Hepatitis and Cirrhosis Similarities and Differences

Hepatitis and cirrhosis are both diseases that affect the liver. Since hepatitis and cirrhosis are in many ways on a continuum of disease, the symptoms may be very similar. However, there are a number of important differences between the two.

In general, hepatitis may or may not be reversible (curable), whereas cirrhosis refers to permanent scarring of the liver, often as the result of chronic hepatitis. While some forms of hepatitis may come on very rapidly, cirrhosis also tends to develop more gradually.

Let's take a look at the symptoms that may occur with both diseases, review the basics of each disease, and then outline some of their main similarities and differences.

General Symptoms of Liver Diseases

Liver disease symptoms may be present with hepatitis, cirrhosis, or any other conditions that result in dysfunction of or damage to the liver. These may include:

• Jaundice. Jaundice, a yellowish discoloration of the skin and the whites of the eyes (the sclera), is a common symptom of liver disease but has many possible causes. Jaundice occurs due to a build-up of bilirubin, a yellow pigment in the blood (hyperbilirubinemia). (Jaundice also occurs in babies, but this is a normal physiological process.) Jaundice can develop rapidly and dramatically (as with acute hepatitis or bile duct obstruction) or instead develop gradually and subtly.
• Enlarged breasts in male patients. Enlarged breasts, referred to as gynecomastia, are common with liver disease due to an increase in estrogen caused by liver dysfunction.
• Itching skin. Chronic itching (pruritis) is common with liver disease, and is due to bile salts, which build up in the skin. This itching usually occurs without a rash.
• Vomiting of blood. Vomiting of blood can be related to liver disease in several ways. One of the more ominous is esophageal varices. Esophageal varices are essentially varicose veins in the esophagus. Varicose veins in the legs develop due to poor blood flow in the legs, causing blood to back up and pool, while blood flow to the esophagus may increase due to damage of the liver, which causes portal hypertension and increased blood pressure in the liver. Portal hypertension is much more common with cirrhosis than hepatitis, as scarring acts as a "kink in the hose" for blood vessels traveling through the liver.
• An enlarged liver. In hepatitis, the liver often becomes tender and enlarged and can be felt below the ribs in the right upper quadrant of the abdomen. With cirrhosis, the liver often becomes small and firm and may feel like a rock when it is felt in the upper abdomen.
• Bacterial peritonitis. Peritonitis refers to an infection in the abdominal cavity.
• Ascites, or fluid in the abdomen. Ascites can cause abdominal swelling and bloating and, when severe, can result in shortness of breath due to the pressure of the abdomen pushing upward on the chest cavity.
• Mental confusion or forgetfulness. One of the primary functions of the liver is to "detoxify" the blood, that is, to remove toxins and other substances from the blood. When the function of the liver is compromised, these toxins can build up in the bloodstream. Hepatic encephalopathy is a condition characterized by lethargy, confusion, abnormal muscle movements, amnesia, and often a dramatic personality change. It is sometimes mistaken as Alzheimer's disease, but is, in some cases, at least partly reversible.
• Fatigue. Chronic tiredness, the kind of tiredness that does not respond to a good night of rest, is extremely common in both hepatitis and cirrhosis.

More symptoms of acute hepatitis are possible, including bleeding gums, edema (or swelling) in your legs, sleep reversal and other sleep disorders, and loss of consciousness.

Hepatitis vs. Cirrhosis

In order to understand the important similarities and differences between hepatitis and cirrhosis, it's helpful to first define and describe these two conditions. There is a significant overlap between them, as noted below.

Hepatitis

Hepatitis is inflammation of the liver and can be caused not only by well-known viruses such as hepatitis B but a host of other factors. Forms of hepatitis include the following:

Infectious hepatitis. There are several infectious causes of hepatitis. These include hepatitis A, B, C, D, and E, as well as viral infections like infectious mononucleosis (Epstein-Barr virus) and cytomegalovirus.

Drug-induced hepatitis. There are many drugs that can cause liver dysfunction.

Alcoholic hepatitis. Chronic alcohol use can affect the liver in many ways, leading to conditions such as alcoholic hepatitis, fatty liver, and cirrhosis.

Obesity. Non-alcoholic fatty liver disease, a condition whose prevalence is increasing in the United States, can progress into a disease known as non-alcoholic steatohepatitis, or NASH. As with many other types of hepatitis, NASH can progress to scarring (cirrhosis) of the liver.

