Cirrhosis of the Liver

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Introduction

What is cirrhosis of the liver?

Cirrhosis of the liver is a serious disease that causes permanent damage to the liver. The liver is a vital organ located in the right upper area of your abdomen under the ribs. Normal liver function is crucial to your overall health and life. Cirrhosis of the liver is caused by an underlying disease or condition that leads to the formation of scar tissue in the liver. Scar tissue reduces the liver's ability to carry out vital functions including:

  • Blood clotting

  • Clearing the blood of toxins

  • Digesting food and beverages to create nutrients and energy

  • Fighting infection

  • Metabolizing medications and other substances

  • Producing bile for digestion of food
  • Producing proteins, enzymes, and healthy blood

  • Removing waste

  • Storing vitamins, minerals and energy

There are a variety of diseases and conditions that can cause cirrhosis of the liver. The most common causes include chronic hepatitis C and excessive alcohol use.

Symptoms of cirrhosis of the liver can differ among individuals depending on such variables as stage of the disease, age, underlying cause, medical history, the presence of complications, and general health. One typical symptom is jaundice, the yellowing of the skin and whites of the eyes.

Scarring of the liver caused by cirrhosis of the liver cannot be reversed or cured. However, patient compliance with a good treatment plan may be able to slow or stop progression of the disease and minimize complications. Treatment may include medication, lifestyle changes, and treating any underlying conditions, such as alcohol dependence or hepatitis.

Cirrhosis of the liver critically affects the liver’s ability to function normally and can result in serious, potentially life-threatening complications, such as portal hypertension, liver failure, hemorrhage, and kidney failure. Seek prompt medical care if you have a history of hepatitis, alcoholism, or other chronic diseases, or if you have unexplained symptoms, such as nausea, fatigue, diarrhea or weakness. Early diagnosis and treatment can reduce your risk of serious complications.

In addition, if you have cirrhosis of the liver, do not take any supplements, over-the-counter medications, or prescription drugs without consulting your health care provider. This is because the liver may not be able to clear the drugs from the body, resulting in dangerous, toxic levels of chemicals or substances in the body.

Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of advanced cirrhosis, liver failure, or other complications. Symptoms include an inability to produce urine, confusion, severe shortness of breath, jaundice, heavy rectal bleeding, vomiting blood, or a change in consciousness or alertness.

Symptoms

What are the symptoms of cirrhosis of the liver?

Most people with cirrhosis of the liver experience no symptoms in the early stages of the disease, because small amounts of liver scarring do not significantly affect liver function. When symptoms of cirrhosis develop, they may include:

If the underlying cause of cirrhosis of the liver, such as alcoholism, is not addressed, the disease can advance and cause more severe damage to the liver tissue. This can result in symptoms such as:

  • Breast enlargement

  • Easy bruising

  • Itching

  • Nosebleeds

  • Small red, spider-like blood vessels under the skin

Serious symptoms that might indicate a life-threatening condition

Cirrhosis of the liver is a serious disease that can lead to life-threatening complications, such as liver failure, esophageal varices, and hemorrhage. Seek immediate medical care (call 911) if you have any of these symptoms:

  • Ascites (a buildup of fluid and swelling in the abdomen)

  • Bleeding, such as vomiting blood or heavy rectal bleeding

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Edema (swelling) in the legs

  • Jaundice (yellowing of the skin and whites of the eyes)

  • Muscle tremors or shakiness

  • Poor cognitive functioning, due to the liver’s inability to filter toxins and a buildup of waste products in the blood and brain

  • Severe shortness of breath or difficulty breathing

Causes

What causes cirrhosis of the liver?

Cirrhosis of the liver is caused by an underlying disease or condition that results in inflammation and the formation of scar tissue in the liver. Some types of cirrhosis are preceded by a condition called steatohepatitis, commonly referred to as a fatty liver. This is a buildup of fat cells and enlargement of the liver. If the cause of fatty liver is not addressed, it can eventually lead to permanent scarring (fibrosis) of liver tissue. Left untreated, scarring progresses and replaces healthy tissue. Scarred liver tissue cannot function normally and can eventually lead to liver failure.

The most common cause of steatohepatitis is long-term alcohol abuse. Other chronic conditions, such as obesity, coronary artery disease, and diabetes increase the risk of nonalcoholic fatty liver disease. Both alcoholic and nonalcoholic fatty liver disease can progress to steatohepatitis and cirrhosis.   

