What to know about alcohol-induced cirrhosis

This factsheet is for people who have alcohol-induced cirrhosis, or who would like information about it.

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.

About alcohol-induced cirrhosis

In cirrhosis, the healthy cells of your liver are gradually replaced by scar tissue in a process called fibrosis. If this happens, your 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 of alcohol-induced cirrhosis

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); if you are a woman, you may have irregular periods

These symptoms aren't always caused by cirrhosis but if you have them, see a doctor.

If you're vomiting blood, have black stools or develop a fever, you should seek urgent medical attention.

Complications of alcohol-induced cirrhosis

Scar tissue can restrict the flow of blood to your liver, causing a build-up of pressure in the vein that takes blood from your gut to your liver (the portal vein). This is known as portal hypertension.

As the pressure increases, your blood tries to find another way back to your heart without going through your liver and expands veins in the lining of your stomach and oesophagus.

These expanded veins (called varices) may bleed slowly, causing anaemia (a condition where you have too few red blood cells or not enough haemoglobin in your 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 your 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 of alcohol-induced cirrhosis

One of your liver's many functions is to process the alcohol you drink. Your liver can handle a certain amount of alcohol, but if you drink heavily and regularly, this can put strain on it.

Your 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, your liver can't function as efficiently. It will then become less able to process chemicals and medicines, which can cause harmful substances (toxins) to build up in your body.

The damage to your 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 of alcohol-induced cirrhosis

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor 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.

Please note that availability and use of specific tests may vary from country to country.

Treatment of alcohol-induced cirrhosis
Self-help

Liver damage from cirrhosis can't 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.

There are a number of ways that he or she can help, including recommending support groups.

Your doctor or dietitian 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, your doctor 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.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of alcohol-induced cirrhosis

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 UK guidelines for sensible drinking are as follows.

• 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.

• A pint of cider at 6% alcohol by volume (abv) is around 3.4 units.

• A 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.

• A measure of spirits at 40% abv is 1 unit.

Please note that drinking guidelines may vary from country to country. For more information, speak to your family doctor.