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Alcohol-induced cirrhosis

Published by Bupa's health information team, January 2010.

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 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 of alcohol-induced cirrhosis
Causes of alcohol-induced cirrhosis
Complications of alcohol-induced cirrhosis
Diagnosis of alcohol-induced cirrhosis
Treatment of alcohol-induced cirrhosis
Prevention of alcohol-induced cirrhosis
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 (this process is called fibrosis). Your liver tissue, which should be smooth, becomes lumpy (nodular) and hard. Alcohol-induced cirrhosis refers specifically to cirrhosis that is caused by drinking alcohol.

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

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

helps to process and remove chemicals and drugs (including alcohol)
produces bile, which helps break down fats from digested food
filters and cleans your blood
makes proteins
breaks down food and converts it into energy and stores glycogen, ready to turn it back into glucose for your body to use when necessary

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 harmful substances (toxins) to build up in your blood.

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. However, as the condition gets worse and your liver finds it more 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 produced by your liver
swelling in your abdomen (tummy) and legs due to a build up of fluid
losing weight or muscle (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 stomach or oesophagus (the pipe that goes from your mouth to your 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're more likely to get certain infections if you have cirrhosis
a reddening of the skin on the palms of your hands and problems with your nails

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

Causes of alcohol-induced cirrhosis

Scar tissue restricts the flow of blood through your liver. This can cause a build up of pressure in the vein that takes blood from your gut to your liver (your portal vein). This is known as portal hypertension. As the pressure increases, the blood tries to find another way back to your heart without going through your liver. It expands veins in the lining of your stomach and oesophagus. These expanded veins (called varices) may bleed slowly, causing anaemia (tiredness and shortness of breath). There is also a risk that they will bleed severely and require emergency treatment.

If you have liver cirrhosis, you're more likely to get liver cancer.

Complications of alcohol-induced cirrhosis

One of your 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 is usually able to repair and renew itself. However, when the cells become too badly damaged they aren't able to do so and your liver becomes permanently scarred. Scarring happens progressively, usually over many years, and eventually stops your liver 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. It doesn't only affect people who have an alcohol addiction. If you're a heavy social drinker or binge drinker you also have a higher chance of getting cirrhosis.

Diagnosis of alcohol-induced cirrhosis

Your GP will ask about your symptoms, examine you and 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
a CT scan, which uses X-rays to make a three-dimensional picture of your liver
an MRI scan, which uses magnets and radiowaves to produce images of your liver
a liver biopsy, in which a tiny piece of your liver is taken using a fine needle and examined under a microscope and check the severity of the damage
a gastroscopy, which is a test that allows your doctor to look at your oesophagus for signs of complications, using a narrow, flexible, tube-like telescopic camera called an endoscope

Treatment of alcohol-induced cirrhosis

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 you can't stop drinking, there are a number of ways that your doctor and support groups can help you.

Your doctor can 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 badly damaged that it can't function (liver failure), a liver transplant may be an option. Your doctor will discuss this with you. If you do have a liver transplant, you must stop drinking alcohol - if you don't, the transplant is likely to fail.

Prevention of alcohol-induced cirrhosis

The best way to reduce your chance 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:

women should drink no more than two or three units of alcohol per day and no more than 14 per week
men should drink no more than three to four units of alcohol per day and no more than 21 per week

If you have exceeded these recommended amounts, you should go without alcohol for 48 hours.

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

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