Health Encyclopedia

Cirrhosis

Definition

Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.

Alternative Names

Liver cirrhosis; Chronic liver disease; End-stage liver disease; Liver failure - cirrhosis; Ascites - cirrhosis

Causes

Cirrhosis is most often the end result of chronic liver damage caused by long-term (chronic) liver disease. Common causes of chronic liver disease in the United States are:

Hepatitis B or hepatitis C infection.
Alcohol abuse.
Buildup of fat in the liver that is NOT caused by drinking too much alcohol (called nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH]). It is closely related to being overweight, having high blood pressure, diabetes or pre-diabetes, and high cholesterol.

Less common causes of cirrhosis include:

When immune cells mistake the liver's normal cells for harmful invaders and attack them, called autoimmune hepatitis (AH)
Bile duct disorders
Some medicines
Liver diseases passed down in families

Symptoms

There may be no symptoms, or symptoms may come on slowly, depending on how well the liver is working. Often, it is discovered by chance when an abdominal ultrasound exam is done or blood is drawn for another reason.

Early symptoms include:

Fatigue and loss of energy
Poor appetite and weight loss
Nausea or belly pain
Small, red spider-like blood vessels on the skin

As liver function worsens, symptoms may include:

Fluid buildup in the legs (edema) and in the abdomen (ascites)
Yellow color in the skin, mucous membranes, or eyes (jaundice)
Redness on the palms of the hands
In men, impotence, shrinking of the testicles, and breast swelling
Easy bruising and abnormal bleeding, most often from swollen veins in the digestive tract
Confusion or problems thinking
Pale or clay-colored stools
Bleeding from upper or lower gastrointestinal tract

Exams and Tests

Your health care provider will do a physical exam to look for:

An enlarged liver or spleen
Excess breast tissue (in men)
Swollen abdomen, as a result of too much fluid
Reddened palms
Red spider-like blood vessels on the skin
Small testicles (in men)
Widened veins in the abdomen wall
Yellow eyes or skin (jaundice)

You may have the following tests to measure liver function:

Other tests to check for liver damage include:

Computed tomography (CT) of the abdomen
Magnetic resonance imaging (MRI) of the abdomen
Endoscopy to check for abnormal veins in the esophagus or stomach
Ultrasound of the abdomen

You might need a liver biopsy to confirm the diagnosis.

Treatment

LIFESTYLE CHANGES

Some things you can do to help take care of your liver disease are:

Drink no alcohol.
Eat a healthy diet that is low in salt, fat, and simple carbohydrates.
Get vaccinated for diseases such as influenza, hepatitis A and B, and pneumococcal pneumonia.
Talk to your provider about all medicines you take, including herbs and supplements and over-the-counter medicines.
Exercise.
Control your underlying metabolic problems, such as high blood pressure, diabetes, and high cholesterol.

MEDICINES FROM YOUR DOCTOR

Water pills (diuretics) to get rid of fluid build-up
Vitamin K or blood products to prevent excess bleeding
Medicines for mental confusion
Antibiotics for infections

OTHER TREATMENTS

Endoscopic treatments for enlarged veins in the esophagus (varices)
Removal of fluid from the abdomen (paracentesis)
Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver

When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

Support Groups

You can often ease the stress of illness by joining a liver disease support group whose members share common experiences and problems.

Outlook (Prognosis)

Cirrhosis is caused by scarring of the liver. In most cases, the liver cannot heal or return to normal function once the damage is severe. Cirrhosis can lead to serious complications.

Possible Complications

Complications may include:

Bleeding disorders
Buildup of fluid in the abdomen (ascites) and infection of the fluid (spontaneous bacterial peritonitis)
Enlarged veins in the esophagus, stomach, or intestines that bleed easily (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 Medical Professional

Contact your provider if you develop symptoms of cirrhosis.

Get emergency medical help right away 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 or 38.3°C)
Diarrhea
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 gets worse quickly

Prevention

DO NOT drink alcohol. Talk to your provider if you are worried about your drinking. Take steps to prevent getting hepatitis B or C or passing it to other people.

References

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 139.

Kamath PS, Shah VH. Overview of cirrhosis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 74.

Mannelli L, Lomas DJ, Kolokythas O. The liver and spleen. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 23.

Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG Clinical Guideline: alcoholic liver disease. Am J Gastroenterol. 2018;113(2):175-194. PMID: 29336434 pubmed.ncbi.nlm.nih.gov/29336434/.

Wilson SR, Withers CE. The liver. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 4.

Review Date:2/6/2022
Reviewed By:Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Internal review and update on 07/16/2023 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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