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Alcohol-induced cirrhosis

Cirrhosis is a condition where your liver becomes permanently scarred and damaged, preventing it from working properly. Cirrhosis can be caused by a number of things. However, our information here will look at how drinking too much alcohol over time can cause 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 
  • hepatitis C 
  • some inherited liver diseases
  • conditions where your immune system reacts against healthy liver tissue

Drinking excessive amounts of alcohol can lead to conditions such as fatty liver disease or alcoholic hepatitis (inflammation of the liver). If you have fatty liver disease it may be reversed if you stop drinking alcohol. If you continue to drink excessively, you’re at risk of developing a more severe type of liver disease, such as cirrhosis, which is irreversible.

Cirrhosis is classed as either compensated or decompensated. If you have compensated cirrhosis, your liver is able to cope with the damage and may continue to carry out its important functions. Most people with compensated cirrhosis have few or no symptoms. However, if you continue to drink alcohol you're likely to develop decompensated cirrhosis. If you have decompensated cirrhosis, you will usually develop severe symptoms and complications.

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Long-term effects of alcohol
If you regularly drink too much alcohol, you can be putting your long-term health at risk

Details

  • Symptoms Symptoms of alcohol-induced cirrhosis

    In the early stages of cirrhosis, you might feel quite well and not have any symptoms. Your GP may only pick up on signs of liver damage from a routine blood test.

    If you do have symptoms, early signs may include:

    • tiredness and weakness
    • a loss of appetite
    • feeling sick and vomiting
    • multiple red spots with a spider like appearance on your skin that are above your waist
    • weight loss

    As cirrhosis progresses, your symptoms may include:

    • itchy skin
    • a yellowing of your skin and/or the whites of your eyes (jaundice)
    • hair loss
    • swelling in your abdomen (tummy) and legs
    • bruising and bleeding easily
    • vomiting blood
    • pale or very black and tarry stools
    • 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
    • hormonal changes – if you’re a man you may notice you have less body hair, smaller testicles (testicular atrophy) and more breast tissue (gynaecomastia)
    • hormonal changes – if you’re a woman you may have irregular periods

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

    If you're vomiting blood, or have black stools, you should seek immediate medical attention.

  • Diagnosis Diagnosis of alcohol-induced cirrhosis

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

    You may need to have one or more of the following tests.

    • A blood test to determine how well your liver is working.
    • Scans, such as an ultrasound.

    If your GP suspects that you have cirrhosis you may be referred to a hepatologist (a doctor who specialises in conditions of the liver). Your hepatologist may recommend further tests.

    • CT or MRI scan may be able to show how advanced your cirrhosis is.
    • A liver biopsy is when a small sample of your liver is taken. It will be sent to a laboratory to be examined under a microscope to see whether the tissue is damaged.
    • If your doctor thinks you may have developed varices in your oesophagus or stomach, you may need to have an endoscopy. This is a test that looks at your oesophagus and stomach using a narrow, flexible, tube-like telescopic camera called an endoscope.
  • Treatment Treatment of alcohol-induced cirrhosis

    Self-help

    The best way to prevent further damage to your liver is to stop drinking alcohol. If you find it difficult to stop drinking, speak to your GP. There are a number of ways that he or she can help, including referral for a medically supervised alcohol detox. They may also be able to give you details about local support groups.

    Our resources section has some information you may find helpful. Your GP or dietitian will also advise you to follow a balanced diet and to exercise regularly. This may help to reduce your chance of developing further problems that are linked to cirrhosis, such as osteoporosis.

    Medicines

    Your GP might prescribe you medicines to help relieve your symptoms, and reduce your chance of complications.

    If you develop fluid in your abdomen, you may be prescribed a diuretic (water tablet). If you’re prescribed a diuretic, you may also be advised to reduce the salt in your diet to less than 2g per day. Some evidence suggests that if you cut down the salt in your diet while taking a diuretic, it may help to reduce ascites.

    If you have portal hypertension, you may be given a beta-blocker to reduce the risk of bleeding.

    It’s important to remember not to take non-steroidal anti-inflammatory drugs (such as aspirin or ibuprofen) and high doses of paracetamol. This is because these medicines may cause further damage to your liver.

    Always ask your GP or pharmacist for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    If you develop end stage cirrhosis you may be offered a liver transplant. This is a major operation to remove your damaged 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. You will also need to take medicines to prevent your donor liver from being rejected by your body.

