What Is Cirrhosis?
Cirrhosis is a condition in which scar tissue gradually replaces your healthy liver cells. It usually happens over a long period, often due to infection, other diseases, or alcohol addiction. Most of the time, you can't fix the damage to your liver. But if you catch it early, some treatments can keep problems in check.
Your liver is an organ about the size of a football that has an important job. It filters toxins from your blood, makes enzymes that help you digest food, stores sugar and nutrients, and helps you fight infections.
Each time your liver gets hurt, it repairs itself and forms tough scar tissue. When too much scar tissue builds up, the organ can't work the way it should.
Your doctor might call this condition cirrhosis of the liver.
Cirrhosis may not cause any symptoms at first. But as the damage to your liver gets worse, you may start to notice some signs.
What are the first signs of cirrhosis?
Early cirrhosis symptoms can be the same as those of other diseases, so it’s important to talk to your doctor when you have them. They can include:
- Swelling in your belly, ankles, or legs
- Feeling very tired or weak
- Poor appetite and weight loss
- Nausea and vomiting
- Muscle weakness or cramps
- Pain on the top right side of your belly
- Itching, which may be intense
- Spider web-like blood vessels on your face, chest, or arms
- Redness in the palms of your hands or whitening of your nails
- Jaundice (when your skin and eyes turn yellow)
Other symptoms of cirrhosis
If you don’t get treatment for the cause of your cirrhosis, it’ll get worse. The symptoms will get worse, too. They might include:
- Changes to the way you think, such as problems with concentration or memory
- Trouble sleeping
- Wider or thicker fingertips (clubbed fingers)
- Hair loss
- Nosebleeds or bleeding gums
- Lack of sex drive or ability
- Pee that looks brownish or orange
- Light-colored poop
- Blood in your poop
- Vomiting blood
- Bones that break more easily
- You stop having periods if you're a woman (or were assigned as female at birth)
- You see shrinkage in your testicles or start to develop breasts if you're a man or were assigned male at birth
Keep in mind that you may not have all these symptoms, and some of these problems are also signs of other conditions.
Go to the emergency room if:
- Your stools are black or look like tar.
- You're vomiting blood.
- You have serious belly pain.
- You feel very confused and sleepy.
- You have a high fever and can’t stop shaking.
- The whites of your eyes suddenly turn yellow.
Learn more about the symptoms of cirrhosis.
Causes and Risk Factors
Cirrhosis always develops because of another liver problem or disease. If you don't treat the cause of your cirrhosis, it'll get worse, and over time your healthy liver cells won't be able to keep up. After a while, your liver may not be able to work well or at all.
It's important to know the cause of your cirrhosis so you can get the right treatment and keep it from getting worse. The most common causes are:
Nonalcoholic fatty liver disease. Type 2 diabetes, metabolic syndrome, and obesity raise your chances of this condition. If your cirrhosis is caused by fatty liver disease, losing weight and keeping your blood sugar levels under control may improve your liver health.
Other conditions that can lead to cirrhosis include:
- Cystic fibrosis
- Diseases that make it hard for your body to process sugars
- Too much iron buildup in your body
- Wilson's disease, in which your liver stores too much copper
- Autoimmune diseases that cause your body to attack liver cells
- Blockage of the bile duct, which carries digestive enzymes from your liver into your intestines
- Certain inherited digestive disorders
- Some infections, including syphilis and brucellosis
- Bad reactions to certain medications
- Chronic heart failure with liver congestion
Cryptogenic cirrhosis is when there's no apparent cause for the scarring on your liver. A doctor usually gives this diagnosis after ruling out other possible causes. It's been linked to a type of fatty liver disease called nonalcoholic steatohepatitis (NASH), which causes long-term inflammation in your liver.
As you might not feel symptoms right away, you may not find out that you have cirrhosis until you get a routine checkup. When you visit your doctor, they'll ask about your alcohol use and medical history. They'll also examine you to check if your liver is tender or larger than it should be.
If your doctor suspects cirrhosis, they’ll do a blood test. It will check for signs that your liver isn't working right, such as:
- High levels of certain liver enzymes
- Buildup of bilirubin, which forms from your body's metabolism of heme. Heme iron is found in foods sourced from animals, such as chicken and red meat.
- Low levels of proteins in your blood
- Abnormal blood count
- Infection with a virus
- Antibodies that appear when you have an autoimmune liver disease
Your doctor may also do an imaging test of your belly, such as an MRI or ultrasound. You may need a procedure called a biopsy, in which a sample of your liver tissue is removed so your doctor can see how much damage has been done and what may have caused your liver disease.