Common causes of cirrhosis of the liver

There are a variety of diseases and conditions that can cause scarring of the liver. The most common causes include:

  • Alcohol dependence and alcoholism

  • Chronic hepatitis B or C

Other causes of cirrhosis of the liver

Less common causes of cirrhosis of the liver include:

  • Autoimmune hepatitis (a form of hepatitis in which the immune system attacks the liver)

  • Congestive heart failure (inability of the heart to effectively pump blood)

  • Cystic fibrosis (an inherited disease that causes a buildup of mucus in the liver, lungs and other organs)

  • Glycogen storage diseases

  • Hemochromatosis (excessive levels of iron in the body that cause liver damage)

  • Primary or secondary biliary cirrhosis

  • Wilson’s disease (an inherited disease that causes excessive retention of copper)

Risk Factors

What are the risk factors for cirrhosis of the liver?

A number of factors increase the risk of developing cirrhosis of the liver. Risk factors include:

  • Alcohol dependence and alcoholism

  • Chronic hepatitis B, C or D

  • Coronary artery disease (due to atherosclerosis or hardening of the arteries, or other causes)

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • Exposure to certain toxins such as arsenic

  • High triglyceride blood levels

  • Intestinal bypass surgery

  • Long-term treatment with corticosteroids

  • Obesity

Reducing your risk of developing cirrhosis of the liver

Not all people who are at risk of cirrhosis of the liver will develop the condition. However, you can significantly lower your risk of developing cirrhosis of the liver by:

  • Avoiding risk factors for hepatitis, such as having unprotected sex with more than one partner, or sharing needles for tattooing or drug use

  • Not drinking alcohol, or limiting alcohol intake to one drink per day for a woman and two drinks per day for a man

  • Seeking regular medical care and following your treatment plan for chronic diseases and conditions, such as diabetes, obesity, high cholesterol, high blood pressure, and coronary artery disease

Treatment

How is cirrhosis of the liver treated?

The scar tissue that forms in the liver due to cirrhosis of the liver is permanent. The goal of treatment is to stop or slow the progression of damage to the liver and minimize and quickly treat any complications, such as portal hypertension, liver failure, and hemorrhage. Treatment plans include a multifaceted, individualized approach that varies depending on the underlying cause of the disease. For example:

  • Alcoholism treatment includes abstaining from alcohol, which often requires participation in an alcohol treatment program.

  • Hepatitis treatment may include corticosteroid drugs for autoimmune hepatitis or the medication, interferon, to treat a hepatitis infection.

Complications of cirrhosis of the liver are also treated as appropriate. Lactulose is often prescribed for cirrhosis-induced encephalopathy. Vascular shunt procedures attempt to alleviate esophageal varices and ascites. In some cases, treatment of liver failure may include liver transplant. This major surgical procedure involves using a healthy donor liver to replace a severely diseased liver.

Complications

What are the possible complications of cirrhosis of the liver?

Complications of cirrhosis of the liver are serious and life threatening. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.

Complications of cirrhosis of the liver include:

  • Ascites, which is a buildup of fluid and swelling in the abdomen

  • Esophageal varices, which are swollen veins in the esophagus due to portal hypertension. These bulging veins can burst, leading to life-threatening hemorrhage.

  • Hepatic encephalopathy, which involves changes in the brain due to an inability of the liver to filter toxins, such as ammonia. Hepatic encephalopathy can lead to coma and death.

  • Higher risk of liver cancer

  • Kidney failure

  • Liver failure

  • Permanent liver damage and loss of normal liver function

  • Portal hypertension, which is high blood pressure in a large abdominal vein that can lead to esophageal varices and other problems

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Oct 21
  1. Cirrhosis. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/.
  2. Cirrhosis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001301/.
  3. Liver Disease. Lab Tests Online. http://www.labtestsonline.org/understanding/conditions/liver_disease.html
  4. Liver Disease. University of Maryland Medical Center.  http://www.umm.edu/liver/common.htm.
  5. The Progression of Liver Disease. American Liver Foundation.  http://www.liverfoundation.org/abouttheliver/info/progression/.  
  6. Portal Hypertension. Vascular Disease Foundation. http://vasculardisease.org/portal-hypertension/
  7. Viral Hepatitis. Centers for Disease Control and Prevention. http://www.cdc.gov/hepatitis/
  8. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
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