Cirrhosis of the Liver

Cirrhosis of the liver is a late stage of chronic liver disease. At this stage, a significant amount of your healthy liver tissue has turned to scar tissue. Scarring comes from long-term inflammation in your liver (hepatitis). When you have too much scar tissue, it can prevent your liver from working properly. This leads to liver failure. While cirrhosis can’t be reversed, treatment may slow or stop it from getting worse.

Are there stages of cirrhosis?

Cirrhosis worsens as scar tissue builds up in your liver. In the beginning, your body compensates for the damage, and you might not notice any symptoms. This is called compensated cirrhosis. As liver function declines, symptoms develop. This is known as decompensated cirrhosis.

How does cirrhosis affect my liver and body?

Scarring in your liver blocks blood and oxygen from flowing through your liver tissues. This reduces your liver’s ability to filter toxins, process nutrients and produce bile and essential proteins. Scar tissue can also compress important blood vessels, including the portal vein, leading to portal hypertension.

How common is cirrhosis?

Cirrhosis is relatively common and is a significant cause of hospitalization and death, especially after middle age. In the United States, it affects about 0.25% of all adults and about 0.50% of adults between the ages of 45 and 54. Each year, about 26,000 deaths in the United States are attributed to cirrhosis, and these rates are rising. Cirrhosis is a global health concern.

Liver cirrhosis symptoms

There are many signs and symptoms of cirrhosis, but they may not appear until late in the process. Cirrhosis symptoms become more recognizable as your liver function declines. Early symptoms may include:

• Nausea or loss of appetite
• Feeling weak and tired
• Feeling generally ill
• Upper abdominal pain
• Visible blood vessels that look like spiders
• Redness on the palms of your hands

Later symptoms may include:

• Jaundice (a yellow tint to your skin and eyes)
• Dark-colored pee and light-colored poop
• Itchy skin (but with no visible rash)
• Small, yellow bumps of fat deposits on your skin or eyelids
• Unexplained weight loss and muscle loss
• Irregular periods
• Swelling in your abdomen (ascites)
• Easy bleeding and bruising

What causes cirrhosis of the liver?

Cirrhosis is a gradual scarring process that’s triggered by chronic inflammation in your liver. Any chronic liver disease that causes inflammation (hepatitis) can lead to cirrhosis. Common causes include:

• Alcohol-induced hepatitis: This is liver damage from long-term, heavy alcohol use. Alcohol may be the most well-known cause of liver cirrhosis, but nonalcoholic causes are also common.
• Metabolic dysfunction-associated steatohepatitis (MASH): This is chronic damage from excess fat storage in your liver. It’s related to metabolic factors like high blood lipids, blood sugar and blood pressure.
• Chronic hepatitis C infection: Hepatitis C is a viral infection that becomes chronic in most people. It’s now curable with antivirals, but many people don’t realize they have it.
• Chronic hepatitis B infection: Hepatitis B is a viral infection that may become chronic in a minority of people. If it does, you’ll have it for life. It’s treatable, but not curable.

Less common causes include:

• Autoimmune disease: Certain autoimmune diseases can cause chronic liver inflammation, including autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis.
• Genetic disorders: Certain inherited conditions can cause toxic substances to build up in your liver and damage it. These include glycogen storage disease, cystic fibrosis and Wilson disease.
• Toxic hepatitis: Long-term exposure to certain environmental toxins or medications may cause chronic liver damage, including common painkillers like NSAIDs and acetaminophen.
• Cardiovascular disease: Conditions that cause blood to build up in your liver (congestive heart failure) or that prevent blood from reaching your liver (chronic ischemia) can damage it.

Risk factors

You might be at a higher risk for cirrhosis of the liver if you:

• Are over 50
• Have a history of heavy alcohol use
• Have a chronic viral hepatitis infection
• Have metabolic syndrome

Early treatment for these conditions can help prevent cirrhosis. Vaccinations can prevent viral hepatitis.

Complications of liver cirrhosis

Side effects of cirrhosis of the liver can include:

• General toxicity, feeling ill, tired and foggy
• Reduced immunity, healing and recovery
• Fluid leakage from your veins, causing swelling in your body
• Hormonal imbalances and deficiencies
• Digestive difficulties, malabsorption and malnutrition
• Cognitive impairment and motor dysfunction (hepatic encephalopathy)

Life-threatening complications of cirrhosis can include:

• Gastrointestinal (GI) varices and gastrointestinal bleeding
• Spontaneous bacterial peritonitis
• Kidney failure (hepatorenal syndrome)
• Respiratory failure (hepatopulmonary syndrome)
• Liver failure
• Liver cancer

How doctors diagnose cirrhosis of the liver

A healthcare provider will begin by physically examining you for signs and symptoms of cirrhosis of the liver. They’ll ask questions about your medical history, medications or supplements you take, and your eating patterns and lifestyle. They’ll look for clues that might suggest a history of liver disease. Then, they’ll follow up with medical tests to look for evidence of cirrhosis of the liver.