Get more information on tests for cirrhosis.
Stages of Cirrhosis
Liver cirrhosis has two basic stages. If you find out you have it, your doctor will tell you what stage you're in. Depending on how well your liver is working, they'll say it's either “compensated” or “decompensated.” Which one it is makes a difference in the kind of treatment you get.
If you have compensated cirrhosis, you won't have any symptoms. Your liver can still do its job because there are enough healthy cells to make up for the damaged cells and scar tissue caused by cirrhosis. You can stay in this stage for many years.
Decompensated cirrhosis is the more advanced of the two cirrhosis stages. At this point, your liver has so much scarring that you develop complications.
Your doctor will know you have decompensated cirrhosis if you show signs of one or more of these conditions:
- Jaundice. It's caused when your liver can't get rid of bilirubin, a blood waste product. It can make your skin and eyes yellow.
- Ascites. This refers to fluid buildup in your belly.
- Bleeding varices. Varices are enlarged blood vessels. Signs that you have bleeding varices include black, tarry, or bloody stools or throwing up blood. This is an emergency that needs treatment right away.
- Hepatic encephalopathy (HE). Toxins can build up in your brain and make you confused and very tired. You may have trouble doing daily activities such as driving or writing.
Damage from cirrhosis can keep your liver from doing important jobs such as removing toxins from your body and helping you digest food. It can lead to problems, such as:
- Portal hypertension. Scars in the liver block blood flow through the portal vein. This is the main blood vessel to the liver. This backup of blood increases pressure in the portal vein, as well as in the system of veins that connect to it. Increased blood pressure makes these vessels swell up. The veins may burst and cause bleeding.
- Varices. These are swollen blood vessels caused by blocked blood flow. They’re usually found in the esophagus and stomach. They can stretch so much that they eventually break open and bleed (variceal bleeding). Bleeding can also result from portal hypertension, which causes blood to be redirected to smaller veins.
- Fluid buildup. Increased pressure in the portal vein and reduced liver function can cause fluid to build up in your belly (called ascites) and legs (edema).
- Liver cancer. Cirrhosis increases your risk for liver cancer. You'll get blood tests or an ultrasound every 6-12 months to look for cancer.
- Hepatic encephalopathy. When your liver isn't able to remove toxins from your body, they build up in your blood. This can affect your brain and cause problems with thinking and memory.
- Infections. People with cirrhosis aren't able to fight off infections effectively. Ascites could lead to a serious infection called bacterial peritonitis.
Cirrhosis isn't curable, but it’s treatable. Doctors have two main goals in treating this disease: to stop the damage to your liver and prevent complications. Your doctor will personalize your treatment based on what caused your cirrhosis, and how much liver damage you have.
They may recommend:
Alcohol abuse treatment
Your liver breaks down and removes toxins from your body. Alcohol is a toxin. When you drink too much, your liver has to work extra hard to process it.
To protect your liver, you must stop drinking. That can be hard to do, especially if you've become dependent on alcohol. Ask your doctor about things you can try that may help you stop drinking, such as:
- 12-step and other support programs such as Alcoholics Anonymous (AA)
- One-on-one counseling with a therapist
- Support groups to help you manage the things that lead you to drink
- Inpatient rehab programs
- Prescription medicines such as acamprosate (Campral) and naltrexone (Revia, Vivitrol)
Get more information on treatments for alcohol use disorder.
Treatments for hepatitis can help prevent liver damage. For hepatitis C, there are antiviral treatments that lead to a cure in the vast majority of people.
- Antiviral drugs. These attack the hepatitis virus. Which antiviral drug you get depends on the type of hepatitis you have. The most common side effects of these medicines are weakness, headache, nausea, and sleep problems.
- Interferon (interferon alpha 2b, pegylated interferon). This helps your immune system fight off the hepatitis virus. Side effects can include trouble breathing, dizziness, weight changes, and depression. Interferon isn't often used to treat hepatitis C because it can be cured with antiviral medications.
Learn more about the different treatment options for hepatitis C.
Nonalcoholic fatty liver disease treatments
The best way to combat this cause of liver damage is to lose excess weight with the help of diet and exercise. With any liver disease, it's important to stay away from alcohol and, in some cases, avoid taking vitamin E.
When you have fat in your liver, but it hasn't yet done any damage, this condition is called nonalcoholic fatty liver disease (NAFLD). When you have fat in your liver along with signs of inflammation and cell damage, it's known as nonalcoholic steatohepatitis (NASH).
There's no medication to reverse the fatty buildup from NASH. However, controlling the conditions that may contribute to it can help stop liver damage. In some cases, liver damage has been known to reverse itself.
