What Is Cirrhosis of the Liver? A Guide to Its Causes, Symptoms, and Treatments

What is cirrhosis of the liver?

Cirrhosis of the liver is a chronic medical condition caused by inflammation and swelling of the liver. This happens when healthy liver tissue is replaced with fibrotic scars. Scar tissue isn’t able to perform the important duties that normal liver cells do. As more and more healthy liver tissue is replaced with scar tissue, liver failure sets in and symptoms of cirrhosis begin to show up. 

What are some of the common causes of cirrhosis?

Several different things cause liver inflammation and increase the risk of liver cirrhosis. The most common causes include: 

• Long-term alcohol use: The liver processes alcohol, and even small amounts of alcohol can cause liver damage.  

• Metabolic dysfunction-associated steatotic liver disease (MASLD): In this condition, formerly known as non-alcoholic fatty liver disease, excess fat builds up in the liver. People who have Type 2 diabetes and obesity are at a high risk for developing MASLD.

• Hepatitis B and C: These viral infections cause inflammation in the liver and can lead to cirrhosis or liver cancer.

Other causes of liver cirrhosis include:

• Drug-induced liver injury caused by certain medications, like methotrexate and amiodarone 

• Some genetic conditions, like alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, and cystic fibrosis

• Autoimmune hepatitis, a condition in which your body’s immune system attacks liver cells

• Congestive heart failure, which occurs when your heart loses its ability to pump enough blood to meet your body’s needs

• Primary sclerosing cholangitis, an autoimmune disease that causes inflammation and scarring of the bile ducts in the liver

What are the symptoms of liver cirrhosis?

In the earlier stages of liver cirrhosis, you may experience no symptoms at all. As the disease progresses, though, you may feel:

• Pain in the upper-right side of the abdomen

• Fatigue

• Nausea and vomiting 

During the later stages of cirrhosis, you may experience other symptoms, such as:

• Yellowing in the white part of the eye or skin (jaundice)

• Itching     

• Easy bruising

• Easy bleeding

• Internal bleeding from enlarged vessels in the esophagus or stomach that form by blood being pushed back from the liver (varices) 

• Swelling of the legs (edema) and abdomen (ascites)

In severe cases, you may also have symptoms of hepatic encephalopathy. This condition is marked by changes in brain function caused by the liver not being able to clear toxins from the blood. Common symptoms of hepatic encephalopathy include:

• Confusion

• Mood changes

• Memory problems

• Behavior changes

• Lethargy 

• Movement changes

How is liver cirrhosis diagnosed?

Damage to your liver is assessed by different tests, which include:

• Liver function tests: These tests check for inflammation and damage to the liver.

• Basic metabolic panel: It checks your electrolytes and kidney function, since liver failure can also affect kidney function.

• Blood tests: These tests look for evidence of a viral liver infection, like hepatitis B and C, or inflammation and fibrosis. 

• Transient elastography (Fibroscan): This test uses ultrasound to measure liver stiffness and scarring.

• Imaging tests: These tests use a CT scan or MRI to help determine the severity of liver damage. Imaging tests can also look at any fluid buildup in the abdomen.

• A liver biopsy: During a biopsy, a medical professional takes a small sample of your liver and looks at it through a microscope. This is to determine how much cell damage is present.

What are the stages of liver cirrhosis?

During stages of early liver damage, there are no symptoms, and the liver still functions relatively well. These are called compensated stages of liver cirrhosis. Decompensated stages occur when there’s more liver damage and other signs of liver failure.

The chart below shows the different stages of liver cirrhosis.

What are the complications of liver cirrhosis?

