Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
Decompensated cirrhosis is the term used to describe the development of specific complications resulting from the changes brought on by cirrhosis. Decompensated cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
- Bleeding easily
- Bruising easily
- Itchy skin
- Yellow discoloration in the skin and eyes (jaundice)
- Fluid accumulation in your abdomen (ascites)
- Loss of appetite
- Swelling in your legs
- Weight loss
- Confusion, drowsiness and slurred speech (hepatic encephalopathy)
- Spiderlike blood vessels on your skin
- Redness in the palms of the hands
- Testicular atrophy in men
- Breast enlargement in men
When to see a doctor
Make an appointment with your doctor if you have any of the signs or symptoms listed above.
A wide range of diseases and conditions can damage the liver and lead to cirrhosis. The most common causes are:
- Chronic alcohol abuse
- Chronic viral hepatitis (hepatitis B and C)
- Fat accumulating in the liver (nonalcoholic fatty liver disease)
Other possible causes include:
- Iron buildup in the body (hemochromatosis)
- Cystic fibrosis
- Copper accumulated in the liver (Wilson's disease)
- Poorly formed bile ducts (biliary atresia)
- Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
- Genetic digestive disorder (Alagille syndrome)
- Liver disease caused by your body's immune system (autoimmune hepatitis)
- Destruction of the bile ducts (primary biliary cirrhosis)
- Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
- Infection such schistosomiasis
- Medications such as methotrexate
Complications of cirrhosis can include:
Complications related to blood flow:
- High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
- Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
- Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be a sign of cirrhosis with portal hypertension.
- Bleeding. Portal hypertension can cause blood to be redirected to smaller veins, causing them to increase in size and become varices. Strained by the extra load, these smaller veins can burst, causing serious bleeding. Life-threatening bleeding most commonly occurs when veins in the lower esophagus (esophageal varices) or stomach (gastric varices) rupture. If the liver can't make enough clotting factors, this also can contribute to continued bleeding. Bacterial infections are a frequent trigger for bleeding.
- Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to spontaneous bacterial peritonitis, a serious infection.
- Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
- Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. Hepatic encephalopathy symptoms may range from fatigue and mild impairment in cognition to unresponsiveness or coma.
- Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
- Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
- Increased risk of liver cancer. A large proportion of people who develop liver cancer that forms within the liver itself have cirrhosis.
- Acute-on-chronic liver failure. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.
People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more laboratory tests that may suggest a problem with your liver, such as cirrhosis.
- Liver function. Your blood is checked for excess bilirubin, which is a product of red blood cells breaking down, as well as for certain enzymes that may indicate liver damage.
- Kidney function. Your blood is checked for creatinine as kidney function may decline in later stages of cirrhosis (decompensated cirrhosis).
- Tests for hepatitis B and C. Your blood is checked for the hepatitis viruses.
- Clotting. Your international normalized ratio (INR) is checked for your blood's ability to clot.
Your doctor may order imaging and other tests to further diagnose cirrhosis:
- Magnetic resonance elastography or transient elastography. These noninvasive imaging tests detect hardening or stiffening of the liver and may eliminate the need for a liver biopsy.
- Other imaging tests. MRI, CT and ultrasound create images of the liver.
- Biopsy. A tissue sample (biopsy) is not necessarily needed to diagnose cirrhosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.
If you have cirrhosis, your doctor is likely to recommend regular diagnostic tests to monitor for signs of disease progression or complications, especially esophageal varices and liver cancer.
Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.
Treatment for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:
- Treatment for alcohol dependency. People with cirrhosis caused by alcohol abuse should stop drinking. If you have cirrhosis, it is essential to stop drinking since any amount of alcohol is toxic to the liver. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.
- Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels. It is important to maintain adequate protein intake while attempting weight loss in the setting of cirrhosis.
- Medications to control hepatitis. Medications may limit further damage to liver cells caused by hepatitis B or C through specific treatment of these viruses.
- Medications to control other causes and symptoms of cirrhosis. Medications may slow the progression of certain types of liver cirrhosis. For example, for people with primary biliary cirrhosis (now known as primary biliary cholangitis) that is diagnosed early, medication may significantly delay progression to cirrhosis.
Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent weak bones (osteoporosis).
Treatment for complications of cirrhosis
Your doctor will work to treat any complications of cirrhosis, including:
- Excess fluid in your body. A low-sodium diet and medication to prevent fluid buildup in the body may help control ascites and swelling. More-severe fluid buildup may require procedures to drain the fluid or other interventions to relieve pressure. At times, a small tube — a transjugular intrahepatic portosystemic shunt (TIPS) — is placed in the vein within the liver to reduce blood pressure in your liver and slow the rate of fluid accumulation.
Portal hypertension. Certain blood pressure medications may control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding. Your doctor will perform an upper endoscopy at regular intervals to look for enlarged veins in the esophagus or stomach (varices) that may bleed.
