-145
May 2021. GL-HEP-XIF-2000176
