Cirrhosis of the Liver

Overview

Cirrhosis occurs when scar tissue replaces healthy liver tissue, partly blocking the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.

Many people are not aware they have cirrhosis because they may not have any signs or symptoms until their liver is badly damaged. Many people with early stages of cirrhosis may not be diagnosed if they have few symptoms or do not feel ill.

People are more likely to develop cirrhosis if they have health conditions that can cause it. Cirrhosis is also more common in people who have a history of heavy alcohol use, have overweight or obesity, have type 2 diabetes, are men, or are age 40 or older.

Signs and Symptoms

You may have no symptoms in the earliest stage of cirrhosis. Symptoms typically may not appear until the liver is badly damaged.

Early symptoms of cirrhosis may include:

• Feeling tired or weak
• Itchy skin
• Poor appetite
• Losing weight without trying
• Nausea and vomiting
• Mild pain or discomfort over the liver in the upper right side of the abdomen
• Muscle cramps
• Sexual problems

Severe symptoms as cirrhosis gets worse:

• Bruising and bleeding easily
• Muscle loss and weakness
• Confusion, difficulty thinking, memory loss, personality changes, or sleep disorders
• Internal bleeding due to the bursting of enlarged veins (varices) in the esophagus, stomach, or intestines
• Swelling in the lower legs, ankles, or feet, called edema
• Swelling of the abdomen from a buildup of fluid, called ascites
• Severe itchy skin
• Darkening of the color of the urine
• Yellowish tint to the whites of the eyes and skin, called jaundice

Related Health Effects

People may develop complications as their liver fails. In some people, complications may be the first sign they have cirrhosis.

Portal Hypertension

Portal hypertension is a serious problem caused by cirrhosis and can lead to some of the most common complications of cirrhosis. It occurs when scar tissue in the liver slows the normal flow of blood, causing high blood pressure in the portal vein — the large blood vessel that carries blood from the intestines, spleen, gallbladder, and pancreas to the liver.

When portal hypertension reaches a certain level, it can cause complications such as.

• Buildup of fluid in the abdomen, called ascites. Ascites can become infected-a serious infection called peritonitis — in the space that surrounds the liver and intestines
• Buildup of fluid in the lungs, called hepatohydrothorax
• Swelling in the legs, ankles, or feet, called edema
• Enlarged veins (varices) in the esophagus, stomach, or intestines, which can lead to internal bleeding if the veins burst
• Confusion or difficulty thinking caused by a buildup of toxins in the brain, called hepatic encephalopathy

Infections

Cirrhosis increases the chance of getting bacterial infections.

Liver Cancer

Cirrhosis increases the chance of getting liver cancer. Most people who develop liver cancer already have cirrhosis.

Liver Failure

Cirrhosis may eventually lead to liver failure, also called end-stage liver disease. With liver failure, the liver is badly damaged and stops working. People with liver failure should see a liver specialist about qualifying for a liver transplant.

Malnutrition

Cirrhosis can lead to malnutrition, meaning the body does not get the right amount of vitamins, minerals, and other nutrients it needs to stay healthy. Research suggests that 50 to 90 percent of people with cirrhosis have malnutrition. The symptoms of cirrhosis — such as nausea and vomiting — may cause people to eat and drink less. When the liver is not working well, the body may have problems digesting foods and drinks or absorbing nutrients

Other Complications

Other complications of cirrhosis may include:

• Bone diseases, such as osteoporosis
• Gallstones
• Problems with the bile ducts, the tubes that carry bile out of the liver
• Malabsorption and malnutrition
• Bruising and bleeding easily
• Falls
• Sensitivity to medicines
• Insulin resistance and type 2 diabetes

Causes and Risk Factors

Cirrhosis has different causes. Some people with cirrhosis have more than one cause of liver damage, and for some people, the cause is not known.

Most Common Causes

The most common causes of cirrhosis are:

• Alcohol-associated liver disease: Damage to the liver and its function from drinking too much alcohol
• Buildup of fat in the liver, called metabolic dysfunction-associated steatotic liver disease (MASLD), which is more common in people with overweight, obesity, or other conditions such as metabolic syndrome or type 2 diabetes
• Long-term, or chronic, infection with the hepatitis C or hepatitis B viruses

Research suggests that certain inherited genes affect how much these conditions damage the liver.

