Cirrhosis is the severe scarring or fibrosis of the liver. It happens in the late stage of liver disease and other conditions that involve liver damage.

The scarring that occurs with cirrhosis is usually irreversible, but treatment can help manage it. Causes of cirrhosis include metabolic dysfunction-associated steatotic liver disease (MASLD), hepatitis, long-term alcohol use, and primary sclerosing cholangitis.

According to the National Institutes of Health (NIH), about 1 in 400 adults are living with cirrhosis in the United States. It’s more likely to affect men than women.

A drawing of how a liver with cirrhosis looks likeShare on Pinterest
Illustration by Jason Hoffman

Many times, there aren’t noticeable symptoms of cirrhosis until the condition has progressed.

Symptoms begin to occur because scarring on the liver has reached the point where the organ is limited in its ability to:

  • purify the blood
  • break down toxins
  • produce clotting proteins
  • help with the absorption of fats and fat-soluble vitamins

Some of the noticeable symptoms of cirrhosis include:

More serious symptoms include:

  • jaundice, or yellow discoloration of your skin and eyes
  • confusion and difficulty thinking clearly
  • bruising or bleeding easily
  • very itchy skin
  • urine that looks darker than usual
  • ascites (abdominal swelling)
  • edema (swelling of your legs)

Symptoms of cirrhosis fall into two technical stages: compensated cirrhosis and decompensated cirrhosis.

If diagnosed early enough and treated, it’s possible to reverse from the decompensated to compensated stage.

  • Compensated cirrhosis: This is the asymptomatic (showing no symptoms) stage. There may still be scarring on the liver, but it has not progressed enough to cause many, or any, symptoms.
  • Decompensated cirrhosis: This is the stage where most of the symptoms, like jaundice or ascites, occur. This is a very serious stage. In some situations, if you can manage the reason cirrhosis started in the first place (such as heavy drinking), you may be able to reverse your diagnosis back to compensated cirrhosis.

There are many causes of cirrhosis. Two of the most common causes in the United States are long-term alcohol misuse and long-term hepatitis infections.

Alcohol misuse

According to a 2019 meta-analysis of studies, the risk of cirrhosis increases at any level of alcohol consumption for women, which means even moderate drinking may have some risk. For men, the risk of cirrhosis increases when an individual has more than one drink a day.

However, every person is different. Enjoying a glass of wine with dinner most nights does not mean cirrhosis will develop. Usually, cirrhosis caused by alcohol is the result of regular heavy drinking over many years.

There are also several other health factors that play into the development of this condition.

Hepatitis

Hepatitis C is a viral infection that can lead to inflammation and damage to the liver. Individuals who are at risk of getting this type of viral hepatitis include those who:

  • share injection drug equipment
  • have sex without a condom or other barrier method
  • are on dialysis

Hepatitis B is another viral form of hepatitis, but it tends to be less common in the United States and more common in:

  • Asia
  • Africa
  • South America
  • Eastern Europe
  • parts of the Middle East

If left untreated, both of these forms of hepatitis can cause cirrhosis.

Metabolic dysfunction-associated steatotic liver disease (MASLD)

Nonalcoholic fatty liver disease (NAFLD) is now known as metabolic dysfunction-associated steatotic liver disease (MASLD). This new name is more accurate and helps reduce the stigma associated with its older name.

MASLD is a condition that causes fat to build up in the liver, but it’s not associated with heavy alcohol use.

Metabolic dysfunction-associated steatohepatitis (MASH) is a more severe form of MASLD. It causes liver damage and inflammation in addition to fat buildup. If MASH is not managed, it can lead to cirrhosis.

Other causes

Other causes of cirrhosis include:

  • Hepatitis D: Hepatitis D is often seen in people who already have hepatitis B.
  • Autoimmune hepatitis: Autoimmune hepatitis causes inflammation that can lead to cirrhosis.
  • Damage to the bile ducts: These ducts function to drain bile. One example of a condition is primary biliary cholangitis.
  • Disorders that affect the body’s ability to handle iron and copper: Two examples are hemochromatosis and Wilson disease.
  • Medication: This includes prescription and over-the-counter drugs like acetaminophen, some antibiotics, and some antidepressants.

A diagnosis of cirrhosis begins with a detailed history and physical exam. Your doctor will take a complete medical history.

It’s important to be transparent about any long-term alcohol misuse, exposure to hepatitis C, family history of autoimmune diseases, or other risk factors.

During the physical exam, your doctor will look for signs such as:

  • skin or eyes that appear more yellowed in color
  • reddened palms
  • hand tremors
  • an enlarged liver or spleen
  • decreased alertness

Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:

  • a complete blood count to look for anemia
  • coagulation blood tests to see how quickly blood clots
  • albumin tests to check for a protein produced in the liver
  • liver function tests
  • alpha fetoprotein, a liver cancer screening

Additional tests that can evaluate the liver include:

  • an upper endoscopy to see whether esophageal varices are present
  • an ultrasound scan of the liver
  • an MRI of the abdomen
  • a CT scan of the abdomen
  • a liver biopsy, which is the most conclusive test for cirrhosis

If your blood is unable to pass through your liver, it creates a backup through other veins, such as those in the esophagus. This backup is called esophageal varices.

These veins are not built to handle high pressure, so they begin to bulge from the extra blood flow.

Other complications from cirrhosis include:

  • bacterial infections, like a urinary tract infection (UTI)
  • bleeding due to decreased clotting proteins
  • sensitivity to medications, as the liver processes medications in the body
  • malnutrition
  • kidney failure
  • liver cancer
  • hepatic encephalopathy, which is confusion due to the effects of blood toxins on the brain
  • gallstones, as interference with bile flow can cause bile to harden and form stones
  • splenomegaly, which is an enlarged spleen

Treatment for cirrhosis varies based on what caused it, your symptoms, and how far the disorder has progressed. Treatments include medications, lifestyle changes, and surgery.

Medications

Depending on the cause of cirrhosis, your doctor may recommend certain medications, such as beta-blockers or nitrates (for portal hypertension). They may also recommend antibiotics or medications to treat hepatitis.

Lifestyle changes

If your cirrhosis is a result of alcohol consumption, your doctor will most likely advise you to stop drinking.

They may also recommend that you lose weight if they consider it medically necessary.

If you have ascites, a low sodium diet may also be recommended.

Surgery

If cirrhosis has progressed to the point where treatment isn’t enough, one of the last options is a liver transplant.

Practicing sex with a barrier method can reduce the risk of getting hepatitis B or C.

The Centers for Disease Control and Prevention (CDC) recommends that all infants and adults with a higher risk, such as healthcare professionals and rescue personnel, be vaccinated against hepatitis B.

Limiting alcohol intake or avoiding alcohol, eating a balanced diet, and getting adequate exercise can help prevent or slow cirrhosis. Other prevention methods include:

  • avoiding recreational drugs
  • talking with your doctor about any medications you take and always taking the appropriate amount
  • getting screened for hepatitis if you believe you may be at risk for it

Cirrhosis is a severe stage of liver disease. It can develop in a variety of ways, such as from long-term alcohol misuse, an unmanaged hepatitis infection, or untreated MASLD.

The liver is an important organ. Once it begins to scar due to liver disease, the damage can’t be reversed — only managed with treatment. If left untreated, the damage can become so severe that the liver can no longer function properly.

While not every case of cirrhosis can be avoided, there are ways to prevent it.

Pursuing a lifestyle that includes a nutritious diet, physical activity, moderate to limited alcohol intake, and regular appointments with a doctor are all ways to keep your liver in great shape.