Liver cirrhosis: causes, symptoms, and treatment

Written by: Professor Raj Mookerjee
Edited by: Conor Lynch

Liver cirrhosis is a condition that occurs when one's liver suffers gradual deterioration as a result of scarring and/or chronic injury, and, if left untreated, can lead to many problematic complications.


In our latest article, esteemed London-based consultant hepatologist, Professor Raj Mookerjee, details the causes and symptoms of liver cirrhosis, whilst also revealing how the condition is most effectively managed and treated.

What is liver cirrhosis?

When the liver is damaged, there is an increase in scar tissue formation. This is usually driven by inflammation-based processes.


Over time, the scar starts to become more organised, which we refer to as fibrosis. Here, a patient will progress through more and more high grades of fibrosis until it’s very organised.


That organised scar tissue in the liver is what we define as cirrhosis. In other terms, this conditions points towards increasing impairment of not only the function of the liver, but also impacts things such as the blood circulation and flow going through the liver, as well as the function of the immune system.


What is the main cause of liver cirrhosis?

In the Western world, the most common causes include alcohol-based liver injuries. In the UK, we probably see between 60 and 70 per cent of causes of cirrhosis driven by alcohol consumption.


However, increasingly, obesity and diabetes are appearing to significantly drive fatty deposition in the liver, and this condition (fatty liver disease) has an increasing impact on progression to liver cirrhosis. Other common cause is inflammatory liver disease.


What symptoms are associated with liver cirrhosis?

Some patients with cirrhosis, in the early stage, will have no symptoms at all. As the disease progresses, symptoms may include abdominal swelling caused by fluid, or an increased swelling of the legs.


What different types of cirrhosis complications are there, and what is the most common?

Abdominal swelling and lower limb swelling is, for sure, the most common presentation and complication associated with liver cirrhosis. Other common complications include the risk of bleeding and kidney dysfunction.


Another very common finding is a change in patient’s higher brain function, which can cause confusion, or just not being as effective when it comes to carrying out and performing daily tasks. Higher brain function changes can then progress to the point where patients become increasingly sleepy.


How is liver cirrhosis managed and treated?

Cirrhosis management is trying to see if one can prevent the onset of complications. So, we go from a stage that we refer to as compensated cirrhosis (where patients are still able to work and live without interference) to a stage that we call decompensation (where the patient is unable to carry on working). So, our priority here is really to do everything we can to avoid patients getting to the stage of decompensation.


Once patients present with decompensation, then the real goal is to try and prevent them progressing further still, which would lead to the patient either requiring a liver transplant or succumbing to the disease.


There is no specific treatment for cirrhosis currently, but I think the new treatments that will become available in the next few years will specifically focus on the sources of inflammation and bacteria forming in the gut, to try and effectively reduce the progression of liver cirrhosis.


Professor Raj Mookerjee is a highly proficient consultant hepatologist who specialises in conditions that affect the liver, such as liver cirrhosis. Consult with him today via his Top Doctors profile.

By Professor Raj Mookerjee

Professor Raj Mookerjee is a consultant hepatologist based in London, with a specialist interest in management of cirrhosis complications and alcoholic liver disease. His practice also addresses management of fatty liver and derangement of liver function tests, in addition to endoscopic management of liver conditions including varices. He privately practices at The Royal Free Private Patient Unit and London Medical, Marylebone.  His NHS practice base is at The Royal Free London NHS Foundation Trust.

Professor Mookerjee's work specifically centres around the complications of chronic liver disease and liver failure. He's at the forefront of research for new therapies for portal hypertension and managing cirrhosis complications, including the application of innovative remote monitoring of cirrhosis to provide early intervention, and incorporating novel biomarkers to assess liver disease progression. Recently, Professor Mookerjee and his team were the first to trial the CirrhoCare app, which will allow hepatologists to remotely monitor liver disease patients. 

Professor Mookerjee qualified with a First Class BSc and then a Distinction MBBS from University College London (UCL). After graduating, he went onto pursue a specialist training program in gastroenterology and hepatology within the Central and North London Deanery, including Liver transplantation experience at The Royal Free. Professor Mookerjee completed his specialist training in 2005. During this period, he also completed a PhD that focussed on new mechanisms for portal hypertension. He then took up a post as Consultant Hepatologist at UCLH and went onto to lead that service before its migration and integration into the Royal Free Liver and Transplantation Unit in 2010, where he continues to be based. 

He also has an esteemed academic research and teaching career which currently sees him as Professor of Translational Hepatology for leading institution University College London, and he is also a Skou Professor of Hepatology at Aarhus University in Denmark. Additionally, his international role also includes him serving on the steering committee for the European Foundation for Chronic Liver Failure research (EF-CLIF), and on the educational committee for the European Association for the Study of the Liver (EASL). 

He is also within a professional working group that has written the International Guidelines for managing cirrhosis complications. Nationally, he serves on the Committee for Hepatology Training and also within the Board of the British Association of Studies of the Liver (BASL), as Secretary-elect, and within a special interest group for managing portal hypertension. He is also a fellow of the Royal College of Physicians.  

Professor Mookerjee's research over the last two decades spans the breath of translation including delivery of First-in-Man studies in cirrhosis patients. He has been principal investigator of many multi-centre clinical trials and has published in many peer-reviewed journals, with an h-index of 50. He is a regular invited speaker to many international meetings and is passionate about seeing new concepts reach early clinical translation for the benefit of patients.  


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