chronic hepatitis damages liver cells over years or even decades, leading the
liver to become scarred and hardened. When this scarring is advanced it is
known as ‘cirrhosis’.
can continue to carry out its functions despite the scarring for a long time
and can compensate for the damage ('compensated cirrhosis'). Later, however,
the liver becomes restricted in its functions ('decompensated cirrhosis').
of cirrhosis may include:
- Muscle wasting.
- Swollen spleen.
- Ascites: swelling of the
abdomen, caused by the accumulation of fluid. It is treated by reduced
salt intake, controlled fluid intake and diuretics (drugs which promote
urination). If this fails to improve the ascites, fluid may be withdrawn
via paracentesis.1 A device called ALFApump
may reduce ascites by channelling the fluid from the abdomen to the
- Oedema: swelling, usually of
the feet, ankles, and lower legs, due to the accumulation of fluid.
- Varices (abnormally
distended blood vessels). Blood vessels around the gullet and stomach
enlarge because the blood is trying to find a way around the scarred
liver. Varices can bleed into the stomach, causing vomiting of blood or
passing of black stools. Burst varices require immediate medical
- Circulatory changes. The
damaged liver may fail to produce blood-clotting proteins, leading to easy
bruising and prolonged bleeding. Patients may also develop high blood
pressure (portal hypertension) as blood backs up in the scarred liver.
Drugs called beta-blockers may be used to relieve portal hypertension.
- Pruritis (itching). People
with cirrhosis may experience an itching sensation of the skin or internal
organs due to the build-up of bile and other toxic chemicals.
- Encephalopathy. Patients may
experience impaired mental function and personality changes because the
liver is not breaking down waste products such as ammonia in the blood as
efficiently as it should or because blood is bypassing the liver. At its
most severe, this can lead to coma or death. Laxatives (lactulose), ornithin
aspartate or a specific antibiotic (rifaximin) are sometimes used to treat