Published by Bupa's Health Information Team, October 2011.

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 excessive amounts of alcohol, usually over many years.

About alcohol-induced cirrhosis
Symptoms of alcohol-induced cirrhosis
Causes of alcohol-induced cirrhosis
Diagnosis of alcohol-induced cirrhosis
Complications of alcohol-induced cirrhosis
Treatment of alcohol-induced cirrhosis
Prevention of alcohol-induced cirrhosis

 

About alcohol-induced 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 and C, and by some inherited liver diseases.

Cirrhosis is the most severe form of a range of alcoholic-related liver diseases. If you drink excessive amounts of alcohol, you can develop a condition such as fatty liver disease or hepatitis (inflammation of the liver). Simple, uncomplicated fatty liver disease can usually be reversed by stopping drinking. People who continue to drink excessively are at risk of developing a more severe type of liver disease, such as hepatitis or cirrhosis.

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 and your GP could only have picked up signs of liver damage from a routine blood test. Early symptoms can include:

  • a loss of appetite
  • feeling sick and vomiting
  • itchy skin
  • weight loss

However, as the condition progresses, your symptoms may include:

  • a yellowing of your skin and/or the whites of your eyes (this is called jaundice)
  • swelling in your abdomen (tummy) and legs
  • muscle wasting
  • having spider-like blood vessels on your skin
  • bruising and bleeding easily
  • vomiting blood or having blood in your faeces (which may appear black and tarry and have an unpleasant smell)
  • 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
  • sexual changes – if you are a man, you may notice you have less body hair, smaller testicles (testicular atrophy) and more breast tissue (gynaecomastia); if you are 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, have black stools or develop a fever, you should seek urgent medical attention.

 

Complications of alcohol-induced cirrhosis

 
Scar tissue can restrict the flow of blood to your liver, causing 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. As the pressure increases, your blood tries to find another way back to your heart without going through your liver and expands veins in the lining of your stomach and oesophagus. These expanded veins (called varices) may bleed slowly, causing anaemia (a condition where you have too few red blood cells or not enough haemoglobin in your blood). There is also a risk that the varices can bleed severely and require emergency treatment.

Cirrhosis can lead to liver failure. This is where your liver is no longer able to function as it should. It can also lead to kidney failure (hepatorenal syndrome) and brain damage (encephalopathy).

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

Causes of alcohol-induced cirrhosis

 

One of your liver's many functions is to process the alcohol you drink. 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 become too badly damaged, the liver tissue can become permanently scarred. As scar tissue builds up, your liver can't function as efficiently. It will then become less able to process chemicals and medicines, 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.

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. In general, 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.

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. Your GP 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, including a liver function test to see how well your liver is working.
  • Scans, such as an ultrasound, CT scan or MRI scan.
  • Liver biopsy, in which a tiny piece of your liver is taken using a fine needle and examined under a microscope to see whether the tissue is damaged.

If your GP thinks you have developed varices in your oesophagus or stomach, you may need to have a gastroscopy. This is a test that allows your doctor to look at your oesophagus and stomach using a narrow, flexible, tube-like telescopic camera called an endoscope.

 

Treatment of alcohol-induced cirrhosis

 
Self-help

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 it difficult to stop drinking, speak to your GP. There are a number of ways that he or she can help, including recommending support groups.

Your GP or dietitian may advise you on your diet and appropriate nutritional supplementation as it’s important to prevent malnutrition.

Medicines

Your GP can give you medicines to help relieve the symptoms. For example, if you have portal hypertension, you may be given a beta-blocker to reduce the risk of bleeding. Or if you have abdominal swelling, your GP may prescribe a diuretic (water tablet) to help remove the fluid from your abdomen.

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

Surgery

If you have liver failure, a transplant may be an option. This is a major operation to remove your diseased 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.

 

Prevention of alcohol-induced cirrhosis

 

he 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. Stopping drinking alcohol can also prevent cirrhosis progressing if you already have it.

The current guidelines for sensible drinking are as follows.

  • Women shouldn’t regularly drink more than two or three units of alcohol per day.
  • Men shouldn’t regularly drink more than three to four units of alcohol per day.

It can be easy to underestimate how many units you're drinking. The following examples should help you track the amount you're drinking. Keep them in mind to make sure you stay within the sensible drinking limits.

  • A pint of cider at 6% alcohol by volume (abv) is around 3.4 units.
  • A pint of lager at 5% abv is around 2.8 units.
  • A standard glass of wine (175ml) at 13% abv is 2.3 units.
  • A large glass of wine (250ml) at 12% abv is 3 units.
  • A measure of spirits at 40% abv is 1 unit.

