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Liver Cirrhosis
Overview
- What is liver cirrhosis?
Cirrhosis is a disease where healthy liver tissue is replaced by scar tissue. Over time, this makes the liver unable to do its normal job. Scar tissue also makes it harder for blood to flow through the liver. This causes high pressure in the veins going into the liver, called portal hypertension. Many problems from liver disease, like fluid buildup and bleeding in the esophagus, are caused by this high pressure.
Cirrhosis is a major cause of illness and death in the United States. It affects about 5.5 million people and causes up to 50,000 deaths each year. The number of people with cirrhosis is expected to keep rising in the coming years. The liver is the largest internal organ and is involved in many complex metabolic functions essential to life. Blood leaving the digestive system (stomach, intestines) passes through the liver on its way back to the heart. Essential functions of the liver include:
- The liver extracts nutrients absorbed by the digestive system from the blood and processes them for later use.
- The liver makes bile, which helps absorb fat and certain vitamins.
- The liver removes medications and toxic waste products from the blood.
- The liver is the body’s main factory for blood proteins, including the proteins involved in normal blood clotting.
Causes
- What causes cirrhosis?
Cirrhosis is caused by long-term damage to the liver. It develops after many years of ongoing inflammation in the liver. There are many causes. The most common is heavy alcohol use. Other common causes are fatty liver disease and viral hepatitis (hepatitis B and C). Less common causes include inherited conditions, problems with the immune system, and sometimes the cause is unknown. Some people may have more than one cause, like alcohol use and viral hepatitis.
Risk Factors
- What increases the risk of cirrhosis?
There are several known risk factors:
- Heavy alcohol use: Drinking more than 2-4 drinks a day for women or 4-6 drinks a day for men over a long time can lead to cirrhosis. People with other risk factors may develop cirrhosis with even less alcohol.
- Viral hepatitis: Long-term infection with hepatitis B or hepatitis C can lead to cirrhosis. Not everyone with these infections will develop cirrhosis, but they are major causes of liver disease worldwide.
- Obesity and diabetes: These can lead to a condition called MASH (metabolic dysfunction-associated steatohepatitis) which can eventually progress to cirrhosis. This is a very common condition and is the second most common cause of cirrhosis in the United States.
Symptoms
- What are the symptoms of liver cirrhosis?
In the early stages, cirrhosis may not cause any symptoms, or the symptoms may be very general. Early signs can include feeling tired and itching. In later stages, patients can develop more serious complications such as ascites, varices with bleeding, jaundice, encephalopathy (confusion), and muscle loss. Below is a description of these symptoms and complications.
- Fatigue: Fatigue is a common symptom of cirrhosis. Many patients with cirrhosis also lose muscle mass which can worsen fatigue. Fatigue due to cirrhosis can be difficult to treat. Other common causes of fatigue such as anemia and thyroid disease should be ruled out as well.
- Itching: Itching (also called pruritus) is a common symptom of cirrhosis. Itching is most common in patients with cirrhosis due to bile duct disorders, but itching can occur in any type of liver disease. A variety of medications can be used to treat cirrhosis-related itching.
- Edema: Edema is the retention of abnormal amounts of fluid in the body, most frequently in the legs.
- Ascites: Ascites is the retention of abnormal amounts of fluid inside the abdominal cavity (belly). When ascites is mild, it may only be seen on an ultrasound or CT scan. As more fluids build up, the belly can get bigger and feel full. People may also have less appetite and feel discomfort in the abdomen. Ascites is usually treated with water pills (diuretics) and lower salt in the diet. If needed, a procedure called paracentesis can be done. In this procedure, a needle is placed into the abdomen after numbing the area, and fluid is drained to give quick relief. This can be repeated as often as needed, especially if water pills do not work well or cause side effects. When a large amount of fluid builds up, it can make it harder for the lungs to expand and may cause shortness of breath. The fluid can also get infected, which is called spontaneous bacterial peritonitis. Symptoms may include fever and belly pain, but they can sometimes be mild or not obvious. This is a serious condition and often requires treatment in the hospital with antibiotics, usually given through a vein.
