Alcoholic Cirrhosis of the Liver

What It Is, and How To Prevent It

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Liver cirrhosis is advanced scarring of the liver. Heavy alcohol use is one of the most common causes of cirrhosis. Although cirrhosis may not cause symptoms in the early stages, complications are serious.

What Does the Liver Do, and Why Is It So Important?

The liver is a large organ in the upper right part of your abdomen. It plays a key role in nutrition, digestion, the immune system, cholesterol, and vitamin storage.

An important function of the liver is to metabolize external substances such as toxins and drugs, including alcohol. Metabolism is the chemical transformation of a substance by an enzyme to convert it into a form more readily eliminated from the body. Liver damage from any cause can make the liver less efficient at metabolizing alcohol.1 In turn, heavy alcohol use itself is one of the main causes of liver damage.

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How Does Alcohol Affect the Liver?

Because the liver is the main organ involved in metabolizing alcohol, the liver is also susceptible to damage from excessive alcohol use. Not only does alcohol directly injure liver cells, but the body’s response (inflammation and scarring) causes additional damage.

Heavy alcohol use can cause short-term and long-term liver disease. For example, drinking more than 40 grams of alcohol per day for months or years greatly increases your risk of developing alcoholic fatty liver disease (the accumulation of triglycerides inside the liver cells).

If alcohol use continues, alcoholic fatty liver disease may progress to a condition called alcoholic steatohepatitis, with active inflammation. And if liver damage and inflammation continues for years beyond this, liver tissue can be replaced by scar tissue in a process called fibrosis. Cirrhosis of the liver is advanced, severe fibrosis.

One serious complication of cirrhosis is a type of liver cancer called hepatocellular carcinoma. People with cirrhosis or alcoholic steatohepatitis may also develop alcoholic hepatitis—an acute episode of liver damage that can cause jaundice (yellowing of the skin and eyes), as well as liver failure.

feet in white shoes on red carpet
infographic showing 4 stages of alcoholic liver disease
infographic showing 4 stages of alcoholic liver disease

What Is Cirrhosis of the Liver?

Liver cirrhosis is the most advanced stage of liver fibrosis. In cirrhosis, much of the liver’s tissue has been replaced by scar tissue.

What Causes Cirrhosis?

Cirrhosis results from prolonged injury to the liver. The most common causes of cirrhosis in western countries are alcohol, infection with the hepatitis C virus, and nonalcoholic fatty liver disease. In the Asia-Pacific region the main cause of liver cirrhosis is infection with the hepatitis B virus.2

Not everybody who drinks heavily will develop cirrhosis. The following factors increase the risk for alcoholic liver disease and cirrhosis among people who are drinking alcohol:

  • Obesity
  • Sex: Females are more sensitive than males to the effects of alcohol
  • Genetic factors
  • Hepatitis B or hepatitis C infection
  • Exposure to other substances that may damage the liver
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What are the Symptoms of Cirrhosis of the Liver?

Although cirrhosis is the most advanced stage of liver fibrosis, it may not cause any symptoms until complications develop.

Common signs and symptoms of cirrhosis include:

  • Fatigue
  • Weight loss
  • Poor appetite
  • Easily bruising or bleeding
  • Hard, nodular liver tissue and/or pain in the upper right part of the abdomen
  • Enlarged spleen in the upper left part of the abdomen
  • Jaundice: Yellowing of the skin, eyes, and tissue lining the mouth
  • Peripheral edema: Swelling of the feet and ankles from accumulation of fluid
  • Ascites: Swelling of the abdomen from accumulation of fluid. This fluid may also become infected.
  • Spider angiomata: Collection of small dilated blood vessels on the skin
  • Vomiting blood
  • Patches of red skin, or thickened knots and bands of tissue on the palm of the hand
  • Enlargement of breast tissue and/or shrunken testicles in men
  • Asterixis: Tremor of the hand when the hand is extended upwards from the wrist
  • Hepatic encephalopathy: Confusion, disorientation, memory loss, trouble concentrating

Read More: Early Signs of Liver Damage From Drinking

How Is Cirrhosis Diagnosed?

