What is the most common complication of cirrhosis?

Ascites (build up of fluid in the abdomen) is the most common complication of cirrhosis. It is often caused by elevated pressure in the blood vessels in and around the liver (portal hypertension) as well as decreased liver function. About 60% of people with cirrhosis will develop ascites requiring therapy during 10 years of observation.

Why is gastrointestinal bleeding a complication of cirrhosis?

Gastrointestinal bleeding in people with cirrhosis is most commonly caused by elevated pressure in the blood vessels in and around the liver (portal hypertension). Specifically, lesions from gastroesophageal varices are formed. This happens due to decreased blood flow to the liver, causing the veins in the esophagus, stomach, and rectum to become enlarged. As the elevated pressure continues to expand the veins, the vein walls become stretched too thin and they can rupture, causing potentially life-threatening bleeding.

Can cirrhosis progression be stopped?

Currently, there is no cure for cirrhosis. However, there are ways to manage the symptoms and any complications that may arise, ultimately slowing its progression. Successful treatment may be able to slowly heal some liver scarring (fibrosis). Doctors will look for and treat the underlying problem that led to cirrhosis to help prevent it from getting worse. Part of treatment to slow cirrhosis often includes avoiding things that could continue to damage the liver, such as certain medications, alcohol, and meals high in fat.

Is cirrhosis of the liver hereditary?

Cirrhosis itself is not hereditary (passed from parent to child). However, there are some inherited diseases that can cause liver damage and lead to cirrhosis. These include hemochromatosis, Wilson's disease, alpha 1-antiprotease (antitrypsin) deficiency, and cystic fibrosis.

Common Complications of Cirrhosis

Cirrhosis is a late-stage liver disease in which there is significant scarring (fibrosis) of the liver. It can bring with it a range of complications, from easy bruising or bleeding to a buildup of toxins in the brain, to potentially fatal conditions such as kidney failure and liver cancer.

Physician showing a liver model — Shidlovski / Getty Images

In fact, more than a million people throughout the world die from complications of cirrhosis each year. Forty thousand of those fatalities occur in the United States, making cirrhosis the 11th leading cause of death in the country, according to the Centers for Disease Control and Prevention.

The signs of liver disease aren't always obvious, though. The early stages can last for years or even decades. During this time, the spread of fibrosis might not bring on any noticeable symptoms. By the time symptoms and/or complications are recognized, liver damage has most likely already progressed to cirrhosis.

How Cirrhosis Develops

The scarring that eventually leads to cirrhosis and its complications is largely due to inflammation caused by persistent and ongoing damage to the liver. This damage can be the result of a number of health problems. The most common of these are:

Chronic heavy drinking of alcohol
Hepatitis (in particular types B and C)
Non-alcoholic fatty liver disease

Less common causes of cirrhosis include obstructed bile ducts of the liver and gallbladder, autoimmune hepatitis, and hereditary conditions such as Wilson's disease (a buildup of copper in the liver) or hemochromatosis (a buildup of iron in the liver).

Complications of Cirrhosis

Although a healthy liver is able to repair itself, the damage is often too extensive once it becomes cirrhotic. Widespread scarring inhibits blood flow to the liver, which in turn compromises its primary functions.

These normal functions include processing nutrients from food, making bile, building proteins, and removing toxins such as bilirubin (the reddish-brown compound that results from the breakdown of red blood cells) from the blood.

It's easy to see how serious complications, including liver failure, can develop as a result of cirrhosis.

