Complications of Cirrhosis

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Buddy T.
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.
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Medically reviewed by Robert Burakoff, MD, MPH on March 23, 2020

Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.

 

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Robert Burakoff, MD, MPH
on March 23, 2020

Cirrhosis is extensive scarring (fibrosis) of the liver that is characteristic of late-stage liver disease. It can lead to a range of complications, from easy bruising or bleeding to a build-up of toxins in the brain to potentially fatal medical problems such as liver cancer and kidney failure.

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.

Liver disease can be tricky, however. In the early stages, which can last for years or even decades, the spread of fibrosis may bring about no obvious symptoms and so it may be only when complications arise that it becomes obvious that liver damage has 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

There also are a handful of less common causes of cirrhosis. These include obstructed bile ducts of the liver and gallbladder, autoimmune hepatitis, and hereditary conditions such as Wilson's disease (build-up of copper in the liver) or hemochromatosis (build-up of iron in the liver).​

Complications of Cirrhosis

Although a healthy liver is able to repair itself, once it becomes cirrhotic the damage is irrevocable. Extensive scarring inhibits blood flow to the liver which in turn compromises its primary normal functions—namely, processing nutrients from food, making bile, removing toxins such as bilirubin (the reddish-brown compound that results from the breakdown of red blood cells) from the blood, and building proteins.

It's easy to see how serious complications, including liver failure, can develop as a result 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 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. 
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  1. Centers for Disease Control and Prevention. Chronic Liver Disease and Cirrhosis. Updated May 30, 2013.

  2. Nusrat S, Khan MS, Fazili J, Madhoun MF. Cirrhosis and its complications: evidence based treatment. World J Gastroenterol. 2014;20(18):5442–5460. doi:10.3748/wjg.v20.i18.5442

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