Blood tests, imaging studies, and liver biopsies are among the most common ways to diagnose cirrhosis of the liver.

When it comes to blood tests, elevated liver enzymes are one of the best-known telltale signs. The classic finding in alcoholic liver disease is aspartate aminotransferase (AST) greater than alanine aminotransferase (ALT). We should note, however, that in severe cirrhosis liver enzymes may revert to normal.

Other common blood test results found in people with cirrhosis include:

  • Elevated bilirubin
  • Decreased albumin
  • Elevated ammonia
  • Decreased sodium
  • Elevated international normalized ratio (INR)—which indicates a decrease in the ability to form blood clots
  • Low hemoglobin, a measure of red blood cells
  • Low platelets, a type of blood cell involved in blood clotting

Imaging studies to examine the liver include:

  • Liver ultrasound: A test that uses the reflection of sound waves to show the size and characteristics of liver tissue.
  • Transient elastography (e.g. FibroScan): A specialized ultrasound of the liver that measures liver stiffness
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)

The definitive test for cirrhosis is a liver biopsy, in which a small piece of liver tissue is removed with a needle and examined under a microscope. Because a biopsy is invasive and only examines a limited area of the liver, the use of blood tests and imaging studies to diagnose cirrhosis is becoming more widespread.

How Is Cirrhosis Treated? Is Cirrhosis Reversible?

Recent evidence suggests that liver cirrhosis may be reversible in some individuals.3 However, care for people with cirrhosis mainly focuses on preventing liver disease from getting worse, and treating complications.

If you’ve been diagnosed with cirrhosis, it’s crucial that you stop drinking alcohol. Continued drinking raises the risk of acute hepatitis on top of cirrhosis. Abstinence from alcohol may also prevent cirrhosis from getting worse.

Many complications of cirrhosis can be treated or prevented, and there are some medications used to treat liver disease. For example:

  • Diuretics (water pills) can help treat ascites and edema, causing the kidneys to eliminate the extra fluid. Antibiotics can treat infection in the ascites fluid. Dietary changes, such as limiting salt intake, can also help with these conditions.
  • Oral medications called beta-blockers can prevent bleeding in the esophagus and stomach.
  • Medications like lactulose or rifaximin can treat encephalopathy, helping with confusion and memory loss.

However, there may be a point at which the complications of liver cirrhosis are no longer treatable with medications. In this case, a liver transplant may be appropriate.

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How Long Can You Live With Cirrhosis of the Liver?

The outlook once you have alcoholic cirrhosis depends on whether you continue to drink, and whether you have any complications.

The Child Pugh Turcotte (CPT) classification system is one way of predicting life expectancy for cirrhosis patients.4 It uses five parameters (encephalopathy, ascites, bilirubin, albumin, and INR) to characterize the severity of cirrhosis. Individuals with the least severe cirrhosis (class A) have an average life expectancy of another 15 to 20 years. Those with the most severe degree of cirrhosis (class C) have an average life expectancy of one to three years.

What Can You Do If You Have Cirrhosis?

If you have alcoholic cirrhosis of the liver, take the following steps to help you maximize your healthy years:

  1. Quit drinking.
  2. See a liver specialist (hepatologist)
  3. See a primary care provider to manage any other chronic illnesses and stay on top of your overall health.
  4. Get vaccinated for hepatitis A and B to prevent infection with these viruses, which could cause further liver damage.
  5. See a dietitian for advice on the best foods and supplements to eat when living with cirrhosis.

If you’re struggling to quit drinking on your own, there are many ways to find support, including online programs like Ria Health. Our medical team is experienced at helping people with advanced liver disease quit using alcohol, and can even prescribe anti-craving medications that may be safe for your liver.

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