Cirrhosis: What You Need To Know

Cirrhosis is the extensive scarring (fibrosis) of the liver caused by long-term injury. The damage is due to persistent and ongoing inflammation, most often in response to a chronic viral infection like hepatitis or chronic alcoholism.

The liver has the ability to repair itself but 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 30,000-plus in the U.S. It is today the country's 12th leading cause of death, affecting twice as many men as it does women.

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

• Hepatitis C leads in the number of cirrhosis diagnoses in the U.S., as well as being the leading indicator for liver transplants.
• 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).
• While hepatitis B is less common in the U.S, affecting less than 1% of the population, rates can increase to 5% or more in many developing countries.
• 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 a large waist size, 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.​

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 and include:

• fatigue
• 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.

Liver biopsy is the most accurate way to diagnose cirrhosis and to properly assess the stage of the liver disease. 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 suggests that the liver is non-functioning. If complications cannot be controlled when the liver ceases functioning, liver transplantation is typically indicated. 

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

Treatment of cirrhosis is dependent largely on the cause and severity of the disease. When the condition becomes symptomatic, a number of approaches should be taken to reduce the progression of liver scarring, including:

• Avoiding alcohol and illegal substances (seeking substance abuse treatment, if needed).
• Increased exercise and healthier, low-fat eating habits.
• Avoiding raw shellfish, which contains a bacterium that can cause serious infection in people with advanced liver disease.
• Vaccinations for hepatitis A and hepatitis B, as well as screening for hepatitis C.
• Antiviral treatment for hepatitis B and hepatitis C.
• Treating other atypical causes for cirrhosis (e.g., ursodiol for bile duct blockages).