If you develop varices, you likely will need medication to reduce the risk of bleeding. If you are not able to tolerate medication and have signs that the varices are bleeding or are likely to bleed, you may need a procedure (band ligation) to stop the bleeding or reduce the risk of further bleeding. In severe cases, a TIPS can be placed in the vein within the liver to reduce blood pressure in your liver and to prevent further bleeding.
- Infections. You may receive antibiotics or other treatments for infections. Your doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.
- Increased liver cancer risk. Your doctor will recommend blood tests and ultrasound exams every six months to look for signs of liver cancer.
- Hepatic encephalopathy. You may be prescribed medications to help prevent the buildup of toxins in your blood due to poor liver function.
In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. People usually need to consider this option when they develop symptoms from cirrhosis, such as jaundice, significant fluid retention (ascites), bleeding varices, hepatic encephalopathy, kidney dysfunction, or liver cancer. A liver transplant replaces your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.
Candidates for liver transplant undergo extensive testing to determine whether they are healthy enough to have a good outcome following surgery. Additionally, transplant centers typically require some period of abstinence alcohol for people with alcohol-related liver disease before they can receive transplants.
Potential future treatments
Scientists are working to expand current treatments for cirrhosis, but success has been limited. Because cirrhosis has numerous causes and complications, there are many potential avenues of approach. A combination of increased screening, lifestyle changes and new medications may improve outcomes for people with liver damage, if started early.
It may be possible in the future to decrease or even reverse the fibrosis that leads to cirrhosis depending on the cause of fibrosis. Some people who received successful hepatitis C treatment or hepatitis B medications may have improvement in their fibrosis.
A number of alternative medicines have been used to treat liver diseases. Milk thistle (silymarin) is the most widely used and best studied. Other herbs used include licorice root (glycyrrhiza), schisandra and astragalus. However, there is not enough evidence of benefit from clinical trials to recommend the use of any herbal products to treat liver cirrhosis. In addition, herbal medications represent an increasing percentage of reported cases of drug-induced liver injury. Talk with your doctor if you're interested in trying alternative medicine to help you cope with cirrhosis.
If you have cirrhosis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist) or the liver (hepatologist).
Here's some information to help you get ready for your appointment and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions, such as diet restrictions on the day before your appointment.
- Write down your symptoms, including when they started and how they may have changed or worsened over time.
- Provide a list of all your medications, vitamins or supplements.
- Write down your key medical information, including other diagnosed conditions.
- Bring results of medical tests done so far, including digital copies of CT, MRI or ultrasound images and biopsy slides if a liver biopsy has been done.
- Write down key personal information, including any recent changes or stressors in your life.
- Take a family member or friend along to help you remember things.
- Write down questions to ask your doctor.
Questions to ask your doctor
Preparing a list of questions can help you make the most of your time. Some basic questions to ask your doctor include:
- What is most likely causing my cirrhosis?
- Is there a way to slow or stop my liver damage?
- What are my treatment options?
- Are there medications or supplements that can hurt my liver?
- What signs and symptoms of complications should I watch for?
- I have other health conditions. How can I best manage them together?
Don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Be prepared to answer questions your doctor is likely to ask, including:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- How often do you drink alcohol?
- Have you been exposed to or taken toxic drugs?
- Do you have a family history of liver disease, hemochromatosis or obesity?
- Have you ever had viral hepatitis?
- Have you ever had jaundice?
- Have you ever had a blood transfusion or used injection drugs?
- Do you have any tattoos?
If you have cirrhosis, be careful to limit additional liver damage:
- Don't drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
- Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
- Eat a healthy diet. Cirrhosis leads to malnutrition and loss of muscle. The best defense against this development is to maintain a healthy diet, with a variety of fruits and vegetables. You also need protein, contrary to outdated but still circulating advice to limit this food group if you have cirrhosis. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
- Avoid infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by washing your hands frequently. Also, get vaccinated for hepatitis A and B, influenza, and pneumonia.
- Use over-the-counter medications carefully. Cirrhosis makes it more difficult for your liver to process drugs. For this reason, ask your doctor before taking any medications, including nonprescription drugs. Avoid drugs such as aspirin and ibuprofen (Advil, Motrin IB, others). If you have liver damage, your doctor may recommend you use a lower dose of acetaminophen (Tylenol, others).
Reduce your risk of cirrhosis by taking care of your liver
- Do not drink alcohol if you have cirrhosis. If you have liver disease but do not have cirrhosis, talk to your doctor about whether you may drink alcohol at all. For healthy adults, that means up to one drink a day for women of all ages and men over age 65, and up to two drinks a day for men age 65 and younger.
- Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat. Caffeinated coffee may protect against fibrosis and liver cancer.
- Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
- Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.
If you're concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.