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

What will happen if I have alcoholic cirrhosis and continue to drink?
What if I feel I can't stop drinking?
If I have cirrhosis and continue to drink, can I receive a liver transplant?
I understand I am at an increased risk of cirrhosis if I binge drink. Drinking how many units of alcohol makes me a binge    drinker?
Can you cut out the part of the liver that has cirrhosis?

What will happen if I have alcoholic cirrhosis and continue to drink?

 
If you continue to drink alcohol when you have alcoholic cirrhosis, your condition will continue to get worse and you will reduce your chance of survival.

Explanation

By the time you find out that you have cirrhosis, your liver is likely to be severely damaged. Your liver can't recover if it's badly affected by cirrhosis, but you can help prevent any further damage by not drinking alcohol. If you stop drinking, you can almost double your chances of survival. However, if you continue to drink alcohol, you will cause further damage to your liver and reduce your chance of survival.

Further information

The British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk

Sources

 

What if I feel I can't stop drinking?

 
If you feel you can't stop drinking alcohol there are many professional services and support groups that can give you the help and support you need.

Explanation

It's important that you stop drinking to reduce any further damage to your liver and increase your chances of survival. If you’re finding it difficult to stop drinking, contact your GP, who will be able to help and can discuss the range of different treatment options with you. These include:

  • medicines to help reduce withdrawal symptoms while you stop drinking and to help stop you starting again
  • talking to your GP or a trained counsellor to address and treat any underlying problems or those caused by drinking, such as anxiety or depression
  • mutual support groups, such as Alcoholics Anonymous, that can help you while you give up (and give ongoing help to prevent you becoming dependent on alcohol again) by sharing personal experiences and advice with others who are alcohol dependent.

 

Further information

The British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk
 
Alcoholics Anonymous
0845 769 7555
www.alcoholics-anonymous.org.uk

Sources

  • Joint Formulary Committee. British National Formulary. 57 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009: 275
  • Who are we? Alcoholics Anonymous. www.alcoholics-anonymous.org.uk, accessed 5 October 2009

 

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

No, you won't be offered a liver transplant if you continue to drink alcohol.

Explanation

Cirrhosis is the main reason why people have a liver transplant. However, a liver transplant is usually only recommended if other treatments haven’t worked and your life is at risk. In the UK, you will be considered for a liver transplant after a period of abstinence (not drinking). If you continue to drink alcohol you won't be considered for a transplant.

If you have a liver transplant you’re expected not to drink alcohol for the rest of your life. You will be asked to sign an agreement, which states that you won’t drink after the transplant and you will take part in regular follow-up assessments.
 

Further information

The British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk
 

Sources

 

I understand I’m at an increased risk of cirrhosis if I binge drink. Drinking how many units of alcohol makes me a binge drinker?

 
Drinking over eight units for men and six units for women in one session is classed as binge drinking.
 

Explanation

Binge drinking is generally thought of as heavy drinking over a short period of time (usually one evening). Drinking heavily over such a short period quickly increases the amount of alcohol in your blood. This can lead to drunkenness and reckless behaviour, as well as breathing problems and heart irregularities.
 
Drinking eight or more units per day for men and six or more for women is regarded as binge drinking. These levels are twice the recommended daily allowance of three to four units per day for men and two to three units a day for women. If you do have a heavy drinking session, you shouldn't drink alcohol for at least 48 hours afterwards.
 

Further information

The British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk
 

Sources

 

Can the part of my liver that has cirrhosis be cut out?

No, part of your liver can't be cut out.

Explanation

If you have cirrhosis, scarring occurs in cells throughout your liver and isn't confined to any particular area. Therefore, having part of your liver removed as a treatment for cirrhosis isn't an option.
 

Further information

The British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk
 

Sources

 
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
 
Publication date: January 2010.

Alcohol-induced cirrhosis factsheet

 
Visit the alcohol-induced cirrhosis health factsheet for more information.
 

Related topics

Abdominal ultrasound
Alcohol dependence
Alcohol - sensible drinking
Anaemia – an overview
Beta blockers
CT scan
Fatty liver disease
Gastroscopy
Hepatitis A
Hepatitis B
Hepatitis C
Liver cancer
MRI scan

Further information

British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk
 
Alcoholics Anonymous UK
0845 769 7555
www.alcoholics-anonymous.org.uk
 

Sources

 
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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