What Is Cirrhosis?

“There are actually four different stages of scarring: F1 (minimal scarring), F2 (significant scarring), F3 (severe fibrosis), and F4 (advanced scarring),” says Christina Lindenmeyer, MD, a hepatologist at Cleveland Clinic in Ohio. Cirrhosis is stage 4.

Signs and Symptoms of Liver Cirrhosis

If the scarring is at an early stage, there could be no symptoms of cirrhosis, says Dr. Lindenmeyer. “You can have cirrhosis with normal liver function” — a stage referred to as “compensated cirrhosis” — she says. Once the liver decompensates, or stops doing its job, you may develop symptoms, she explains.

Many people learn they have cirrhosis incidentally because of a CT scan or other imaging for a different medical condition. “Until the scan, they had no idea they had liver disease,” says Lindenmeyer.

• Loss of appetite
• Extreme fatigue
• Weight loss
• Itchy skin
• A brownish or orange urine color
• Yellowing of the eyes and skin (jaundice)
• Swelling in the legs, ankles, feet, or abdomen (edema)
• Pale fingernails
• Confusion or slurred speech
• Redness in the palms

Causes and Risk Factors of Cirrhosis

Chronic Viral Hepatitis B, C, or D Chronic hepatitis C is a common cause of cirrhosis in the United States. It causes the liver to swell, which can eventually lead to cirrhosis.

About 1 in 4 people with hepatitis C develop cirrhosis. Although it’s less common, hepatitis B and D can also cause cirrhosis.

Heavy Alcohol Use Alcohol is toxic to the liver, and drinking too much can lead to inflammation and changes in the liver cells themselves. This causes swelling and, eventually, cirrhosis. The level of alcohol use that leads to cirrhosis differs from person to person.

Metabolic Associated Steatohepatitis (MASH) Fat buildup in the liver that’s not related to alcohol is called metabolic dysfunction–associated liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. If MASLD worsens, it can lead to MASH, which is when inflammation appears in the liver along with fat.

Bile Duct Diseases These diseases limit or even prevent bile from flowing to the small intestine, which can cause backup in the liver and lead to cirrhosis.

Genetic Diseases These can increase someone’s chances of developing cirrhosis. Wilson disease, hemochromatosis, glycogen storage diseases, alpha-1 antitrypsin deficiency, and cystic fibrosis are all genetic diseases that can cause cirrhosis.

How Is Cirrhosis Diagnosed?

Preliminary tests for cirrhosis include a complete medical exam and discussion of symptoms, a review of the person’s medical history and lifestyle, and blood tests.

The gold standard for diagnosing cirrhosis is a biopsy to determine the amount of scarring, says Lindenmeyer. A biopsy involves removing a small piece of tissue from the liver for examination under a microscope.

But, according to Lindenmeyer, “a biopsy is fairly invasive and carries its own risk of potential adverse events, so we’ve actually developed a number of noninvasive ways to assess the amount of scarring.”

An MRI, CT scan, or abdominal sonogram can also provide detailed images of the liver to diagnose cirrhosis.

Treatment and Medication Options for Cirrhosis

The first step in treating cirrhosis is avoiding whatever the insult is to the liver, says Lindenmeyer. For example, in the case of autoimmune hepatitis, you would treat the inflammation from hepatitis.

Regardless of the primary cause of a patient’s cirrhosis, avoid any behaviors or conditions that might further damage the liver. For example, those with autoimmune-related cirrhosis should also avoid alcohol.

The overall goal of the therapy is to stop the progression of the disease and prevent liver failure, says Lindenmeyer.

Medication Options

In addition to medications that treat the underlying cause of cirrhosis, such as antivirals for hepatitis, certain medications may be used to treat resulting complications. These include:

Surgery

When medication can no longer control the complications of cirrhosis, a liver transplantation is often the only remaining option for treatment.

Complementary Therapies

There are a number of supplements on the market that claim to “cleanse” or “support” liver health. Most of these supplements have no scientific evidence to back these claims.

Lifestyle Changes for Cirrhosis

Cirrhosis is a progressive disease, which means it may get worse over time. Liver damage can’t usually be reversed, but the injury can be slowed down with treatment or lifestyle changes.

• Follow a nutritious diet in discussion with your nutritionist and doctor.
• Avoid alcohol.
• Engage in regular exercise. A total of 150 minutes of moderately vigorous activity per week along with two days of strength training is best.
• Limit salt intake if you have fluid retention associated with cirrhosis.
• Avoid raw shellfish, which can contain the bacteria Vibrio vulnificus and make you very ill.
• Talk to your doctor about the medication you take and whether it might be contributing to your liver damage.
• Prevent potential hepatitis infection by practicing safe sex and never sharing needles or razors.
• Stay up to date on vaccinations, especially those that protect against hepatitis A and B.

Cirrhosis Prognosis

Life expectancy in cirrhosis depends on the severity as well as the underlying cause of the disease. If cirrhosis is identified and treated early and its progression is slowed, it may have little impact on mortality.

Complications of Cirrhosis

• Hormonal imbalances
• Digestive problems
• Gastrointestinal bleeding
• Hepatic encephalopathy, a buildup of toxins in the brain that causes confusion and, in advanced stages, coma
• Kidney failure
• Problems with other organs, such as heart failure
• Liver cancer

The Takeaway

• Cirrhosis involves the replacement of healthy liver tissue with scar tissue, often resulting from chronic hepatitis, alcohol use, metabolic dysfunction (aka fatty liver disease), or other liver diseases.
• Cirrhosis treatment focuses on stopping disease progression and symptom management.
• Medications can address specific symptoms or complications, but lifestyle changes like avoiding alcohol and eating a nutritious diet are crucial for management.
• Many supplements claiming to support liver health lack scientific evidence, and some might exacerbate liver problems.