Complications of Cirrhosis
Complication	Description
Bruising and Bleeding	Cirrhosis causes the liver to slow or stop production of proteins needed for blood clotting. When blood doesn't clot properly, bruising and bleeding can occur spontaneously.
Portal Hypertension	Portal hypertension is another potential cause of severe and even life-threatening bleeding. The portal vein carries blood from the intestines and spleen to the liver. Cirrhosis slows this flow, resulting in elevated pressure inside the vein. As a result, blood may be rerouted to smaller veins that can burst under the increased pressure. In addition, veins in the esophagus or stomach may become enlarged (varices), making them prone to life-threatening bleeding.
Fluid Retention and Swelling	Portal hypertension also can cause fluid to accumulate in the legs (edema) or abdomen (ascites). Edema and ascites also can result from the liver's inability to make enough of certain proteins such as albumin.
Peritonitis	This is a serious bacterial infection of built-up fluid in the abdomen. It requires a quick diagnosis and prompt treatment.
Jaundice	Jaundice is a yellowing of the skin and whites of the eyes, as well as a darkening of urine, that occurs when the diseased liver is unable to adequately remove bilirubin from the blood.
Severe Itching	The liver produces bile to aid in the digestion of fats. When the liver isn't functioning normally, bile can build up and leave deposits on the skin that cause intense itching.
Gallstones	Gallstones are a complication for about a third of people with cirrhosis, research shows—particularly those whose liver damage is due to heavy drinking, hepatitis C infection, or non-fatty liver disease.
Hepatic Encephalopathy	Because a damaged liver cannot adequately clear toxins from the blood, they can accumulate in the brain. Toxins can dull mental functioning and cause personality changes, coma, or death.
Sensitivity to Medication	Cirrhosis impairs the liver's ability to filter medications from the blood, allowing them to remain in the body for longer periods of time than is ideal. The result can be increased sensitivity to certain drugs and their side effects.
Malnutrition	Cirrhosis can interfere with the body's ability to process nutrients. Side effects of malnutrition include weakness and weight loss.
Enlarged Spleen (Splenomegaly)	Portal hypertension can cause the spleen to swell and trap white blood cells and platelets. A decrease in these cells and platelets often is a first sign of cirrhosis.
Insulin Resistance/Type 2 Diabetes	Cirrhosis interferes with the body's ability to use insulin properly. To compensate, the pancreas will attempt to make more insulin, but eventually levels of sugar (glucose) in the blood will build up, ultimately resulting in type 2 diabetes.
Bone Disease	Cirrhosis can cause weakening of bones in some people, putting them at an increased risk of fractures.
Hepatorenal Syndrome	Hepatorenal syndrome is one potential cause of kidney damage in people with liver disease and often is associated with portal hypertension. It often leads to kidney failure.
Liver Cancer (Hepatocellular Carcinoma)	According to the American Cancer Society, most people who develop liver cancer have some evidence of cirrhosis.
Acute-on-Chronic Cirrhosis (ACLF)	This syndrome associated with cirrhosis frequently leads to multi-organ failure that in most cases is fatal.

Summary

Cirrhosis of the liver causes extensive scarring and inflammation that can lead to moderate to very serious complications. When caught early and with effective treatment, the chances of slowing the progression of the disease are greater. This can help extend life-expectancy after diagnosis.

Regularly visiting with your medical team to review how your condition is progressing is important. This allows for adjustments to your treatment plan, as well as early identification, intervention and treatment of any complications that may arise.

A Word From Verywell

Cirrhosis and the accompanying fibrosis causes significant damage to the liver. Without proper treatment, the scarring and damage will worsen and can quickly lead to various complications, such as easy bruising and bleeding, gallstones, or liver cancer.

A diagnosis of cirrhosis doesn't mean you have an immediate fatal condition. By following an effective treatment plan set out by your healthcare team, you can help slow the progression of cirrhosis and delay or prevent possible complications—especially if caught early.

Frequently Asked Questions

What is the most common complication of cirrhosis?

Ascites (build up of fluid in the abdomen) is the most common complication of cirrhosis. It is often caused by elevated pressure in the blood vessels in and around the liver (portal hypertension) as well as decreased liver function. About 60% of people with cirrhosis will develop ascites requiring therapy during 10 years of observation.

Learn More: How Cirrhosis From Chronic Hepatitis Can Cause Ascites
Why is gastrointestinal bleeding a complication of cirrhosis?

Gastrointestinal bleeding in people with cirrhosis is most commonly caused by elevated pressure in the blood vessels in and around the liver (portal hypertension).
Specifically, lesions from gastroesophageal varices are formed. This happens due to decreased blood flow to the liver, causing the veins in the esophagus, stomach, and rectum to become enlarged. As the elevated pressure continues to expand the veins, the vein walls become stretched too thin and they can rupture, causing potentially life-threatening bleeding.

Learn More: Bleeding From Esophageal Varices: Causes and More
Can cirrhosis progression be stopped?

Currently, there is no cure for cirrhosis. However, there are ways to manage the symptoms and any complications that may arise, ultimately slowing its progression. Successful treatment may be able to slowly heal some liver scarring (fibrosis).
Doctors will look for and treat the underlying problem that led to cirrhosis to help prevent it from getting worse. Part of treatment to slow cirrhosis often includes avoiding things that could continue to damage the liver, such as certain medications, alcohol, and meals high in fat.

Learn More: What to Eat When You Have Cirrhosis
Is cirrhosis of the liver hereditary?

Cirrhosis itself is not hereditary (passed from parent to child). However, there are some inherited diseases that can cause liver damage and lead to cirrhosis. These include hemochromatosis, Wilson's disease, alpha 1-antiprotease (antitrypsin) deficiency, and cystic fibrosis.

Learn More: Cirrhosis: Symptoms, Causes and More