A healthy liver is important for many functions, including blood clotting, filtering the blood, and making protein. That’s why liver failure can cause issues affecting many body systems. Some of the most common complications of liver cirrhosis include:

• Jaundice: yellowing of the eyes and skin

• Ascites: fluid buildup in the abdomen

• Hepatic encephalopathy: mental status changes

• Hepatic hydrothorax: fluid buildup in the chest cavity that affect the lungs

• Diabetes: from the liver no longer being able to manage blood glucose levels

• Hepatocellular carcinoma: a form of liver cancer

• Hepatopulmonary syndrome: buildup of fluid within the lungs that leads to shortness of breath and low oxygen levels

• Hepatorenal syndrome: kidney failure due to cirrhosis

• Portal hypertension: increased blood pressure in the veins leading to the liver due to liver scarring

• Varices: stretched blood vessels in the esophagus or stomach due to increased liver pressure

• Hemorrhage: excessive bleeding due to reduced clotting

What are the treatments for liver cirrhosis?

Since liver scarring can’t be reversed, treatments for liver cirrhosis focus on the different issues you may experience, such as:

• Edema: Swelling in your legs can be treated with a water pill (diuretic) and a low-salt diet.

• Ascites: Large amounts of fluid in the abdomen can be drained using a needle (paracentesis).

• Portal hypertension: A transjugular intrahepatic portosystemic shunt (TIPS) procedure relieves increased blood pressure in the liver and lowers the risk of bleeding varices. Medications can also be given to lower blood pressure.

• Bleeding varices: Endoscopy (small tube with a camera) can be used to inject medication to stop the bleeding or apply bands around the vessels. Medications like octreotide can also be used to clamp down the blood vessels.

• Hepatic encephalopathy: Medications like lactulose can help get rid of the toxin buildup affecting brain function. 

• Liver failure: If treatments aren’t working and your liver no longer functions, you may need a liver transplant.

How long can you live with cirrhosis of the liver​?

How long you can live with cirrhosis depends on a couple of factors. Measurements like the Child-Pugh score and the model for end-stage liver disease (MELD) score help healthcare professionals assess the severity and likelihood of survival from cirrhosis. 

The Child-Pugh score ranges from 5 to 15 points and takes into account how well the liver is functioning and any complications you may have developed. A lower score (5 to 6 points) is most closely linked to compensated cirrhosis. In this stage, the liver continues to do most of its work normally. And in general, you can expect to live many years. A higher score (10 to 15 points) is linked to more advanced cirrhosis and a lower life expectancy. 

The chart below shows the percentage of people expected to live at least 2 years, based on their Child-Pugh scores.

The MELD score is used as a predictor of short-term survival, typically over 3 months. It ranges from 6 to 40 points and uses lab test results to assign a score. Higher scores are linked to a lower likelihood of 3-month survival. It’s often used to assess people with end-stage liver disease.

How can you prevent liver cirrhosis?

Fortunately, you can help prevent some of the causes of liver damage that may lead to cirrhosis. Tips include: 

• Avoid excess alcohol use: As mentioned earlier, long-term alcohol use is one of the most common causes of liver cirrhosis.

• Eat a balanced diet: Limiting the amounts of fried foods, saturated fats, trans fats, and processed sugar can be part of a wholesome diet that’s good for your overall health and prevents fat buildup around the liver.

• Exercise regularly: Exercise helps to prevent obesity and Type 2 diabetes. These conditions increase the risk of liver damage.  

• Avoid intravenous (IV) drug use: Avoiding sharing needles with others prevents hepatitis B and C infections.

• Use protection during sex: This can prevent sexually transmitted hepatitis B and C infections.

• Get vaccinated against hepatitis B: This is especially important if you are at high riskfor hepatitis.

When to see a healthcare professional if you think you have cirrhosis

If you think you’re having any symptoms of liver disease, you should see a healthcare professional right away. They can do the necessary testing to check your liver and figure out the cause of your symptoms. Early diagnosis of cirrhosis will give you the best chance of successful treatment. It may also help you to avoid serious complications of cirrhosis, as well. 

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Written by:

David L. Miller, DO, FACOI

David L. Miller, DO, FACOI, is a retired internal medicine physician with over 20 years of clinical experience. He attended the University of New England College of Osteopathic Medicine and completed his residency in Detroit at the Henry Ford/Horizon Health System.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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