- Digestive Tract Bleeding: People with cirrhosis can develop enlarged veins, called varices, inside the digestive system. These are similar to varicose veins in the legs. They most often form in the lower part of the esophagus or in the stomach. Your doctor may suggest an upper endoscopy (EGD) to check for them. The walls of these veins are thin, so they can break and bleed. Varices usually do not cause symptoms unless they start bleeding. When they bleed, it can cause vomiting of blood. This is a medical emergency and needs immediate treatment at a hospital. Medicines called beta blockers can help lower the risk of bleeding from varices and may be recommended by your doctor.
- Jaundice: Jaundice is a yellowing of the skin and the whites of the eyes. It happens when a substance called bilirubin builds up in the body as liver disease gets worse.
- Hepatic Encephalopathy: In cirrhosis, the liver cannot filter the blood as well as it should. Blood coming from the intestines is not properly cleaned of waste from digestion. These waste products can travel to the brain and cause a condition called hepatic encephalopathy. Symptoms can include slow thinking, confusion, feeling very sleepy, and slurred speech. In severe cases, it can lead to coma. Your doctor may check for a certain type of hand tremor as a sign of this condition. Blood tests may also be done to check ammonia levels, which can be high in this condition. There are medicines that can help lower ammonia levels and treat hepatic encephalopathy.
Screening/Diagnosis
- How is liver cirrhosis diagnosed?
Cirrhosis can be diagnosed by taking a small sample of the liver, called a biopsy, and looking at it under a microscope. This test can confirm cirrhosis and may also help find the cause.
However, a biopsy is often not needed. Doctors can often diagnose cirrhosis based on a physical exam, blood tests, and imaging tests like ultrasound, CT scan, or MRI. Sometimes, special ultrasound or MRI tests are used to measure how stiff the liver is, which can also help diagnose cirrhosis.
Treatment
- How is liver cirrhosis treated?
Medical care for people with cirrhosis has a few main goals: treat the cause when possible, prevent problems, and manage symptoms. Cirrhosis is a long-term disease, so patients need regular care from a liver specialist.
When possible, doctors try to treat the cause of cirrhosis. Some conditions can improve with treatment and may slow down liver damage. In more advanced cases, treatment may not be possible.
People with cirrhosis should not drink alcohol. Stopping alcohol can greatly improve liver health in those who drink regularly.
Doctors may also recommend vaccines to help prevent infections. These often include a yearly flu shot and a pneumonia vaccine. You may also be tested for hepatitis A and B and vaccinated if needed.
People with cirrhosis have a higher risk of liver cancer. Regular testing, such as ultrasound, CT scan, or MRI every 6 months, can help find cancer early. Blood tests may also be used, but imaging tests are still needed. This is very important because liver cancer is curable if found early.
Doctors may use different treatments to manage symptoms and prevent problems, including:
- Lowering salt in the diet and using water pills to control fluid buildup
- Draining fluid from the belly with a procedure called paracentesis
- Using antibiotics to prevent or treat infections
- Giving medicines to treat confusion caused by liver disease (hepatic encephalopathy)
- Using medicines or procedures to prevent bleeding from enlarged veins (varices)
In some cases, a procedure called TIPS may be used. This places a small tube in the liver to help blood flow better and reduce pressure in the portal vein. It is usually used for severe symptoms that cannot be controlled with medications alone and may not be right for everyone.
For people with very severe liver disease, a liver transplant may be an option. This surgery replaces the damaged liver with a healthy one. It is a major procedure and requires lifelong medication and careful testing before and after surgery. Not all patients with cirrhosis need or qualify for a transplant.
Author(s) and Publication Date(s)
William Sanchez, MD and Jayant A. Talwalkar, MD, MPH, FACG, Mayo College of Medicine, Rochester, MN – Published January 2009. Updated December 2012.
Nader A. Dbouk, MD, Emory Transplant Center, Atlanta, GA - Updated April 2026.