Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. It is the result of long-standing injury most commonly due to alcohol in excess but there are a number of other important causes (see below).

The destruction of the normal architecture and the loss of liver cells prevents the liver from functioning normally. It plays an important part in digestion of food but it also has a major role in metabolising drugs and making proteins, including those that help the blood to clot.

Cirrhosisis a serious condition. Only 30 per cent of patients with this problem will survive five years after diagnosis and the outlook is worse if the cause is alcohol and the patient continues to drink.

The symptoms will depend on how much damage has occurred to the liver.

In the early stages there may be no symptoms at all and the disease may be discovered as a result of an investigation for another illness.

As the disease progresses, tiredness, weakness, lack of energy, loss of appetite, nausea and weight loss may develop.

In the later stages the liver is struggling to perform all its functions and any or all of the following symptoms may be present.

• Jaundice: this is the yellowing of the skin (jaundice) and the eyes due to the failure of the liver to remove a substance called bilirubin from the blood.
• Nail changes: the shape and appearance of the nails may change. They may be more curved (clubbing) and they may be white rather than pink.
• Skin changes: about a quarter of patients will have darkening of the skin.
• Fluid retention: this is common at some stage in cirrhosis. An important function of the liver is to rid the body of excess fluid through the kidneys and when it fails, fluid gathers in the legs (oedema) or in the abdomen (ascites).
• Abnormal blood vessels: the commonest abnormality is a spider naevus, which is a spot surrounded by fine blood vessels. A red face is also common.
• Easy bruising: nosebleeds and easy bruising occur as a result of abnormal blood vessels and delayed clotting because the liver does not make enough clotting proteins.
• Enlargement of breasts in men: the liver destroys the female sex hormones and in cirrhosis these accumulate and cause enlargement of the breasts and shrinking of the testes in men.

The liver is responsible for removing poisonous substances from the blood. In cirrhosis, the blood may bypass the liver and these poisonous substances pass to the brain where they may result in alteration in brain function, causing confusion, drowsiness and finally coma. This is called hepatic encephalopathy. This is also serious and requires hospital treatment.