Cirrhosis of the liver


Hampered liver function

Cirrhosis is the presence of scar tissue in the liver, the largest solid organ in your body. The early signs of cirrhosis are often subtle, making it likely to go undetected for several years. Later, it can cause flu-like symptoms, such as fatigue, fever, loss of appetite, nausea, and vomiting. In later stages it can cause malnutrition, swelling in the legs (edema) or abdomen (ascities), and jaundice.

If the disease progresses into "decompensated" cirrhosis, the liver becomes too damaged to function properly. Most often the result of heavy drinking over a period of many years, the scarring of liver tissue characteristic of cirrhosis can also be caused by viral hepatitis, several inherited diseases and, less frequently, by exposure to environmental toxins or severe reactions to prescribed medications.

The first line of defense against cirrhosis is to remove, if possible, the cause of the damage. If the cirrhosis is alcohol-induced, stopping drinking immediately will halt the damage. When caused by hepatitis or another disease, treating the disease is the crucial. If caught early, the symptoms of cirrhosis can be controlled.

Detailed Description

Performing a number of functions, the liver is vital to good health. It is responsible for filtering all the blood in the body and removing toxins and waste. It also produces the proteins the body needs for energy and other processes, such as blood clotting. It is responsible for carbohydrate, fat, protein metabolism and vitamin storage. It also produces bile, which your body uses to digest fats. It also plays a role in immune functions.

The scar tissue that forms in cirrhosis destroys the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.

If left unchecked, cirrhosis can lead to mental dysfunction, such as confusion and disorientation, hemorrhage, and kidney or liver failure.

How Common Is Cirrhosis?

Cirrhosis is the seventh leading cause of death by disease in the United States and the third leading cause of death for adults between ages 45 and 65. About 25,000 people die from cirrhosis each year, though many more suffer the symptoms for years. An estimated 50% of cases are alcohol-induced. Women are more sensitive to the toxic effects of alcohol than men, and, even though they drink less, are more likely to develop cirrhosis.

Conventional Treatment

Goals of Treatment

The damage to liver tissue caused by cirrhosis is permanent, but your liver can function even when part of it is damaged. Medications for less serious symptoms and surgery in more advanced stages can keep the effects on your life to a minimum. For treatment to be successful, it is crucial to arrest the destruction of tissue by removing or neutralizing the underlying cause.

Treatment Overview

Treatment for cirrhosis depends on what stage the disease was diagnosed and the underlying cause. Delaying or preventing continued damage to the liver is the first goal of treatment. If alcohol is the issue, your doctor will work with you to find a treatment program or support system. If the cirrhosis is caused by hepatitis, your doctor will prescribe medications to keep the hepatitis in check. If the liver damage is in its later stages, transplant surgery may be necessary.

Drug Therapy

Several drugs can help ease the symptoms associated with cirrhosis. Your doctor, however, will prescribe with care because of the body's weakened ability to metabolize medications.

Several drugs can help ease the symptoms associated with cirrhosis. Your doctor, however, will prescribe with care because of the body's weakened ability to metabolize medications.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


In some cases, surgery may be necessary in the treatment of cirrhosis. Often surgery is indicated because of increased pressure in the portal vein, which leads into the liver. When portal vein is blocked, the body will grow other veins in an effort to go around the obstruction. These veins, called varices, can grow into esophagus and or stomach. Surgery can remove pressure and stop the growth of varices by diverting the blood flow into a vein connected directly to the heart.

When the liver becomes too damaged to function, a liver transplant is the treatment of last resort.

Appropriate Health Settings

Care for people with cirrhosis is usually provided on an outpatient basis, unless severe complications arise, including:

  • Gastrointestinal bleeding
  • Kidney failure
  • Encephalopathy

Healthcare Professionals Who May Be Involved in Treatment

Professionals who may be involved in cirrhosis treatment include:

  • Family physicians
  • Internists
  • Gastroenterologists
  • General surgeons
  • Transplant surgeons
  • Interventional radiologists

Activity and Diet Recommendations

Eating a well-balanced, nutritious diet is especially important for people with cirrhosis. Carbohydrates and protein help promote liver regeneration and provide energy for muscle rebuilding. Keeping salt at a minimum helps prevent the fluid retention (both in the abdomen and limbs) that's typical of cirrhosis.

Exercise is also essential to keeping the symptoms of cirrhosis in check. Physical activity can help keep the swelling caused by edema in check. As will elevating the legs above the level of your heart when sitting or lying down.

Several nutritional supplements can be helpful, including A, B complex, D, and K — to make up for the liver's inability to store them properly — and vitamin B-12, folic acid, and thiamin to treat anemia.

Possible Complications

These complications or secondary diseases may accompany cirrhosis:

  • Liver failure
  • Portal hypertension
  • Bleeding esophageal varices
  • Cancer of the liver
  • Renal failure
  • Mental confusion
  • Coma


Women with some autoimmune diseases, such as Crohn's disease, arthritis, and fibromyalgia, often develop primary biliary cirrhosis, a type of cirrhosis in which the bile ducts become inflamed and, in severe cases, permanently scarred. Women between the ages of 35 and 50 are most at risk for this type of cirrhosis.

