Cirrhosis of the Liver

What is cirrhosis of the liver?

Cirrhosis of the liver is late stage liver disease, in which healthy liver tissue has been gradually replaced with scar tissue. This is a result of long-term, chronic hepatitis. Hepatitis is inflammation in your liver, which has many causes. When inflammation is ongoing, your liver attempts to repair itself by scarring. But too much scar tissue prevents your liver from working properly. The end stage is chronic liver failure.

Are there stages of cirrhosis?

Cirrhosis is a progressive condition that worsens as more and more scar tissue develops. In the beginning, your body adjusts to compensate for your reduced liver function, and you might not notice it too much. This is known as compensated cirrhosis. Eventually, though, as your liver function declines further, you will begin to experience noticeable symptoms. This is known as decompensated cirrhosis.

How does cirrhosis affect my liver and body?

Scarring in your liver blocks the flow of blood and oxygen through your liver tissues. This slows your liver's ability to process your blood, metabolize nutrients and filter out toxins. Cirrhosis reduces your liver's ability to produce bile and essential blood proteins. Scar tissue can also compress blood vessels running through your liver, including the important portal vein system, leading to a condition called portal hypertension.

How common is cirrhosis?

Cirrhosis is relatively common and is a significant cause of hospitalization and death, especially after middle age. That’s because it develops gradually over time. In the United States, cirrhosis 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.

What are the signs and symptoms of cirrhosis of the liver?

Signs and symptoms of cirrhosis depend on how advanced it is. You might not have symptoms at all early on, or you might only have vague symptoms that resemble many other conditions. Symptoms of cirrhosis become more recognizable as your liver function declines. For example, you might see signs that bile isn’t traveling where it needs to go, and instead is overflowing into places it doesn’t belong.

What are the first signs of cirrhosis of the liver?

Early signs and symptoms of cirrhosis may include:

• Nausea or loss of appetite.
• Feeling weak or tired (fatigue).
• Feeling generally ill (malaise).
• Upper abdominal pain (especially on the right).
• Visible blood vessels that look like spiders (spider angiomas).
• Redness on the palms of your hands (palmar erythema).

What are symptoms of advancing cirrhosis?

Recognizable symptoms of cirrhosis fall into two categories: symptoms related to declining liver function, and symptoms related to portal hypertension. Symptoms of stalled bile flow, like jaundice, are common indicators of declining liver function. Symptoms of portal hypertension indicate cirrhosis specifically. It’s scar tissue in your liver that compresses your portal vein.

Cirrhosis symptoms related to declining liver function include:

• Jaundice (yellow tint to your skin and eyes).
• Pruritus (itchy skin, but with no visible rash).
• Dark-colored pee and light-colored poop.
• Digestive difficulties, especially with fats.
• Small yellow bumps of fat deposits on your skin or eyelids.
• Unexplained weight loss and muscle loss.
• Hepatic encephalopathy (confusion, disorientation, mood changes).
• Motor dysfunction (twitching, tremors or lapses in muscle control).
• Disruptions to your menstrual cycle.
• Enlarged male breast tissue and shrunken testes in people AMAB.

Cirrhosis symptoms related to portal hypertension include:

• Swelling in your abdomen (ascites).
• Swelling in your hands, feet, legs and/or face (edema).
• Easy bleeding and bruising (coagulopathy).
• Blood in your vomit or blood in your poop.
• Low urine output (from chronic kidney failure).
• Shortness of breath (from chronic respiratory failure).

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 chronic hepatitis can lead to cirrhosis. The most common causes include:

• Alcohol-induced hepatitis. This is chronic liver damage from chronic heavy alcohol use. Alcohol may be the most well-known cause of liver cirrhosis, but nonalcoholic causes are also common.
• Non-alcohol-related steatohepatitis. 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 of cirrhosis include:

• Autoimmune biliary 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, such as glycogen storage disease, cystic fibrosis and Wilson disease.
• Toxic hepatitis. Long-term exposure to certain environmental toxins or use of certain medications may cause chronic liver damage, including over-the-counter painkillers.
• 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.

What are some risk factors for this condition?

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

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

What are the complications of cirrhosis?

Downstream effects of cirrhosis and portal hypertension 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.
• Mild cognitive impairment and motor dysfunction.

Life-threatening complications of cirrhosis and portal hypertension can include:

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

How is cirrhosis of the liver diagnosed?

A healthcare provider will begin by physically examining you for signs and symptoms of cirrhosis of the liver. They’ll ask you about when your symptoms began and whether they’ve changed over time. They’ll also ask questions about your medical history, what medications, herbs or supplements you take, and your diet and lifestyle. They’ll look for clues that might suggest a history of liver disease or liver damage.