Less Common Causes

Some less common causes of cirrhosis include:

• Autoimmune hepatitis, a disease in which the immune system attacks the liver
• Diseases that damage, destroy, or block bile ducts, such as primary biliary cholangitis and primary sclerosing cholangitis
• Inherited liver diseases, such as Wilson disease, hemochromatosis, and alpha-1 antitrypsin deficiency
• Long-term use of certain medicines and high doses of vitamin A daily
• Chronic heart failure with liver congestion, a condition in which blood flow out of the liver is slowed

Additional Risk Factors

Cirrhosis is more common in people who:

• Are men
• Are age 40 or older

Diagnosis

Doctors diagnose cirrhosis based on medical history, a physical exam, and the results of tests.

Family and Medical History

Your doctor may ask about your symptoms and whether you have a history of health conditions that increase the risk of developing cirrhosis. When taking your medical history, your doctor may ask about:

• Any recent changes in weight or appetite
• Alcohol use
• Prescription and over-the-counter medicines or herbal supplements or recreational drugs you take

Your doctor may also ask if you have a family history of health conditions, including liver conditions.

Physical Exam

In a physical exam, your doctor will:

• Look for jaundice, or a yellowish tint to your skin or the whites of your eyes.
• Check your skin for rashes and legs for swelling.
• Use a stethoscope to listen to your heart, lungs, and abdomen.
• Tap or press on different areas of your abdomen to check for swelling or tenderness.
• Check to see if your liver has become larger.
• Check your hands for tremors.

Blood Tests

Your doctor may recommend the following blood tests:

• Liver tests that can show if liver enzyme levels are higher or lower than normal; Your doctor may suspect cirrhosis if you have higher levels of the liver enzymes alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase; higher levels of bilirubin; or lower levels of albumin or higher levels of immunoglobulins
• Complete blood count, which can show signs of infection and anemia that may be caused by internal bleeding
• Tests for viral infections to see if you have hepatitis B or hepatitis C
• Tests for autoimmune liver conditions, which include the anti-nuclear antibody (ANA), anti-smooth muscle antibody (SMA), and anti-mitochondrial antibody tests
• Test for liver cancer such as the alphafetoprotein

Imaging Tests

Imaging tests can show the size, shape, and texture of the liver and how much fat is in the liver. Some tests can also measure the stiffness of the liver, which cirrhosis increases. Your doctor may use one or more of the following:

• Ultrasound uses a hand-held device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure.
• Magnetic resonance imaging (MRI) uses radio waves and magnets to produce detailed images of organs and soft tissues without using X-rays.
• Computed tomography (CT) scans use a combination of X-rays and computer technology to create images of the liver.
• Elastography is a special test that measures the stiffness of the liver. An increase in liver stiffness may be a sign of fibrosis, or scarring.

Liver Biopsy

Your doctor may perform a liver biopsy to see how much scarring is in your liver. A liver biopsy can diagnose cirrhosis when the results of other tests are uncertain. During a liver biopsy, a doctor uses a needle to take small pieces of tissue from the liver, and a pathologist examines the tissue under a microscope.

Treatment and Management

Doctors do not have specific treatments that can cure cirrhosis and reverse liver damage. However, treating the causes of cirrhosis may prevent cirrhosis or slow liver damage. Treating the complications of cirrhosis may keep them from getting worse and prevent liver failure.

Treating the Causes of Cirrhosis

To treat the causes of cirrhosis, doctors often recommend lifestyle changes or prescribe medicines to prevent more liver damage.

