GPAtlas🧭 When to suspect
Cirrhosis is the end stage of chronic liver disease – diffuse fibrosis and regenerative nodules that progressively replace and destroy normal architecture.
The central clinical truth for primary care is that it is silent for years: compensated cirrhosis frequently produces no symptoms and is found incidentally on blood tests or imaging, while overt illness appears only once the liver decompensates.
In the UK the dominant causes are:
• Alcohol
• Chronic viral hepatitis (B and C)
• Metabolic dysfunction-associated steatotic liver disease (MASLD) – the condition formerly called non-alcoholic fatty liver disease (NAFLD), driven by obesity and type 2 diabetes
Less commonly:
• Autoimmune hepatitis
• Haemochromatosis
• Primary biliary cholangitis
• Wilson's disease
• Alpha-1 antitrypsin deficiency
The two skills that matter most:
• Suspect cirrhosis in at-risk patients before they decompensate – so they can be referred, monitored and offered cause-specific treatment
• Recognise decompensation as an emergency
Note the counterintuitive point that runs through this topic: routine liver blood tests can be entirely normal in established cirrhosis, so a normal LFT never excludes it.
| Feature | Compensated cirrhosis | Decompensated cirrhosis |
|---|---|---|
| What it means | • Liver scarred but still working • The body copes |
• Liver can no longer meet demands • Complications appear |
| Typical patient | • Often asymptomatic • May feel well, or only fatigue/anorexia |
Symptomatic and unwell |
| Clinical clues | • None, or non-specific • Abnormal fibrosis markers, low platelets |
Jaundice, ascites, variceal bleeding, encephalopathy |
| Prognosis & action | • Years of stable disease • A window for surveillance and prevention |
• Sharp fall in prognosis • Needs urgent specialist input |
Source: NICE NG50
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