Cirrhosis of the Liver: Symptoms, Causes, and Treatment

Cirrhosis is the extensive scarring (fibrosis) of the liver caused by long-term injuries and disease. The damage is due to persistent and ongoing inflammation in response to chronic liver damage, such as chronic viral hepatitis infection, excessive alcohol consumption, and other causes.

Although cirrhosis is typically irreversible, the condition can be managed with treatment. Learn more about cirrhosis and how this condition is diagnosed and treated.

Cirrhosis and the Liver

The liver has many important functions, one notable one being the filtration of blood. When conditions or lifestyle habits like hepatitis or excessive alcohol consumption cause damage to the liver, the liver is usually able to repair itself, replacing damaged liver cells with new ones.

However, when liver damage occurs repeatedly, scar tissue (a collection of collagen and other cells) can build up between liver cells as the liver continually tries to self-heal. This beginning stage of scarring is known as fibrosis.

Over time, if the cause of liver damage is not addressed, the scarring accumulates and leads to cirrhosis, where the scarring permanently affects the liver. Cirrhosis interferes with the circulatory flow to the liver and can disrupt essential liver functions.

In some cases, the damage from cirrhosis can lead to liver failure and even death. Over one million people die each year of cirrhosis, including over 50,000 people in the United States.

Cirrhosis Symptoms

The progression of liver damage from early-stage fibrosis to cirrhosis generally takes years, and even decades, to cause symptoms. In the early years, there are often few, if any, symptoms. As the disease progresses, 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)
• Abdominal or general pain

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

Causes

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 is typically associated with heavy drinking over a period of 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 a high cause of cirrhosis in the United States.
• 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, unhealthy cholesterol levels, high blood pressure, and higher than normal blood glucose levels, are most prone to cirrhosis.

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

Diagnosis

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 (a test that can assess the stiffness of certain body areas) 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 a damaged liver that is still relatively functional.
• Decompensated cirrhosis represents a rapid deterioration of liver function.

If liver function is declining and medical treatment is not adequate, liver transplantation is typically considered. 

Cirrhosis can lead to hepatocellular carcinoma (HCC), the most common form of liver cancer.

Treatment

Many cases of cirrhosis are manageable for years before they progress and require transplantation. Management of cirrhosis is largely dependent on the cause and severity of the disease, and 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 is crucial.
• It's important to avoid 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 their effect on the liver.
• Raw shellfish can contain a bacterium that potentially causes serious infection in people with advanced liver disease, so this food should not be consumed.
• Get screening tests for and vaccinations for hepatitis A and hepatitis B, as well as screening for hepatitis C.
• Take antiviral treatment for hepatitis B and hepatitis C, if needed.
• Screening and treating secondary causes of cirrhosis (such as ursodiol for bile duct blockages), if needed
• Evaluation for liver transplantation will follow specific criteria.
• Research suggests that exercising regularly can reduce the risk of death from liver conditions like cirrhosis.

A Word From Verywell

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 healthcare provider. 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.