An Overview of Cirrhosis

Cirrhosis is the extensive scarring (fibrosis) of the liver caused by long-term injury. The damage is due to persistent and ongoing inflammation in response to chronic liver injury, whether from chronic viral hepatitis infection, excessive alcohol consumption, or a variety of other causes.

The liver has the ability to repair itself. However, as it gradually builds up scar tissue, it is less able to function properly. Over time, as the amount of scarring increases and the circulatory flow to the liver is decreased, essential liver functions are compromised. In some cases, this can lead to liver failure and even death. Over one million people die each year of cirrhosis, including over 40,000 people in the United States.

The progression of liver damage from early-stage fibrosis to cirrhosis generally takes years, and even decades, to manifest symptomatically. In the early years, there are often few, if any, symptoms.

When symptoms do appear, they are sometimes misdiagnosed, ignored, or attributed to other possible causes. As the disease progresses, however, the tell-tale symptoms can become more apparent. These symptoms include:

• Fatigue
• Confusion
• Weakness
• Itching
• Loss of appetite
• Weight loss
• Nausea
• Easy bruising
• Jaundice (the yellowing of skin and/or eyes)
• Spider angioma (the spider veining on the skin, often around the nose and cheeks)
• Edema (the swelling of feet, ankles, and legs due to a buildup of fluid)
• Abdominal bloating from ascites (a buildup of fluid in the belly)

Many of these symptoms are caused by portal hypertension, in which scar tissue partially blocks the normal flow of blood to the liver.

The most common causes of cirrhosis are alcohol-related liver disease, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease. 

• Alcohol-related liver disease follows close behind and is typically associated with heavy drinking over several years (on average, over two drinks per day for women and over three for men ten or more years).
• Hepatitis B-related cirrhosis is a prevalent cause of cirrhosis. Vaccination against hepatitis B in many countries has been successful in decreasing the rates of hepatitis B-related complications, like cirrhosis and liver cancer.
• Hepatitis C is one of the greatest causes of cirrhosis diagnoses in the United States, as well as being the leading indicator for liver transplants.
• Non-alcoholic fatty liver disease is typically associated with obesity, as well as diabetes, high blood pressure, and high cholesterol. People with metabolic syndrome, characterized by large waist sizes, high triglycerides, abnormal cholesterol level, high blood pressure, and higher than normal blood glucose levels, are most prone to cirrhosis.

Some less common causes of cirrhosis are obstructed bile ducts of the liver and gallbladder, autoimmune hepatitis, and hereditary diseases like Wilson's disease or hemochromatosis, medication and celiac disease.

Liver biopsy is the most accurate way to diagnose cirrhosis and to properly assess the stage of the liver disease. An ultrasound or magnetic resonance elastography are noninvasive ways to detect liver fibrosis. A number of blood tests and imaging tools (including ultrasound, CT scan and, MRI) can be used to monitor disease progression.

Cirrhosis can be typically classified as either compensated or decompensated. Compensated cirrhosis is simply a damaged liver that is still relatively functional, while decompensated cirrhosis represents acute deterioration of liver function. If complications cannot be controlled when the liver ceases functioning, liver transplantation is typically indicated. 

About 5 percent of people with cirrhosis will develop hepatocellular carcinoma (HCC), the most common form of liver cancer.

Many cases of cirrhosis are manageable for many years before they progress and require transplantation. Management of cirrhosis is largely dependent on the cause and severity of the disease, but it should start as soon as it is diagnosed.

A number of approaches should be taken to reduce the progression of liver scarring, including:

• Avoiding alcohol and medications that can cause liver injury
• Avoiding over-the-counter herbal agents and supplements, as some have been linked to liver injury
• Cirrhosis increases the risk of prescription drug liver injury, and all prescriptions should be carefully reviewed for effect on the liver.
• Avoiding raw shellfish, which can contain a bacterium potentially causing serious infection in people with advanced liver disease
• Screening for and vaccinations for hepatitis A and hepatitis B, as well as screening for hepatitis C
• Antiviral treatment for hepatitis B and hepatitis C
• Screening and treating secondary causes of cirrhosis (such as ursodiol for bile duct blockages)
• Evaluation for liver transplantation

Over one million people die from cirrhosis every year—however, the disease remains difficult to detect in its early stages. If you are experiencing symptoms of cirrhosis or suspect that you are at risk for developing cirrhosis, speak with your doctor. Remember, the most common causes of cirrhosis include alcohol-related liver disease, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease. Management of cirrhosis should begin as soon as you are diagnosed.