• Alcohol-associated liver disease: Doctors will recommend that people completely stop drinking alcohol and may refer them for alcohol treatment.
• Metabolic dysfunction-associated steatotic liver disease (MASLD): Doctors may recommend weight loss for people with overweight or obesity. Weight loss can help reduce fat in the liver, inflammation, and scarring. Doctors sometimes recommend additional weight-loss treatments such as medicines or surgery.
• Chronic hepatitis C: Doctors may prescribe one or more antiviral medicines that attack the virus. Studies have shown that these medicines can cure more than 95% of people with chronic hepatitis C in 8 to 12 weeks.
• Chronic hepatitis B: Doctors may prescribe antiviral medicines that slow or stop the virus from further damaging the liver.
• Autoimmune hepatitis: Doctors treat autoimmune hepatitis with medicines that suppress, or decrease the activity of, the immune system.
• Diseases that damage or block bile ducts: Doctors usually treat these conditions using medicines or medical procedures to open bile ducts that have become narrow or blocked.
• Inherited liver diseases: Treatment depends on the disease and may help prevent, improve, or manage symptoms and complications such as cirrhosis.
• Cirrhosis due to long-term use of certain medicines: The only treatment is usually to stop taking the medicines that caused the problem. Talk with your doctor before you stop taking any medicines.

Treating Cirrhosis Complications

• Portal hypertension: Doctors treat portal hypertension with medicines to lower high blood pressure in the portal vein. In severe cases, doctors may recommend making a blood flow channel in the liver known as a transjugular intrahepatic portosystemic shunt (TIPS).
• Ascites: Doctors may prescribe medicines that remove fluid from the body and recommend limiting sodium intake. Doctors may use a needle or tube to drain large fluid accumulations.
• Edema: Doctors may prescribe medicines that remove fluid from the body and recommend limiting sodium intake.
• Varices: Doctors may prescribe medicines to lower blood pressure in the veins. Doctors may perform procedures during an upper GI endoscopy or use surgical procedures to stop bleeding.
• Hepatic encephalopathy: Doctors may prescribe medicines that help lower the levels of toxins in the brain and improve brain function.
• Infections: Doctors will prescribe antibiotics to treat bacterial infections.
• Liver cancer: Doctors may recommend checking for liver cancer every 6 months using blood tests and imaging. For people who develop liver cancer, doctors may treat it with surgery, radiation therapy, chemotherapy, or a liver transplant.
• Liver failure: The only treatment for liver failure is a liver transplant.

Liver Transplant

Doctors will consider a liver transplant when cirrhosis leads to liver failure. Doctors consider liver transplants only after they have ruled out all other treatment options. A successful liver transplant can be a life-saving procedure for people with liver failure.

Living With Cirrhosis

If you have cirrhosis, you can take steps to help keep it from getting worse.

• Do not drink alcohol or use illegal drugs.
• Talk with your doctor before taking prescription medicines, over-the-counter medicines (including pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, and sleep aids), dietary supplements, and complementary and alternative medicines.
• Take your medicines as directed by your doctor.
• Get a vaccine for hepatitis A, hepatitis B, flu, pneumonia caused by certain bacteria, and shingles.
• Get a screening blood test for hepatitis C.
• Consume healthy foods and drinks.
• Avoid raw or undercooked shellfish, fish, and meat.
• Try to reach and stay at a healthy body weight.

Eating and Nutrition

Your doctor may refer you to a registered dietitian to help create healthy meal plans that fit your nutrition needs. Cirrhosis changes the way the body stores nutrients and uses them for energy. People with cirrhosis should avoid fasting.

Healthcare professionals may recommend:

• Having smaller, more frequent meals
• Eating every 3 or 4 hours while awake
• Having a snack before going to sleep at night or having an early breakfast after waking up

Avoid eating raw or undercooked shellfish, fish, and meat, and unpasteurized milk and milk products, as bacteria or viruses from these foods may cause severe infections in people with cirrhosis. Your doctor may also recommend limiting sodium in foods and drinks.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on cirrhosis of the liver.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH conducts and supports research to find new ways to prevent, detect, or treat liver disease and improve quality of life.

Researchers are studying many aspects of cirrhosis, such as:

• New treatments to prevent cirrhosis from getting worse
• New ways to prevent liver cancer in people with cirrhosis
• Improved treatments for cirrhosis complications, such as hepatic encephalopathy

NIH has supported many research projects to learn more about cirrhosis causes, complications, and treatments. Recent examples include the Liver Cirrhosis Network. The network conducts research to better understand factors that worsen cirrhosis complications and to study treatments that may improve the health of people with cirrhosis.

NIH also funds the Nonalcoholic Steatohepatitis Clinical Research Network and its research on nonalcoholic steatohepatitis, a liver disease that can cause cirrhosis.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.