Your doctor may suggest vitamin E or pioglitazone to help. Vitamin E alone is often prescribed for people who have NASH and don't have diabetes or cirrhosis.
Treatments for autoimmune hepatitis and primary biliary cirrhosis
In both of these diseases, your body’s natural defense system (immune system) attacks and damages your liver. Primary biliary cirrhosis destroys the bile duct, which is the tube that carries the digestive fluid (bile) from your liver to your gallbladder and intestine.
Doctors treat autoimmune hepatitis with steroid drugs and other medicines that stop the immune system from attacking the liver. Side effects may include weight gain, diabetes, weak bones, and high blood pressure.
The main treatment for primary biliary cirrhosis is to slow liver damage with the drug ursodiol (Actigall, Urso). Ursodiol can cause side effects such as diarrhea, constipation, dizziness, and back pain.
Know more about the treatment options for primary biliary cirrhosis.
Treatments for cirrhosis complications
Treatments are available for many of the main complications of cirrhosis:
- Portal hypertension. High blood pressure drugs called beta-blockers lower pressure in the portal vein and other blood vessels so they don't swell to the point of breaking.
- Varices. Your doctor can tie a special rubber band around these swollen blood vessels to stop the bleeding they cause. This procedure is called band ligation. A surgery called TIPS is sometimes needed to “shunt”, which means to redirect, the blood flow.
- Ascites. Your doctor can prescribe medicines called diuretics to help your body get rid of the extra fluid. You might also need antibiotics to prevent bacteria from growing in it and causing an infection. Your doctor can do a procedure to remove fluid from your belly or relieve pressure in your portal vein.
- Liver cancer. If you develop liver cancer, the main treatments are surgery, radiation, or chemotherapy.
- Hepatic encephalopathy. To prevent this complication, your doctor can give you medicines to reduce the toxins in your blood.
Your doctor may also recommend:
- Blood pressure medications to lessen bleeding inside your body caused by swollen and burst blood vessels. You may need surgery if you have seriously enlarged veins.
- Antibiotics and vaccinations to treat and prevent other infections.
- Steroids to treat inflammation in your liver.
- A low-sodium diet to help control swelling. Your doctor may also ask you to take medications for this problem. If you have serious fluid buildup, you may need to get it drained.
Your doctor can treat symptoms such as fatigue and itching with medications. Dietary supplements can address malnutrition due to cirrhosis and help to prevent weak bones.
Cirrhosis can damage your liver to the point where it no longer works. This is called liver failure. In a transplant, your damaged liver is replaced with a healthy one from a donor. You can wait on an organ transplant list for a deceased donor, or get part of a liver from a living friend or family member.
It can help you live longer, but it's a major surgery that comes with risks such as bleeding and infection. After surgery, you'll need to take medicines to prevent your body from rejecting the new organ. Because these drugs suppress your immune system, they can increase your risk for infection.
Get more information on what you should know about liver transplantation.
Can cirrhosis be reversed?
You generally can't reverse the damage that cirrhosis does to your liver. But with a prompt diagnosis and treatment for the issue that's causing your cirrhosis, you can protect against further damage.
Learn more about treatment options for cirrhosis.
Some lifestyle changes can help keep your liver as healthy as possible:
- Eat a liver-friendly diet. Cirrhosis can rob your body of nutrients and weaken your muscles. To combat these effects, eat lots of healthy foods such as fruits, vegetables, and lean protein from poultry or fish. Avoid oysters and other raw shellfish, because they contain bacteria that could cause an infection. Also, limit salt, which increases fluid buildup in your body.
- Get vaccinated. Both cirrhosis and some of its treatments can weaken your immune system and make it harder to fight off infections. Protect yourself by getting vaccinated against hepatitis A and B, COVID-19, the flu, and pneumonia.
- Be careful when you take medicine. Cirrhosis damage makes it harder for your liver to process and remove medicines. Ask your doctor before you take any over-the-counter drug, including herbal remedies. Be very cautious about medicines that can cause liver damage, such as acetaminophen, aspirin, or ibuprofen. You can't take these medications if you have ascites.
It's also important to:
- Keep all your doctor's appointments.
- Eat enough protein. People with cirrhosis need more than most folks.
- Practice good hygiene. Wash your hands often.
- Drink enough fluids, even if you have ascites, to avoid dehydration.
- Eat a low-salt diet if you have ascites.
- Eat a high-protein, high-calorie diet.
- Take a diuretic (a water pill) if your doctor prescribes one to help manage ascites.
