Cirrhosis is scarring of the liver and poor liver function. It is the final phase of chronic liver disease.A.D.A.M.

Causes, incidence, and risk factors

Cirrhosis is the end result of chronic liver damage caused by chronic liver disease. Common causes of chronic liver disease in the United States are:

• Hepatitis B or C infection
• Alcohol abuse

Less common causes of cirrhosis include:

• Autoimmune hepatitis
• Bile duct disorders
• Some medicines
• Hereditary diseases
• Other liver diseases such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

Symptoms

There may be no symptoms or symptoms may come on slowly, depending on how well the liver is working.

Early symptoms include:

• Fatigue and loss of energy
• Poor appetite and weight loss
• Nausea or belly pain
• Small, red spider-like blood vessels on the skin

As liver function worsens, symptoms may include:

• Fluid buildup of the legs (edema) and in the abdomen (ascites)
• Yellow color in the skin, mucus membranes, or eyes (jaundice)
• Redness on the plams of the hands
• In men, impotence, shrinking of the testicles, and breast swelling
• Easy bruising and abnormal bleeding
• Confusion or problems thinking
• Pale or clay-colored stools
• Small, red spider-like blood vessels on the skin 

Signs and tests

Your doctor will do a physical exam to look for:

• An enlarged liver or spleen
• Excess breast tissue
• Swollen abdomen, as a result of too much fluid
• Reddened palms
• Red spider-like blood vessels on the skin
• Small testicles
• Widened veins in the abdomen wall
• Yellow eyes or skin (jaundice)

You may have the following tests to measure liver function:

• Complete blood count
• Prothrombin time
• Liver function tests
• Blood albumin level

Other tests to check for liver damage include:

• Computed tomography (CT) of the abdomen
• Magnetic resonance imaging (MRI) of the abdomen
• Endoscopy to check for abnormal veins in the esophagus or stomach
• Ultrasound of the abdomen

You will need a liver biopsy to confirm the diagnosis.

Treatment

LIFESTYLE CHANGES

• Limiting alcohol
• Eating a healthy diet that is low in salt
• Getting vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia
• Talking to your doctor about all medicines you take including herbs and supplements and over-the-counter medicines

MEDICINES FROM YOUR DOCTOR

• "Water pills" (diuretics) to get rid of fluid build-up
• Vitamin K or blood products to prevent excess bleeding
• Medicines for mental confusion
• Antibiotics for infections

OTHER TREATMENTS

• Endoscopic treatments for enlarged veins in the throat (bleeding varicies)
• Removal of fluid from the abdomen (paracentesis)
• Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver

When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

Support Groups

You can often ease the stress of illness by joining a liver disease support group whose members share common experiences and problems.

Expectations (prognosis)

Cirrhosis is caused by scarring of the liver. The liver cannot heal or return to normal function once damage is severe. Cirrhosis can lead to serious complications.

Complications

• Bleeding disorders (coagulopathy)
• Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
• Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
• Increased pressure in the blood vessels of the liver (portal hypertension)
• Kidney failure (hepatorenal syndrome)
• Liver cancer (hepatocellular carcinoma)
• Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)

Calling your health care provider

Call your health care provider if:

• You develop symptoms of cirrhosis

Call your provider, go to the emergency room, or call the local emergency number (such as 911) if you have:

• Abdominal or chest pain
• Abdominal swelling or ascites that is new or suddenly becomes worse
• A fever (temperature greater than 101 °F)
• Diarrhea
• New confusion or a change in alertness, or it gets worse
• Rectal bleeding, vomiting blood, or blood in the urine
• Shortness of breath
• Vomiting more than once a day
• Yellowing skin or eyes (jaundice) that is new or gets worse quickly

Prevention

Don't drink alcohol heavily. Talk to your doctor if you are worried about your drinking. Take steps to prevent getting or passing hepatitis B or C.

References

1. Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009;104:1802-1829. [PubMed: 19455106]
2. Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
3. Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93:901-915. [PubMed: 19577121]

Review Date: 11/16/2012.

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.