Digestive Health More Digestive Diseases What Is Cirrhosis? By Charles Daniel Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis. Learn about our editorial process Charles Daniel Medically reviewed by Medically reviewed by Caitilin Kelly, MD on November 30, 2019 Caitilin Kelly, MD, is board-certified in internal medicine. She is clinical physician practicing at Indiana University Health Bloomington Hospital and the chair of the American College of Physicians' Hospital Ethics committee. She is a delegate for the Indiana State Medical Association House of Delegates. Learn about our Medical Review Board Caitilin Kelly, MD on November 30, 2019 Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment 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. Cirrhosis is now the 9th leading cause of death in the Unites States, affecting nearly twice as many men as it does women. Illustration by Emily Roberts, Verywell Cirrhosis Symptoms 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: FatigueConfusionWeaknessItchingLoss of appetiteWeight lossNauseaEasy bruisingJaundice (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. 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 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. 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 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. Treatment 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. Cirrhosis is generally not curable except by liver transplantation. A number of approaches should be taken to reduce the progression of liver scarring, including: Avoiding alcohol and medications that can cause liver injuryAvoiding over-the-counter herbal agents and supplements, as some have been linked to liver injuryCirrhosis 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 diseaseScreening for and vaccinations for hepatitis A and hepatitis B, as well as screening for hepatitis CAntiviral treatment for hepatitis B and hepatitis CScreening and treating secondary causes of cirrhosis (such as ursodiol for bile duct blockages)Evaluation for liver transplantation 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 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. Diet for Managing Cirrhosis Was this page helpful? Thanks for your feedback! Gas pain? Stool issues? Sign up for the best tips to take care of your stomach. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. FastStats - Chronic Liver Disease or Cirrhosis. Centers for Disease Control and Prevention. May 30, 2013. Guss D, Sherigar J, Mohanty SR. Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients. Gastroenterology Res. 2018;11(5):333-339. doi:10.14740/gr1074w Symptoms & Causes of Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases. Mar 1, 2018. Cirrhosis: MedlinePlus Medical Encyclopedia. MedlinePlus. Sept 11, 2019. Cirrhosis: MedlinePlus Medical Encyclopedia. MedlinePlus. Sept 11, 2019. Nderitu P, Bosco C, Garmo H, et al. The association between individual metabolic syndrome components, primary liver cancer and cirrhosis: A study in the Swedish AMORIS cohort. Int J Cancer. 2017;141(6):1148-1160. doi:10.1002/ijc.30818 Hung TH, Liang CM, Hsu CN, et al. Association between complicated liver cirrhosis and the risk of hepatocellular carcinoma in Taiwan. PLoS ONE. 2017;12(7):e0181858. doi:10.1371/journal.pone.0181858 Cirrhosis of the Liver Prevention. Cleveland Clinic. Jan 11, 2019. Additional Reading Centers for Disease Control and Prevention (CDC). National Vital Statistics Report, Volume 67, Number 5. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf. Published July 26, 2018. National Institute of Diabetes and Digestive and Kidney Diseases. Cirrhosis. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis#signs