Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
Damage of the liver that was done by cirrhosis generally can’t be undone. But if liver cirrhosis were diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
What is cirrhosis of the liver?
Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Moreover, scar tissue keeps your liver from working properly.
In addition to that, there are many types of liver diseases and conditions which cause cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.
The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs, and natural toxins (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly. Late-stage cirrhosis is life-threatening.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
- Easily bleed or bruising
- Loss of appetite
- Swelling in your legs, feet or ankles (edema)
- Weight loss
- Itchy skin
- Yellow discoloration in the skin and eyes (jaundice)
- Fluid accumulation in your abdomen (ascites)
- Spiderlike blood vessels on your skin
- Redness in the palms of the hands
- For women, absence or loss of periods not related to menopause
- For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
- Confusion, drowsiness and slurred speech (hepatic encephalopathy)
What causes cirrhosis?
The most common causes of cirrhosis of the liver are the following:
Anything that damages the liver can lead to cirrhosis. Other causes include:
- Alcohol abuse (alcohol-related liver disease caused by long-term [chronic] use of alcohol).
- Chronic viral infections of the liver (hepatitis B and hepatitis C).
- Fatty liver associated with obesity and diabetes and not alcohol. This condition is called non-alcoholic steatohepatitis.
- Inherited diseases such as:
- Alpha-1 antitrypsin deficiency (build-up of an abnormal protein in the liver)
- Hemochromatosis (excess iron stored in the liver).
- Wilson disease (excess copper stored in the liver).
- Cystic fibrosis (sticky, thick mucus builds up in the liver).
- Glycogen storage diseases (liver can’t store or break down glycogen, a form of sugar).
- Alagille syndrome (born with fewer than normal number of bile ducts; affects bile flow and causes jaundice).
- Autoimmune hepatitis (your body’s own immune system attacks healthy liver tissue causing damage).
- Diseases that damage or blocked bile ducts in the liver (tubes that carry bile from the liver to other parts of the digestive system; bile helps digest fats):
- Primary biliary cholangitis (bile ducts become injured, then inflamed, then permanently damaged).
- Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver).
- Blocked bile duct (can cause infections, backup of products in the liver).
- Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing damage, scarring, loss of liver tissue and cirrhosis).
- Chronic heart failure (causes fluid to back up in your liver, swelling in other areas of your body and other symptoms).
- Rare diseases, such as amyloidosis, in which abnormal deposits in the liver of an abnormal protein called amyloid disrupts normal liver function.
Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if injury – from whatever cause – continues, liver cells start to die. Over time, scar tissue replaces the damaged liver cells and the liver can’t function properly.
How is cirrhosis of the liver diagnosed?
Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol abuse, injectable drug abuse, or have had hepatitis B or C and have the symptoms listed in this article.
To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:
- Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis, including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).
- Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include the following:
- Lower than normal levels of albumin and blood clotting factors (lower levels mean your liver has lost its ability to make these proteins).
- Raised levels of liver enzymes (suggests inflammation).
- Higher level of iron (may indicate hemochromatosis).
- Presence of autoantibodies (may indicate autoimmune hepatitis or primary biliary cirrhosis).
- Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood).
- High white blood cell count (indicates an infection).
- High creatinine level (a sign of kidney disease that suggests late-stage cirrhosis).
- Lower levels of sodium (is an indicator of cirrhosis).
- Raised level of alpha-fetoprotein (indicates presence of liver cancer).
In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.
- Imaging tests: Imaging test show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered include computerized tomography (CT) scan, abdominal ultrasound and magnetic resonance imaging (MRI). A special ultrasound, called a transient elastography, measures the fat content and the amount of stiffness in your liver. Two different types of endoscopies might be ordered: an endoscopic retrograde cholangiopancreatography to detect bile duct problems, and/or upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach or intestines.
- Biopsy: A sample of liver tissue (biopsy) is removed from your liver and examined under the microscope. A liver biopsy can confirm a diagnosis of cirrhosis, determine other causes or extent of liver damage or enlargement or diagnosis liver cancer.
Is there a cure for cirrhosis of the liver?
There’s no cure for cirrhosis of the liver. In short, the damage already done to your liver is permanent. However, depending on the underlying cause of your cirrhosis, there may be actions you can take to keep your cirrhosis from getting worse. These actions may include the following :
- Stop drinking alcohol.
- Treat chronic hepatitis (if you have it).
- Avoid medications that stress the liver.
- Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet.
Follow other tips listed under the Prevention section in this article.
What are the goals of cirrhosis treatment?
The goals of treatment for cirrhosis of the liver are to:
- Slow further damage to your liver.
- Prevent and treat symptoms.
- Prevent and treat complications.
How is cirrhosis of the liver treated?
Treatment depends on what’s causing your cirrhosis and how much damage exists.
Although there is no cure for cirrhosis, treatments can delay or stop its progress and reduce complications.
Treatments for the causes of cirrhosis are as follows:
- Alcohol-related liver disease: If you’ve developed cirrhosis from alcohol abuse, stop drinking alcohol. If you need help, ask your health care provider for recommendations for alcohol addiction treatment programs.
- Hepatitis B or C: Several approved antiviral medications are available to treat hepatitis types B and C.
- Nonalcoholic fatty liver disease: Management of nonalcoholic fatty liver disease includes losing weight, following a healthy diet, getting physical exercise and following your provider’s instructions for managing your diabetes.
- Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
- Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
- Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease.
- Inherited liver diseases: Treatment depends on the specific inherited disease. Treatments are aimed at treating symptoms and managing complications. Treatment of alpha-1 antitrypsin deficiency may include medicines to reduce swelling in your abdomen and legs, antibiotics to treat infections and other medicines for complications. For hemochromatosis, the treatment is to remove blood to reduce the level of iron in your blood. And, for Wilson disease, treatment is medicine to remove copper from your body and zinc to prevent absorption of copper. For cystic fibrosis, medications are prescribed to improve lung function, methods to clear mucous and treatment of complications. Treatment for glycogen storage diseases that involve the liver is to keep glucose at the right level.
- Autoimmune hepatitis: Treatment includes medications to suppress your immune system.
- Diseases that damage or block bile ducts in the liver: Treatments include medications such as Ursodiol (Actigall®) or surgery to open narrowed or blocked bile ducts.
- Heart failure: Treatment depends on the cause and stage of your heart failure. Medications include drugs to treat high blood pressure, reduce cholesterol, remove excess fluids (edema) from your body and improve heart pumping function. Other treatments include implantation of devices to help pump blood or monitor the heart rhythm, surgeries to unblock arteries or replace or repair heart valves and transplant surgery to replace your heart.
- Medications that may be contributing to cirrhosis: Your provider will review all of your medications to determine if any are causing problems for your liver and if so, stop the drug, lower the dosage or change to a different drug if possible.
Complications of cirrhosis can include:
- High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.
- Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
- Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
- Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can’t make enough clotting factors, this also can contribute to continued bleeding.
- Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
- Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
- Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn’t able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
- Jaundice. It occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
- Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
- Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
- Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don’t fully understand its causes.
Reduce your risk of cirrhosis by taking these steps to care for your liver:
- Do not drink alcohol if you have cirrhosis. If you have liver disease, you should avoid alcohol.
- Eat a healthy diet. Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
- Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
- Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.
If you’re concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.