    You may also need surgery if you develop varices and they start to bleed severely. You may need a procedure called band ligation. This is when small elastic bands are placed around your varices to tie them off to stop the bleeding.

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  • Causes Causes of alcohol-induced cirrhosis

    As its name suggests, alcohol-induced cirrhosis is caused by drinking alcohol – usually after many years of heavy drinking. Your liver has many functions, one of which is to process substances like alcohol. 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 in your liver become too badly damaged, your liver tissue can become permanently scarred. As the scar tissue builds up, it stops your liver from functioning efficiently. This will prevent it from processing chemicals and drugs, 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.

    There’s no specific amount of alcohol that will cause cirrhosis; it varies from person to person. But, 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.

  • Complications Complications of alcohol-induced cirrhosis

    Organ failure

    If you have alcohol-induced cirrhosis, the healthy cells of your liver are gradually replaced by scar tissue. This may cause liver failure. Liver failure is when your liver is no longer able to function as it should.

    Cirrhosis may also lead to kidney failure (hepatorenal syndrome) and brain damage (encephalopathy).

    Liver cancer

    If you have cirrhosis, your risk of getting hepatocellular carcinoma, the most common type of liver cancer, increases.

    Fluid in your abdomen

    A common complication of cirrhosis is fluid in your abdomen (ascites). This is when your abdomen becomes swollen due to a build-up of fluid. If the fluid becomes infected it can cause abdominal pain and a fever. If this happens you will need urgent medical attention.

    High blood pressure

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

    When this happens the veins in the lining of your stomach and oesophagus (the pipe that goes from your mouth to your stomach) expand. These expanded veins, often referred to as varices, may bleed slowly, causing anaemia (a condition where you have too few red blood cells). Sometimes varices can cause you to lose blood very quickly. If this happens, you will need immediate medical treatment.

  • Prevention 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. Not drinking alcohol can also prevent cirrhosis progressing if you already have it. When it comes to alcohol, sensible drinking means staying within recommended limits. In the UK, proposed new guidelines recommend that you should not regularly drink more than 14 units over the course of a week. If you do drink as much as 14 units, you should spread it over three days or more, rather than 'saving up' units.

    An easy way to cut back on your intake is to have several drink-free days each week.

    The examples below might give you an idea of how much you're drinking. Keep them in mind to make sure you stay within the sensible drinking limits.

    • A pint of cider is around 3.4 units.
    • A pint of lager is 3 units.
    • A large glass of wine (250ml) is 3 units.
    • A measure of spirits (25ml) is 1 unit.

    If you want to find out how many units you’re drinking, try our alcohol calculator.

  • FAQs FAQs

    If I have alcohol-induced cirrhosis and continue to drink, can I have a liver transplant?

    Answer

    If you’ve been selected for a liver transplant, you will be asked not to drink alcohol for a certain amount of time before your transplant. You will also be asked not to drink at all following your transplant.

    Explanation

    A liver transplant is a major operation to remove your damaged liver and replace it with a healthy liver from a donor. You may only be offered a liver transplant if other treatments haven't worked or you have developed a complication. You may be considered for a liver transplant after a period of abstinence (not drinking), usually for six months.

    If you have a liver transplant you will be expected not to drink alcohol for the rest of your life. This is because drinking alcohol will put strain on your new liver. You will be asked to sign an agreement, which states that you won't drink alcohol after your transplant and will take part in regular follow-up assessments. This includes routine blood tests to check that you haven’t had any alcohol. 

    I have alcohol-induced cirrhosis, but am finding it difficult to stop drinking. How can I help myself?

    Answer

    If you’re struggling to stop drinking talking to your GP should be your first step. They can put you in touch with professional services and support groups that can give you the help you need.

    Explanation

    If you have alcohol-induced cirrhosis, it's important that you stop drinking to reduce any further damage to your liver. But if you're finding it difficult to give up, contact your GP.

    Talking to your GP may help to identify your difficulties with alcohol and any underlying problems you may have, such as anxiety or depression. They may be able to refer you for a medically supervised alcohol detox. Your GP may also be able to recommend support groups, such as Alcoholics Anonymous.

    Support groups such as Alcoholics Anonymous can help you give up alcohol and ensure that you don’t start drinking again. The support provided by others sharing personal experiences and advice, can help you to stay away from alcohol.

    You may also find it helpful to speak to family or friends.

    What is binge drinking?

