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Alcohol-induced cirrhosis

Published by Bupa's health information team, February 2008.

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 normal 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 which has been brought on by consuming large amounts of alcohol, usually over many years. It's the cause of most cases of liver cirrhosis in the UK.

About alcohol-induced cirrhosis
Symptoms
Causes
Diagnosis
Complications
Treatment
Prevention
Questions and answers
Related topics
Further information
Sources

About alcohol-induced cirrhosis

In cirrhosis, the healthy cells of your liver are gradually replaced by scar tissue (fibrosis). The liver tissue, which should be smooth, becomes lumpy (nodular). Alcohol-induced cirrhosis refers specifically to cirrhosis which is caused by the consumption of alcohol.

If you drink large amounts of alcohol it can lead to a range of alcoholic liver diseases. The damage to the liver builds up gradually over many years until the liver stops working properly. Cirrhosis is the most severe type of alcoholic liver disease.

The liver is sometimes described as your body's "factory" as it carries out many different functions. To name a few, the liver:

helps to process and remove chemicals and drugs (including alcohol)
produces bile, which helps break down fats from digested food
filters and cleans the blood
makes enzymes and other proteins, such as the factors involved in blood clotting

As more scar tissue builds up, your liver can't function as efficiently and these processes can become disrupted. For example, your liver can become less able to process chemicals and drugs, which can cause toxins to build up in your blood.

Scar tissue also restricts the flow of blood through the liver and this can cause 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. The increased pressure can cause swellings in the vein to develop (called varices) in the lining of your stomach and oesophagus (the pipe that goes from your mouth to your stomach) which can bleed easily.

Symptoms

You may not have symptoms in the early stages of cirrhosis. However, as the condition gets worse and your liver finds it increasingly difficult to carry out its functions, your symptoms may include:

a yellowing of your skin and/or the whites of your eyes (jaundice) due to a chemical called bilirubin which is produce by the liver
swelling in your abdomen (tummy) and legs due to a build up of fluid
losing weight or muscle bulk (not including the weight caused by fluid building up in your body)
spider-like blood vessels showing up on your skin
bruising and bleeding easily
vomiting blood or blood in your faeces (which may appear black and tarry) - due to bleeding in your oesophagus or stomach
feeling confused or having a poor memory - due to toxins collecting in your brain
itchy skin - due to a build up of toxins
a high temperature (fever) due to infection - you are more prone to some infections if you have cirrhosis
a reddening of the skin of the palms of the hands and problems with the nails

Although not necessarily a result of cirrhosis, if you have these symptoms you should visit your GP. If you are vomiting blood, have black stools or develop a fever you should seek urgent medical attention.

Causes

There are a number of different causes of cirrhosis. In the UK, one of the main causes is high alcohol intake. It usually occurs as a result of many years of heavy drinking.

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

Your liver has an amazing capacity to repair and renew itself. However, when the cells become too badly damaged they are unable to do so and your liver becomes permanently scarred. Scarring happens progressively, usually over many years, and finally interferes with your liver's ability to work properly.

There is no specific amount of alcohol that will cause cirrhosis; the amounts that can cause liver damage vary from person to person. It's not just a condition which affects people who have an alcohol addiction. If you are a heavy social drinker or binge drinker you are also at an increased risk.

Diagnosis

Your GP will ask about your symptoms, examine you and will ask about your medical history. He or she 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.
An ultrasound, which uses sound waves to produce an image of your liver (see Related topics).
A CT scan, which uses X-rays to make a three-dimensional picture of your liver (see Related topics).
An MRI scan, which uses magnets and radiowaves to produce images of your liver (see Related topics).
A liver biopsy, in which a tiny piece of your liver is taken using a fine needle so that the doctor can look at it under the microscope and check the severity of the damage.
A gastroscopy, which is a test that allows your doctor to look at your oesophagus, as it may bleed as a result of portal hypertension. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope (see Related topics).

Complications

If you have liver cirrhosis, you are at an increased risk of getting liver cancer (see Related topics).

Treatment

Liver damage from cirrhosis is irreversible but you can prevent further damage to your liver. The most effective way to do this is to stop drinking alcohol. If you find you can't stop drinking, there are a number of ways that your doctor and support groups can help you (see Further information, and Related topics).

Your doctor will give you treatments that help to relieve any symptoms you may have as a result of cirrhosis. For example, you may be given a beta-blocker medicine for portal hypertension or diuretics for abdominal (tummy) swelling.

When your liver is so severely damaged that it can't function (liver failure), a liver transplant may be an option for you. Your doctor will discuss this with you but it is vital that you stop drinking alcohol - if you don't, the transplant is likely to fail.

Prevention

The best way to reduce your risk of getting alcoholic cirrhosis is to limit the amount of alcohol you drink or not drink alcohol at all.

The current guidelines for sensible drinking are:

for women, no more than two or three units of alcohol per day and no more than 14 per week
for men, no more than three to four units of alcohol per day and no more than 21 per week
to go without alcohol for 48 hours if you have exceeded these recommended amounts

It can be easy to underestimate how many units you are drinking, particularly as many alcoholic drinks are now stronger than they used to be. The following examples should help you track the amount you are drinking. Keep them in mind to keep yourself within sensible drinking limits.

A standard glass of wine (175ml) at 12% alcohol by volume (abv) is 2.1 units
A large glass of wine (250ml) at 12% abv is 3 units
A measure of spirits at 40% abv is 1.4 units
A pint of lager is around 2.3 units
A pint of cider is around 3.4 units