A medication called ursodiol (ursodeoxycholic acid) appears to be effective in slowing the course of primary biliary cirrhosis.

Women with cirrhosis may find it harder to get pregnant because cirrhosis can cause irregularities in the menstrual cycle, most often amenorrhea (the cessation of periods). Once pregnant, women with cirrhosis have a higher risk of miscarriage and premature labor. The symptoms of cirrhosis often worsen during pregnancy.

Considerations for Children and Adolescents
Cirrhosis in children is usually caused by an inherited condition, such as glycogen storage disease, galactosemia, fructose intolerance, tyrosinemia, or acid cholesterol ester-hydrolase deficiency. Bilary atresia (a congenital abnormality of the bile ducts) can also cause cirrhosis in infancy.

Cirrhosis of the liver

Last updated 25 May 2012


  • Si-ROH-sis


Established Causes

The leading cause of cirrhosis is excessive drinking of alcohol, accounting for about half of all cases in the United States. Cirrhosis can also be caused by hepatitis viruses B, C or D, several inherited diseases (including Wilson's disease, cystic fibrosis, hemochromatosis, and galactosemia), some drugs, liver infection, and bile-duct obstruction.

Risk Factors

By far, the largest risk factor for developing cirrhosis of the liver is alcoholism. Other risk factors include:

  • Chronic viral hepatitis C or B
  • Wilson's disease
  • Cystic fibrosis
  • Hemachromatosis
  • Primary biliary cirrhosis, autoimmune hepatitis, or primary sclerosing cholongitis

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.

Symptoms & Diagnosis

In the initial phases of the disease, people with cirrhosis may have no symptoms at all. As the disease progresses, symptoms become increasingly pronounced and disabling.

Symptoms in the early stages:

  • Fatigue and weakness
  • Poor appetite
  • Nausea or vomiting
  • Weight loss
  • Enlarged liver
  • Red palms
  • Abdominal discomfort or distention
  • Generalized itching
  • Diarrhea or constipation
  • Muscle cramps

In later stages:

  • Susceptibility to infections
  • Bleeding from the gums or nose
  • Tendency to bruise easily
  • Testicular atrophy
  • Loss of chest and armpit hair
  • Extremely dry, itchy skin
  • Swollen legs (edema)
  • Malnutrition
  • Spider blood vessels of the skin
  • Musty breath
  • Pain in the abdomen that gets worse when sitting up or leaning forward
  • Jaundice (yellowing of skin and eyes)
  • Menstrual abnormalities
  • Loss of sex drive
  • Painfully enlarged breasts in men (gynecomastia)

In end stage:

  • Encephalopathy (a brain disease marked by delirium, drowsiness, and slurred speech)
  • Ascites (fluid in the abdomen)
  • Kidney failure
  • Liver failure
  • Coma
  • Gastrointestinal bleeding due to portal hypertension and esophageal varices

Conditions That May Be Mistaken for Cirrhosis

Conditions that are sometimes confused with cirrhosis:

  • Acute fulminant hepatitis
  • Congestive heart failure
  • Liver cancer
  • Constrictive pericarditis

How Cirrhosis Is Diagnosed

Your doctor will ask you about your lifestyle, take your medical history and examine you for signs of cirrhosis, including an enlarged liver and perhaps a low fever and jaundice. Blood and imaging tests can help to pinpoint the specific type of cirrhosis, and a biopsy of liver tissue can help determine both the cause and the extent of the cirrhosis.

Laboratory Work

Your doctor may check your blood to see if there are any abnormalities in the liver enzymes known as AST, ALT. Blood tests can also reveal abnormalities in alkaline phosphatase, bilirubin, albumin, and alpha 1-antitrypsin.


X-rays can determine if the liver is enlarged, which is typical of cirrhosis. A CT scan, ultrasound, radioisotope, or exploratory laparoscopy can be used to look for scarring on the liver.

Self care & Prevention

Preventing Cirrhosis

Limiting your intake of alcoholic beverages over the course of your lifetime will help prevent cirrhosis from ever developing.

To minimize your risk of hepatitis B and C, which can cause cirrhosis, don't share needles with others. Since hepatitis B and C can also be transmitted through sexual activity, be diligent about practicing safer sex — use a latex barrier such as a condom during any sexual activity. The hepatitis B virus can also be prevented with a vaccine.

Self-Care Measures

If you drink, you must stop — completely. Alcohol abuse is the leading cause of cirrhosis.

Be careful what drugs you take. Medications — both over-the-counter and prescription brands — are processed by the liver, and can strain one already impaired by cirrhosis. Ask your doctor about nondrug treatments for your ailments.

If your work or hobbies involve exposure to toxic chemicals, wear adequate protective gear. Toxic chemical exposure can damage the liver.

Cirrhosis increases your risk of bleeding. Do what you can to avoid cuts, bruises, and hemorrhoids.

People with cirrhosis should get flu shots every year. Pneumococcal vaccines are also recommended.