Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.

Causes

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)

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 palms 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

Exams 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.

Treatments

Lifestyle Changes

Some things you can do to help take care of your liver disease are:

• Drink less alcohol.
• Eat a healthy diet that is low in salt
• Get vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia
• Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines

Medicine from the 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 Treatment

• 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.