Life, Liver Cirrhosis and Me

The Liver

Your liver is your body’s ‘factory’ carrying out hundreds of jobs that are vital to life. It is very tough and able to continue to function when most of it is damaged. It can also repair itself – even renewing large sections.

Your liver has around 500 different functions.
Importantly it:

• fights infections and disease
• destroys and deals with poisons and drugs
• filters and cleans the blood
• controls the amount of cholesterol
• produces and maintains the balance of hormones
• produces chemicals – enzymes and other proteins –responsible for most of the chemical reactions in the body, for example, blood clotting and repairing tissue
• processes food once it has been digested
• produces bile to help break down food in the gut
• stores energy that can be used rapidly when the
  body needs it most
• stores sugars, vitamins and minerals, including iron
• repairs damage and renews itself.

Cirrhosis

Cirrhosis is a serious condition that destroys healthy tissue, leaving scar tissue, which blocks the flow of blood through an organ. It is usually associated with the liver, but can also affect other organs in the body.

The liver carries out many important functions. It stores glycogen, breaking it down into glucose that is then released into the bloodstream, providing energy. It also processes fats and proteins from digested food, produces essential blood clotting substances, removes poisons and toxins, such as alcohol, from the body, and produces bile that passes into the gut and helps digest fats.

Cirrhosis progresses slowly, and gradually causes a decline in the function of the liver. In the early stages of the disease, there may not be any symptoms, but as the condition of the liver deteriorates, serious problems can develop. For example, the liver will fail to control infection and blood clotting, and prevent bile from passing into the small intestine.

Causes

There are many different causes of cirrhosis, but in the UK, drinking alcohol and the hepatitis C infection are the most common causes.

Alcohol-related cirrhosis

The liver breaks down toxins and poisons, such as alcohol, but too much alcohol can damage the cells of the liver. If you are a heavy drinker, your chances of developing cirrhosis are increased. However, cirrhosis of the liver is not just a condition that affects people dependent on alcohol (alcoholics). If you are a heavy social drinker, you can also develop cirrhosis.

Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking, and affects about 10% of heavy drinkers. Some people are more susceptible to liver cell damage than others, although the reasons for this are unknown. Women who drink heavily are more susceptible to liver damage than men.

Hepatitis C-related cirrhosis

Hepatitis C is a blood-borne infection that can cause damage to the liver which, over time, may develop into cirrhosis. Other forms of the infection, hepatitis B and D, can also cause cirrhosis.

Other causes

A number of other conditions and inherited diseases that prevent healthy liver function can also lead to cirrhosis. For example:

• Heart failure – if you have had several instances of heart failure, it can cause high blood pressure and congestion in the liver.
• Autoimmune hepatitis – normally, the immune system makes antibodies to attack bacteria and viruses. However, if you have an autoimmune disease, such as autoimmune hepatitis, your immune system will make antibodies which attack healthy organs of the body, such as the liver.
• Some rare, genetic conditions such as Haemochromatosis (an excess build up of iron in the liver and other parts of the body), and Wilsons Disease (an excess build up of copper in the liver and other parts of the body).
• Any condition that causes the bile ducts to become blocked such as cancer of the bile ducts and cancer of the pancreas.

The use of certain drugs and exposure to certain environmental poisons and toxins can also cause cirrhosis.

If you have type 2 diabetes and you develop cirrhosis, your diabetes may get worse. In this type of diabetes, the body’s cells do not use insulin (a hormone produced by the pancreas) properly. This is known as insulin resistance. Cirrhosis can increase your resistance to insulin even more. If you have diabetes and you develop cirrhosis, you should discuss the implications with your GP.

Diagnosis

If, from your symptoms, your GP suspects that you have cirrhosis, s/he will carry out a physical examination and refer you for a number of further tests. If your liver feels enlarged or harder than usual, you may have liver damage.

A blood test will highlight any abnormal liver function. An ultrasound examination, or CT scan, may be carried out to diagnose problems in your liver. To confirm a diagnosis, a biopsy will be performed. This involves a small sample of liver cells being taken for examination under a microscope. The outcome may also provide further information about the underlying cause of your cirrhosis.

Treatment

Cirrhosis cannot be cured, but treatment can be provided to slow the progress of the condition. Cirrhosis tends to get progressively worse if the underlying cause persists. The way that cirrhosis is treated may depend on the underlying cause. 

If you have cirrhosis, you should not drink alcohol because doing so increases the rate that the condition progresses, regardless of the cause. You should talk to your GP or pharmacist if you are taking over-the-counter or prescription medicines as some medications are processed in the liver.

Treatment for underlying causes may include:

• medicines to treat autoimmune diseases that cause liver damage for example, removing copper from the body will help ease cirrhosis that occurs as a result of Wilsons Disease,
• medication, such as Interferon, to treat hepatitis, and
• regularly removing blood (approximately one pint) to reduce the high level of iron which occurs in Haemochromatosis.

There are also a number of treatments that are available to ease the symptoms of cirrhosis. For example, a low-sodium (low salt) diet, or water tablets, will help reduce the amount of fluid in your body. Also, medication to reduce high blood pressure (hypertension) and medicines and creams to reduce itching.

If you have bleeding from swellings (varices) in your oesophagus or gut, it is a medical emergency. You should see your GP, or go to A&E immediately, if you vomit blood, or pass blood in your faeces. Surgery can be used to stop the bleeding, and reduce the risk of it happening again.

If, as a result of long-term cirrhosis, your liver is extremely damaged by scarring, it may stop functioning altogether. In this situation, a liver transplant is the only option.

Prevention

Alcohol consumption

Heavy alcohol consumption is one of the most common causes of cirrhosis of the liver. Therefore, the best way to prevent alcohol-related cirrhosis developing is to stick to the recommended limits. These are as follows:

• men up to 21 units per week (3-4 units a day),
• women up to 14 units per week (2-3 units a day), and
• pregnant women one or two alcoholic drinks (1-2 units) once or twice a week, is unlikely to harm your unborn baby. However, the amount of alcohol that is definitely safe during pregnancy is unknown, so many women decide not to consume any while pregnant.

To find out how many units different types of alcoholic drinks equate to, you can use the interactive drinking calculator (see ‘related articles’).

If you have cirrhosis, you should stop drinking alcohol immediately because it speeds up the rate at which the condition progresses, regardless of the cause. If you are a heavy drinker, you need to cut down because the more alcohol that you consume above the recommended amounts, the greater the risk that you will develop cirrhosis.

Medication

If you have cirrhosis and are taking any prescribed or over-the-counter (OTC) medicines, you should tell your GP or pharmacist. If the medication that you are taking is processed by the liver, the dose may need to be changed, or you may be advised to stop taking it altogether.

Hepatitis B and C

Cirrhosis can be caused by infectious diseases, such as hepatitis B and C. Those who inject drugs and use dirty needles, are at risk of getting hepatitis B and C. People who are at risk of getting hepatitis B, such as police officers and social care workers, can be protected by being vaccinated against the condition.

Information page has been provided by NHS Direct and also the British Liver Foundation

A fantastic PDF document created by the British Liver Foundation can be downloaded here.