Tests may include:

• Blood tests: A panel of liver function tests can show signs of liver disease and liver failure. Blood tests may also indicate specific diseases or known side effects, like reduced blood clotting.
• Imaging tests: Imaging can show the size, shape and texture of your liver. A special type of imaging test called elastography can also measure the level of stiffness or scarring in your liver.
• Liver biopsy: A liver biopsy is a minor procedure to take a small tissue sample from your liver to test in a lab. While not always necessary, a biopsy can confirm cirrhosis and help find the cause.

Can cirrhosis of the liver be reversed or cured?

Cirrhosis means permanent liver scarring that can’t be reversed. While your liver normally has strong healing abilities, cirrhosis leaves too little healthy tissue for recovery. Still, treatment may help slow or stop further damage, depending on the cause and how well you respond to it.

What are cirrhosis treatments?

Treatments for cirrhosis of the liver include:

Treating the cause

• Medications: These can treat certain types of liver diseases, with varying levels of success. For example, antivirals can cure hepatitis C but only suppress (not cure) hepatitis B. Corticosteroids and immunosuppressants can help manage some autoimmune diseases, but not all.
• Alcohol dependency treatment: If you have toxic or alcohol-related liver disease, eliminating those toxins from your life is the only treatment. To manage this, some people may need treatment for a substance use disorder.
• Managing metabolic factors: If you have nonalcohol-related liver disease, managing metabolic factors like cholesterol, blood sugar and overweight can help relieve it. Some people may need medications to help manage these factors.

Diet and lifestyle

• Eliminate alcohol and drugs: Even if your liver disease isn’t related to alcohol or drugs, eliminating them from your life will help preserve your liver longer.
• Destress your metabolism: Healthcare providers recommend that anyone with any type of liver disease should try to eat healthy foods and reduce excess weight.
• Add dietary supplements: Some people might need dietary supplements to treat nutritional deficiencies.

Treating the complications

Once your healthcare provider has diagnosed you with cirrhosis of the liver, they’ll also check for common side effects. Your treatment might include procedures to manage these complications.

For example, you might need:

• Sclerotherapy to seal a bleeding vein
• Paracentesis to remove built-up fluids
• Blood transfusion
• Kidney dialysis
• Oxygen therapy
• Treatment for liver cancer

Liver transplantation

Healthcare providers recommend liver transplantation when they feel that your health will continue to decline without one. This might be the case if you’re in active liver failure, have liver cancer and/or you aren’t responding to treatment for your liver disease. If you meet the qualifications for a liver transplant, you’ll join a national waiting list to receive one. Your condition will determine your place on the list.

What can I expect if I have cirrhosis of the liver?

Cirrhosis means permanent liver damage. But it doesn’t always continue to worsen. If you still have compensated cirrhosis with little to no symptoms or side effects, you may continue that way for a long time. If you can stop or minimize the inflammation causing cirrhosis, it may not progress to the decompensated stage. But you’ll have to continue to protect your liver for the rest of your life.

What is life expectancy with cirrhosis of the liver?

Life expectancy with liver cirrhosis varies widely, depending on many factors, including:

• How advanced it is
• What complications you may have
• The availability and effectiveness of treatment
• Your overall health or other conditions you might have

Healthcare providers use scoring methods like the Child-Turcotte-Pugh (CTP) system and the Model for End-Stage Liver Disease (MELD) to forecast your prognosis (outlook) and determine your place on the liver transplant waiting list. These scores are based on your liver function test results and whether you have complications (decompensated cirrhosis).

In the early stages of compensated cirrhosis, life expectancy may still be upwards of 15 years. When portal hypertension develops, it reduces that timeline because of the risk of internal bleeding. Decompensated cirrhosis has an average life expectancy of seven years. Other diseases and complications can speed up that timeline.

Can cirrhosis be prevented?

You might be able to prevent liver disease from progressing to cirrhosis by intervening earlier in the process. This depends on whether you’re aware of it and whether there are steps you can take to prevent it. Many people don’t have symptoms in the early stages, but a routine health checkup could help bring it to light. This could give you the chance to make important changes or begin treatment.