Cirrhosis in over 16s: assessment and management

Context

Cirrhosis is a condition that occurs as a response to liver damage. It is characterised at a cellular level by distortion of the normal liver structure into nodules of liver tissue surrounded by fibrosis. It usually takes several years for liver damage to develop into cirrhosis. Approximately 10% to 20% of people with 1 of the 3 most common chronic liver diseases (non-alcoholic fatty liver disease, alcohol-related liver disease and chronic viral hepatitis) develop cirrhosis over a period of 10 to 20 years. Although people may have physical signs of cirrhosis or its complications, such as jaundice, abdominal swelling due to ascites, muscle wasting, enlargement of male breast tissue and testicular atrophy, the clinical identification of cirrhosis is imperfect, especially in people with compensated disease. In addition, 40% of people with cirrhosis have no symptoms of liver disease.

People admitted to hospital with liver disease in England in 2012 were more likely to die compared with all-cause admissions (8.8% compared with 1.4%). Nearly half of liver disease admissions were for alcohol-related liver disease and 12.3% of these admissions resulted in death. Finished admission episodes with a primary diagnosis of cirrhosis in English NHS hospitals rose from 3,783 in 2005 to 2006 to 5,621 in 2014 to 2015 (a 48.6% increase). Consequently, the Chief Medical Officer has identified liver disease as 1 of the key issues for health in England because it is the only major cause of mortality and morbidity that is on the increase.

This guideline offers best practice advice on the diagnosis and management of suspected or confirmed cirrhosis in people aged 16 years or older. The causes of cirrhosis in children and young people are generally different from those in adults (for example, biliary atresia), and the diagnosis and management of these conditions is different. However, the recommendations may be useful to clinicians who are caring for young people who transition into this care pathway when they reach 16. This guideline is for clinicians in primary and secondary NHS-commissioned care.