    Answer

    The term ‘binge drinking’ usually refers to consuming lots of alcohol in a short space of time, or drinking to get drunk.

    Explanation

    Binge drinking is generally thought of as heavy drinking over a short period of time (usually one evening). It’s important to note that getting very drunk can affect your balance and co-ordination. This can lead to accidents and falls. Binge drinking can also cause aggressive and anti-social behaviour. Rarely, binge drinking can cause you to stop breathing or stop your heart.

    Binge drinking can be defined by the number of units you drink. In a single session, this is eight or more units for men and six or more for women.

    What will happen if I have alcohol-induced cirrhosis and continue to drink?

    Answer

    Your condition is likely to progressively get worse and lead to liver failure, which can be fatal. However, further damage to your liver can be prevented if you stop drinking.

    Explanation

    If you have alcohol-induced cirrhosis, your liver will be scarred and damaged. If you continue to drink, you will cause further damage to your liver and it may lead to liver failure. This is where your liver is no longer able to function as it should. You may not be able to reverse the damage to your liver from cirrhosis. However, you can prevent further damage to it by not drinking alcohol. If you have cirrhosis and stop drinking alcohol, you can improve your chances of survival.

  • Resources Resources

    Further information

    Sources

    • Cirrhosis, Alcohol, Alcohol and drugs, Patient and carer support. British Liver Trust. www.britishlivertrust.org.uk, accessed 24 March 2014
    • Life after liver transplant. The British Liver Trust. www.britishlivertrust.org.uk, published October 2008
    • Ascites. PatientPlus. www.patient.co.uk/patientplus.asp, accessed 19 March 2014
    • Steatohepatitis and steatosis (fatty liver). PatientPlus. www.patient.co.uk/patientplus.asp, published 2 July 2013
    • Diuretics. PatientPlus. www.patient.co.uk/patientplus.asp, published 11 June 2013
    • Alcoholism and alcohol abuse - management. PatientPlus. www.patient.co.uk/patientplus.asp, published 14 December 2012
    • Alcohol-related problems. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 October 2012
    • Oesophageal varices. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 July 2012
    • Cirrhosis. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 October 2011
    • Portal hypertension. PatientPlus. www.patient.co.uk/patientplus.asp, published 25 August 2010
    • Alcoholic liver disease. BMJ Best Practice. bestpractice.bmj.com, published 27 February 2014
    • Cirrhosis. BMJ Best Practice. bestpractice.bmj.com, published 12 April 2013
    • Alcohol - problem drinking. Nice Clinical Knowledge Summaries. cks.nice.org.uk, published December 2011
    • Functions of the liver, Compensated cirrhosis. The Hepatitis C Trust. www.hepctrust.org.uk, accessed 3 March 2014
    • Concise colour medical dictionary. 3rd ed. Oxford: Oxford University Press; 2002:27, 28, 392, 701 (printed version)
    • What is an alcohol unit? Drinkaware. www.drinkaware.co.uk, published April 2014
    • Alcohol and liver disease, Alcohol dependence, Alcohol and mental health, Binge drinking. Drinkaware. www.drinkaware.co.uk, published March 2014
    • How much alcohol is too much? Drinkaware. www.drinkaware.co.uk, published February 2014
    • Alcohol guidelines. House of Commons Science and Technology Committee, www.publications.parliament.uk, published 7 December 2011
    • Gu X, Yang X, Zhu H, et al. Effect of a diet with unrestricted sodium on ascites in patients with hepatic cirrhosis. Gut Liver 2012; 6(3):355–61. doi:10.5009/gnl.2012.6.3.355
    • O’Shea R S, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology 2010; 51(1):307–28. doi:10.1002/hep.23258
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 26 March 2014 (online version)
    • Reduce harmful drinking. GOV.UK. www.gov.uk, published 25 March 2013
    • Alcoholics Anonymous. www.alcoholics-anonymous.org.uk, accessed 27 March 2014
    • Liver selection policy. Organ donation and transplantation. www.odt.nhs.uk, published January 2014
    • European Association for the study of the liver. Clinical practice guidelines on the management of alcoholic liver disease. Journal of Hep 2012; 57:399–420
    • Endoscopy. The Merck Manuals. www.merckmanuals.com, published February 2013
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    Reviewed by Kuljeet Battoo, Bupa Health Information Team, July 2014.

    This information was updated in January 2016 following revisions to the Department of Health’s guidelines for alcohol consumption.

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