Autoimmune hepatitis. Autoimmune diseases are those in which our bodies make antibodies against our own tissues.

Toxin or chemical exposures. There are a number of common compounds that are toxic to the liver, from insecticides to chemicals found in ordinary household cleaners.

Cirrhosis of the Liver

Cirrhosis is the scarring of the liver. The liver is fairly unique in its ability to regenerate after injury, yet with repeated injury or chronic infections, such as chronic hepatitis, this process is interrupted. Eventually, the liver becomes incapable of working effectively, and scarring begins to develop.

The causes of cirrhosis are essentially the same as those that cause hepatitis, but that overcome the ability of the liver to heal itself, such as when the insult to the liver is repeated or as with chronic infections. The most common causes of cirrhosis in the United States include alcoholic liver disease and hepatitis C.

Cirrhosis may also be caused by conditions other than hepatitis, including hemochromatosis (a hereditary iron overload disease); alpha-1-antitrypsin deficiency, a hereditary absence of an enzyme; and bile duct conditions, such as congenital biliary atresia (when the bile ducts are blocked or absent).

As cirrhosis worsens, the function of the liver is lost and, simultaneously, the organ becomes smaller and solidifies. If you have an unhealthy liver, fluid accumulates in the legs and abdomen. Bile salts can easily build up in the skin, which can lead to jaundice and itching. Bleeding from the large veins in your GI tract and esophagus may occur. Toxins can also accumulate in the blood, which can result in confusion and mental slowing. For those individuals with advanced cirrhosis, the only true treatment for this disease is a liver transplant.

Unfortunately, there are many possible complications of cirrhosis, including liver failure and liver cancer.

Cirrhosis is also a condition in which healthy liver tissue is replaced with nonfunctional scar tissue. This condition often occurs in individuals who don’t control their alcohol intake. According to research, there is no medical cure for cirrhosis. Nonetheless, proper treatment will reduce the severity of the symptoms and slow the progression of the disease. The first step that you should consider to reduce the symptoms of cirrhosis is to stop drinking alcohol. If you continue to drink alcohol, it can lead to liver damage and premature death. New research is looking at further methods for preventing the progression of hepatitis to cirrhosis and the worsening of cirrhosis. For example, statins may reduce the risk of cirrhosis in people with liver disease. If you have hepatitis or have developed cirrhosis, it's important to find a hepatologist who is familiar with recent research.

Similarities Between Hepatitis and Cirrhosis

• Both hepatitis and cirrhosis are conditions involving the liver that can cause abnormal liver function tests and symptoms of liver dysfunction.
• Both hepatitis and cirrhosis can lead to liver cancer, liver failure, or the need for a liver transplant.

Differences Between Hepatitis and Cirrhosis

There are many important differences between hepatitis and cirrhosis, even when they may have the same cause.

• Reversibility. By definition, cirrhosis (scarring) is irreversible, whereas hepatitis may be completely reversible depending on the cause.
• Blood tests. Liver enzymes (such as AST and ALT) are often very elevated with hepatitis, especially acute hepatitis. With cirrhosis, however, at least in the early stages, liver function tests may be only slightly abnormal.
• Conditions other than hepatitis can lead to cirrhosis. For example, hemochromatosis, alpha-1-antitrypsin deficiency, and more can lead to cirrhosis.
• Treatments. With hepatitis, the goal is usually to alleviate the disease—for example, treat the infection, remove a drug causing drug-related hepatitis, or decrease weight and increase metabolism with NASH. With cirrhosis, the scarring is permanent and cannot be treated. Therefore, the goal is to treat symptoms related to cirrhosis and to prevent any further liver injury.
• Symptoms. Portal hypertension (see above) leading to esophageal varices, an enlarged spleen, a low platelet count, and a low protein level in the blood (leading to other problems) are more common with cirrhosis than with hepatitis.

A Word From Verywell

In many ways, hepatitis and cirrhosis are similar processes, but exist on a continuum. Thankfully, many of the causes of liver inflammation that lead to cirrhosis are reversible in the early stages with good medical care. For example, quitting drinking can make an enormous difference in alcohol-related cirrhosis, and treatment of chronic hepatitis C may help to prevent cirrhosis and its many complications. It's been found that the treatment of hepatitis C can result in the resolution of at least 90 percent of infections, yet many people are unaware that they have the disease until they develop cirrhosis. It's now recommended that people with risk factors for hepatitis, as well as anyone born between 1945 and 1965, should undergo hepatitis C testing.