Cirrhosis is scarring of the liver and poor liver function as a result of chronic liver disease.
Cirrhosis is caused by chronic liver disease. Common causes of chronic liver disease in the United States include:
Hepatitis C infection
Long-term alcohol abuse (see alcoholic liver disease)
Other causes of cirrhosis include:
Autoimmune inflammation of the liver
Disorders of the drainage system of the liver (the biliary system), such as primary biliary cirrhosis and primary sclerosing cholangitis
Metabolic disorders of iron and copper (hemochromatosis and Wilson’s disease)
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
Symptoms may develop gradually, or there may be no symptoms.
When symptoms do occur, they can include:
Abdominal indigestion or pain
Confusion or problems thinking
Impotence, loss of interest in sex, and breast development (gynecomastia) in men
Nausea and vomiting
Nosebleeds or bleeding gums
Pale or clay-colored stools
Small, red spider-like blood vessels on the skin
Swelling or fluid buildup of the legs (edema) and in the abdomen (ascites)
Vomiting blood or blood in stools
Yellow color in the skin, mucus membranes, or eyes (jaundice)
Tests & diagnosis
During a physical examination the health care provider may find:
An enlarged liver or spleen
Excess breast tissue
Expanded (distended) abdomen, as a result of too much fluid
Red spider-like blood vessels on the skin
Smaller (contracted) fingers
Small testicles in men
Widened (dilated) veins in the abdomen wall
Yellow eyes or skin (jaundice)
Tests can reveal liver problems including:
Anemia (detected on a CBC)
Liver function problems (detected on liver function tests)
Low serum albumin
The following tests may be used to evaluate the liver:
Magnetic resonance imaging (MRI) of the abdomen
Computed tomography (CT) of the abdomen
Ultrasound of the abdomen
A liver biopsy confirms cirrhosis.
Some patients will be screened for liver cancer every six months. Your doctor will use a blood test to check for levels of alpha fetoprotein and will do an imaging test (ultrasound, MRI, or CT scan).
All patients with cirrhosis can benefit from certain lifestyle changes, including:
Stop drinking alcohol.
Limit salt in the diet.
Eat a nutritious diet.
Get vaccinated for influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia (if recommended by your doctor).
Tell your doctor about all prescription and nonprescription medications, and any herbs and supplements you take now or are thinking of taking.
Other treatment options are available for the complications of cirrhosis:
Bleeding varices — upper endoscopy with banding and sclerosis
Excess abdominal fluid (ascites) — take diuretics, restrict fluid and salt, and remove fluid (paracentesis)
Coagulopathy — blood products or vitamin K
Confusion or encephalopathy — lactulose medication and antibiotics
Infections — antibiotics
A procedure called transjugular intrahepatic portosystemic shunt (TIPS) is sometimes necessary for bleeding varices or ascites.
When cirrhosis progresses to end-stage liver disease, patients may be candidates for a liver transplant.
Cirrhosis is caused by irreversible scarring of the liver. Once cirrhosis develops, it is not possible to heal the liver or return its function to normal. It is a serious condition that can lead to many complications.
A gastroenterologist or liver specialist (hepatologist) should help evaluate and manage complications. Cirrhosis may result in the need for a liver transplant.
Bleeding disorders (coagulopathy)
Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
Increased pressure in the blood vessels of the liver (portal hypertension)
Kidney failure (hepatorenal syndrome)
Liver cancer (hepatocellular carcinoma)
Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)
When to contact a doctor
Call your health care provider if:
You develop symptoms of cirrhosis
Call your provider, go to the emergency room, or call the local emergency number (such as 911) if you have:
Abdominal or chest pain
Abdominal swelling or ascites that is new or suddenly becomes worse
A fever (temperature greater than 101 °F)
New confusion or a change in alertness, or it gets worse
Rectal bleeding, vomiting blood, or blood in the urine
Shortness of breath
Vomiting more than once a day
Yellowing skin or eyes (jaundice) that is new or suddenly becomes worse
Don’t drink alcohol heavily. If you find that your drinking is getting out of hand, seek professional help.
Measures for preventing the transmission of hepatitis B or C include:
Avoid sexual contact with a person who has acute or chronic hepatitis B or C.
Use a condom and practice safe sex.
Avoid sharing personal items, such as razors or toothbrushes.
Do not share drug needles or other drug paraphernalia (such as straws for snorting drugs).
Clean blood spills with a solution containing 1 part household bleach to 10 parts water.