Cirrhosis

What is cirrhosis?

Cirrhosis is a chronic liver disease in which healthy liver tissue is replaced by scar tissue. Over time, fibrosis (scarring) impairs the liver’s ability to remove toxins, fight infections, process nutrients, and metabolize medications.

Stages of cirrhosis

  • Compensated cirrhosis

    The liver remains able to perform most functions and symptoms may be absent for years.

  • Decompensated cirrhosis

    Extensive scarring leads to complications such as jaundice, fluid buildup (ascites), bleeding varices, and hepatic encephalopathy. This stage carries higher risk of liver failure and cancer.

Causes of cirrhosis

  • Alcohol-related liver disease
  • Chronic viral hepatitis B and C
  • Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
  • Autoimmune hepatitis
  • Biliary diseases (primary biliary cholangitis, primary sclerosing cholangitis)
  • Genetic disorders (Wilson’s disease, hemochromatosis)
  • Long-term exposure to toxins or certain medications

Symptoms

  • Fatigue and weakness
  • Loss of appetite, weight loss, malnutrition
  • Easy bruising and bleeding
  • Jaundice (yellow skin and eyes)
  • Itchy skin
  • Fluid buildup (ascites, leg swelling)
  • Spider angiomas and reddened palms
  • Confusion or drowsiness (hepatic encephalopathy)
  • Dark urine
  • Sexual dysfunction and menstrual changes

Diagnosis

  • Medical history and physical exam

    Assessment of risk factors, alcohol use, liver enlargement, spider veins, and fluid accumulation.

  • Blood tests

    Liver function panels, complete blood count, clotting tests, and hepatitis serologies.

  • Imaging

    Ultrasound, CT, MRI, and elastography to evaluate liver structure and fibrosis.

  • Endoscopy

    Screening for varices when portal hypertension is suspected.

  • Liver biopsy

    Direct assessment of scarring when noninvasive tests are inconclusive.

Treatment

Address underlying cause

  • Abstinence from alcohol
  • Antiviral therapy for hepatitis B and C
  • Weight loss, diet, and diabetes control for NAFLD
  • Immunosuppression for autoimmune hepatitis

Manage complications

  • Diuretics for fluid build-up
  • Medications (lactulose, rifaximin) for encephalopathy
  • Beta blockers to prevent variceal bleeding
  • Vitamin and nutrient supplementation
  • Antibiotics for infections

Procedures and surgery

  • Endoscopic banding for bleeding varices
  • Paracentesis to remove ascitic fluid
  • TIPS (transjugular intrahepatic portosystemic shunt) to lower portal pressure
  • Liver transplant for end-stage disease or cancer

Supportive care

  • Low-sodium diet and healthy nutrition
  • Avoidance of alcohol and hepatotoxic drugs
  • Regular exercise and weight management
  • Surveillance for liver cancer with ultrasound and AFP tests

Sources

  • National Institute of Diabetes and Digestive and Kidney Diseases. Cirrhosis. Accessed May 3, 2024.
  • Feldman M, ed. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.
  • JAMA Network. What is Cirrhosis? Accessed May 3, 2024.
  • Medscape. Cirrhosis. Accessed May 3, 2024.
  • National Library of Medicine. Hepatic Cirrhosis. Accessed May 3, 2024.