- Take medicine your doctor prescribes if you have constipation (trouble pooping).
What to Expect
Most people with cirrhosis that's found in its early stage can live healthy lives.
If your cirrhosis is caused by long-term hepatitis, treating the infection can lower your chances of more problems if the damage is caught early.
If you have obesity or diabetes, losing weight and controlling your blood sugar can lessen the damage caused by fatty liver disease. If the damage is caused by alcohol abuse, you can manage cirrhosis better if you stop drinking right away.
Can your liver survive cirrhosis?
While you can't reverse cirrhosis, your liver can still work and bounce back even if two-thirds of it has been destroyed or removed.
In part because of the links to alcohol use disorder and obesity, people with cirrhosis may experience discrimination or stigma. You might face discrimination and negative attitudes from other people, from the health care system, or even feel shame about your own condition. Stigma can keep you from getting the care you need and worsen your health. It can also affect your work and social life, as well as your mental health.
It may help to talk with others who understand what you're going through. You can find online support groups through the American Liver Foundation, and your doctor may be able to recommend an in-person group. It's also important to know your rights. The Americans With Disabilities Act offers legal protections against workplace discrimination.
Life expectancy with cirrhosis
If you're diagnosed with cirrhosis, your life expectancy depends on what stage your illness is, your overall health, and what treatment you get, among other things. In general, for those in the early stages of compensated cirrhosis, the average life expectancy is more than 15 years. With decompensated cirrhosis, the average life expectancy is 7 years. Treatment and lifestyle changes can prolong your life.
A healthy lifestyle is a key part of preventing cirrhosis.
Go easy on alcohol. Drinking too much alcohol causes your liver to swell. Over time, this leads to cirrhosis. But this doesn’t happen overnight. Alcohol-related cirrhosis is often the result of 10 or more years of heavy drinking, but some people are more prone to the disease than others. Research has shown that women who drink heavily are more likely to get cirrhosis than men. To lower your chances of getting the disease, limit yourself to no more than 14 units of alcohol a week. Here are roughly how many units are present in common alcoholic drinks:
- A small shot (25 milliliters, or 0.85 ounces) of liquor is 1 unit.
- A small glass (125 milliliters, or 4.2 ounces) of wine is 1.5 units.
- 20 ounces of normal-strength lager beer is 2 units.
Protect yourself against hepatitis. Most often, a virus causes this inflammation of the liver. The most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Chronic (long-term) hepatitis B and C can cause cirrhosis. Hepatitis B is passed from one person to another through blood, semen, and other body fluids. Hepatitis C is caused by blood-to-blood contact. If you have chronic hepatitis C, there’s a higher chance you'll develop cirrhosis.
To lower your chances of getting hepatitis, avoid unprotected sex, and don’t share needles to inject drugs. Don't get tattoos or body piercings in unclean environments. If you do get a tattoo, make sure the instruments are properly sterilized and needles aren't shared.
Get vaccinated. If you work in health care, law enforcement, or any other profession where you might come in contact with people who have hepatitis, consider getting vaccinated against hepatitis B. There’s no vaccine for hepatitis C.
In the U.S., a vaccine for hepatitis B is also recommended for:
- Anyone under 19
- Anyone who has unprotected sex or uses intravenous drugs
- Anyone who’s been infected with hepatitis C or HIV
- Kidney patients on dialysis
- People with liver disease
- Gay men
- People with diabetes who are aged 19-59
- People traveling to areas with a higher incidence of hepatitis B, such as South Asia and Africa
To lower your chances of developing both NASH and cirrhosis:
- Follow a diet that is rich in fruits, vegetables, and whole grains, and low in fat, sugar, salt, and highly processed foods.
- Control portion sizes.
- Maintain a weight that your doctor says is healthy for you.
Talk to your doctor about statins. These drugs are usually used to treat high cholesterol. They may also help protect you from developing cirrhosis if you have hepatitis C or hepatitis B. Studies have shown that people with hepatitis B who took statins were less likely to get cirrhosis than those with hepatitis who weren’t on statins.
Get tested. If you were born in South Asia, Africa, or other parts of the world where hepatitis B and C are common, get screened for cirrhosis. Early treatment for hepatitis can prevent cirrhosis.
Anyone who needs a vaccine for hepatitis B should also be screened, along with all baby boomers (those born between 1945 and 1965).
Cirrhosis is a disease in which scar tissue replaces healthy tissue in your liver and keeps it from working as it should. It develops when your liver is damaged from things such as alcohol misuse, a hepatitis infection, or fatty liver disease. Treatment and healthy lifestyle changes can help prevent further damage and prolong your life.