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. These measure liver products like liver enzymes, proteins and bilirubin levels in your blood. Blood tests may also indicate specific diseases or known side effects, like reduced blood clotting.
• Imaging tests. Imaging tests like an abdominal ultrasound, CT scan or MRI can show the size, shape and texture of your liver. A special type of imaging test called elastography uses ultrasound or MRI technology to measure the level of stiffness or fibrosis 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. A healthcare provider can usually take the sample through a hollow needle. While not always necessary, a liver biopsy can confirm cirrhosis and may help determine the cause.

Can cirrhosis of the liver be reversed or cured?

Cirrhosis involves permanent scarring in your liver, which can’t be undone. While your liver has great healing powers in general, cirrhosis is a stage of disease where it doesn’t have enough healthy cells left to heal itself with. But you may be able to slow or stop cirrhosis from progressing further. This depends on what’s causing it, how treatable the cause is, and how well you respond to the treatment.

How do healthcare providers treat cirrhosis of the liver?

Treatment for cirrhosis of the liver includes:

• Managing the cause, if possible, to slow or reduce the damage.
• General diet and lifestyle measures to reduce stress on your liver.
• Managing or screening for complications of cirrhosis.
• As a last resort, liver transplantation.

Treating the cause

Medications can treat certain types of liver diseases, with varying levels of success. For example, antivirals can cure chronic hepatitis C but only suppress (not cure) chronic hepatitis B. Corticosteroids and immunosuppressants can help manage some autoimmune diseases, but not all. Other medications can reverse the effects of certain inherited diseases but may only treat the symptoms of others.

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. 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

Even if your liver disease is from other factors, eliminating alcohol and drugs that damage your liver will help preserve your liver longer. The same is true of metabolic stress factors. Healthcare providers recommend that anyone with any type of liver disease should try to maintain eat healthy foods and achieve a weight that's healthy for you. In addition, some people might need dietary supplements to treat nutritional deficiencies.

Treating the complications

Once your healthcare provider has diagnosed cirrhosis, they’ll also check for common side effects. Portal hypertension is the most common side effect and comes with its own set of complications, each requiring specific treatments.

You might need:

• A minor procedure to seal a bleeding vein.
• Blood transfusion to replace blood cell count.
• Kidney dialysis.
• Oxygen therapy.
• Paracentesis and antibiotics for ascites.
• Laxatives to absorb and purge toxins from your GI tract.

Liver cancer

Primary liver cancer (hepatocellular carcinoma) is another possible complication of cirrhosis. Not everyone with cirrhosis develops liver cancer, but most people who do develop liver cancer have cirrhosis. If you develop cancer with cirrhosis, your provider might treat it with cancer therapies like radiation or chemotherapy. Or they might judge that the best solution is a complete liver transplant.

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 are 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.

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.

Can your liver recover from cirrhosis?

Once you have cirrhosis, your liver won’t get better. But it won’t necessarily get worse. If you still have compensated cirrhosis with little to no symptoms or side effects, you may continue that way for some 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 cirrhosis varies widely, depending on many factors, including:

• How advanced it is (compensated or decompensated).
• What complications you may have developed.
• 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 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 like ascites or hepatic encephalopathy, which would indicate 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 expectancy, primarily due to the risk of internal bleeding it can cause. Decompensated cirrhosis has an average life expectancy of seven years. Severe, untreatable diseases and other complications can speed up that timeline. Some people have less than two years.

How do I take care of myself while living with cirrhosis of the liver?

You can help extend the life of your liver by:

• Eating healthy, whole foods and lean protein.
• Avoiding alcohol, tobacco and over-the-counter drugs as much as possible.
• Taking medications only as directed and discussing all medications with your provider.
• Keeping up with routine healthcare appointments and screenings for complications.

A note from Cleveland Clinic

Cirrhosis of the liver befalls all sorts of people for all sorts of reasons. While it’s often associated with chronic alcohol use, you can also get it from conditions that you’re unaware of or that are beyond your control. Many people have no idea their livers are suffering until they experience symptoms of decompensated cirrhosis. Once you know about it, cirrhosis is a serious wake-up call. But hope remains.

Many liver diseases respond to lifestyle changes and medications. Even if you have permanent scarring, you can stop the progress of liver disease if you can stop the damage. While some cases are more advanced than others, you and your provider can work out a treatment plan that will give you the best possible prognosis. If you’re on the waiting list for a liver transplant, a transplant might save your life.