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Cirrhosis

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

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

Causes

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

Less common causes of cirrhosis include:

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 x-ray is done 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 of 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

Exams and Tests

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

  • An enlarged liver or spleen
  • Excess breast tissue
  • Swollen abdomen, as a result of too much fluid
  • Reddened palms
  • Red spider-like blood vessels on the skin
  • Small testicles
  • 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:

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.
  • 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.

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 throat (bleeding 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 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 (bacterial peritonitis)
  • Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal 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

Call 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 heavily. Talk to your provider if you are worried about your drinking. Take steps to prevent getting or passing hepatitis B or C.

References

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the AmericanGastroenterological Association. Hepatology. 2012;55(6):2005-2023. PMID: 22488764 www.ncbi.nlm.nih.gov/pubmed/22488764.

Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009;104(7):1802-1829. PMID: 19455106 www.ncbi.nlm.nih.gov/pubmed/19455106.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

Kamath PS, Shah VH. Overview of cirrhosis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 74.

Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93(4):901-915. PMID: 19577121 www.ncbi.nlm.nih.gov/pubmed/19577121.

O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;105(1):14-32. PMID: 19904248 www.ncbi.nlm.nih.gov/pubmed/19904248.

    • Clubbing

      Clubbing - illustration

      Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

      Clubbing

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Liver cirrhosis, CT scan

      Liver cirrhosis, CT scan - illustration

      A CT scan of the upper abdomen showing cirrhosis of the liver.

      Liver cirrhosis, CT scan

      illustration

      • Clubbing

        Clubbing - illustration

        Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

        Clubbing

        illustration

      • Digestive system organs

        Digestive system organs - illustration

        The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

        Digestive system organs

        illustration

      • Digestive system

        Digestive system - illustration

        The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

        Digestive system

        illustration

      • Liver cirrhosis, CT scan

        Liver cirrhosis, CT scan - illustration

        A CT scan of the upper abdomen showing cirrhosis of the liver.

        Liver cirrhosis, CT scan

        illustration

      A Closer Look

       

      Review Date: 8/14/2015

      Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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