Cirrhosis

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Definition & Facts

What is cirrhosis?

Cirrhosis is a condition in which your liver is scarred and permanently damaged. Scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through your liver. As cirrhosis gets worse, your liver begins to fail.

Many people are not aware that they have cirrhosis, since they may not have signs or symptoms until their liver is badly damaged.

A healthy liver and a liver with cirrhosis.
A healthy liver (left) and liver with cirrhosis (right).

How common is cirrhosis?

Researchers estimate that about 1 in 400 adults in the United States has cirrhosis. Cirrhosis is more common in adults ages 45 to 54. About 1 in 200 adults ages 45 to 54 in the United States has cirrhosis. Researchers believe the actual numbers may be higher because many people with cirrhosis are not diagnosed.1

Who is more likely to get cirrhosis?

People are more likely to get cirrhosis if they have certain health conditions. People are also more likely to get cirrhosis if they1

What are the complications of cirrhosis?

As the liver fails, complications may develop. In some people, complications may be the first sign of the disease. Complications of cirrhosis may include the following.

Portal hypertension

Portal hypertension is the most common serious complication of cirrhosis.2 Portal hypertension is a condition that occurs when scar tissue partly blocks and slows the normal flow of blood through your liver, which causes high blood pressure in the portal vein. Portal hypertension and its treatments may lead to other complications, including

  • enlarged veins—called varices—in your esophagus, stomach, or intestines, which can lead to internal bleeding if the veins burst
  • swelling in your legs, ankles, or feet, called edema
  • buildup of fluid in your abdomen—called ascites—which can lead to a serious infection in the space that surrounds your liver and intestines
  • confusion or difficulties thinking caused by the buildup of toxins in your brain, called hepatic encephalopathy

Infections

Cirrhosis increases your chance of getting bacterial infections, such as urinary tract infections and pneumonia.

Liver cancer

Cirrhosis increases your chance of getting liver cancer.3 Most people who develop liver cancer already have cirrhosis.4

Liver failure

Cirrhosis may eventually lead to liver failure. With liver failure, your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. This may require a liver transplant.

Other complications

Other complications of cirrhosis may include

  • bone diseases, such as osteoporosis
  • gallstones
  • problems with the bile ducts—the tubes that carry bile out of the liver
  • malabsorption and malnutrition
  • bruising and bleeding easily
  • sensitivity to medicines
  • insulin resistance and type 2 diabetes
  • References

Symptoms & Causes

What are the symptoms of cirrhosis?

You may have no signs or symptoms of cirrhosis until your liver is badly damaged.

Early symptoms of cirrhosis may include

  • feeling tired or weak
  • poor appetite
  • losing weight without trying
  • nausea and vomiting
  • mild pain or discomfort in the upper right side of your abdomen

As liver function gets worse, you may have other symptoms, including

  • bruising and bleeding easily
  • confusion, difficulties thinking, memory loss, personality changes, or sleep disorders
  • swelling in your lower legs, ankles, or feet, called edema
  • bloating from buildup of fluid in your abdomen, called ascites
  • severe itchy skin
  • darkening of the color of your urine
  • yellowish tint to the whites of your eyes and skin, called jaundice

What causes cirrhosis?

Cirrhosis has different causes. Some people with cirrhosis have more than one cause of liver damage.

Most common causes

The most common causes of cirrhosis are

Less common causes

Some of the less common causes of cirrhosis include

Diagnosis

How do doctors diagnose cirrhosis?

Doctors diagnose cirrhosis based on your medical history, a physical exam, and the results of tests.

Medical history

Your doctor will ask about your symptoms. He or she will also ask if you have a history of health conditions that make you more likely to develop cirrhosis.

Your doctor will ask about your use of alcohol and over-the-counter and prescription medicines.

Patient medical history form.
Your doctor will ask about your history of health conditions.

Physical exam

Your doctor will examine your body, use a stethoscope to listen to sounds in your abdomen, and tap or press on specific areas of your abdomen. He or she will check to see if your liver is larger than it should be. Your doctor will also check for tenderness or pain in your abdomen.

What tests do doctors use to diagnose cirrhosis?

Blood tests

Your doctor may recommend the following blood tests

  • liver tests that can show abnormal liver enzyme levels, which may be a sign of liver damage. Your doctor may suspect cirrhosis if you have
    • increased levels of the liver enzymes alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP)
    • increased levels of bilirubin
    • decreased levels of blood proteins
  • complete blood count, which can show signs of infection and anemia that may be caused by internal bleeding
  • tests for viral infections to see if you have hepatitis B or hepatitis C
  • blood tests for autoimmune liver conditions, which include the antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), and anti-mitochondrial antibody (AMA) tests

Based on the blood test results, your doctor may be able diagnose certain causes of cirrhosis.

Your doctor can use blood tests to tell how serious your cirrhosis is.

Vials of blood for blood tests.
Your doctor can use blood tests to tell how serious your cirrhosis is.

Imaging tests

Imaging tests can show the size, shape, texture, and stiffness of your liver. Measuring the stiffness of the liver can show scarring. Your doctor can use stiffness measures to see if the scarring is getting better or worse. Imaging tests can also show how much fat is in the liver. Your doctor may use one or more of the following imaging tests

Liver biopsy

Your doctor may perform a liver biopsy to see how much scarring in is your liver. A liver biopsy can diagnose cirrhosis when the results of other tests are uncertain. The biopsy may show the cause of cirrhosis. Sometimes your doctor may find that something other than cirrhosis has caused your liver to become damaged or enlarged. Your doctor can also diagnose liver cancer based on liver biopsy results.

Treatment

How do doctors treat cirrhosis?

Doctors do not have specific treatments that can cure cirrhosis. However, they can treat many of the diseases that cause cirrhosis. Some of the diseases that cause cirrhosis can be cured. Treating the underlying causes of cirrhosis may keep your cirrhosis from getting worse and help prevent liver failure. Successful treatment may slowly improve some of your liver scarring.

How do doctors treat the causes of cirrhosis?

Doctors most often treat the causes of cirrhosis with medicines. Your doctor will recommend that you stop activities such as drinking alcohol and taking certain medicines that may have caused cirrhosis or may make cirrhosis worse.

Alcoholic liver disease

If you have alcoholic liver disease, your doctor will recommend that you completely stop drinking alcohol. He or she may refer you for alcohol treatment.

Nonalcoholic fatty liver disease

If you have nonalcoholic fatty liver disease, your doctor may recommend losing weight. Weight loss through healthy eating and regular physical activity can reduce fat in the liver, inflammation, and scarring.

Chronic hepatitis C

If you have chronic hepatitis C, your doctor may prescribe one or more medicines that have been approved to treat hepatitis C since 2013. Studies have shown that these medicines can cure chronic hepatitis C in 80 to 95 percent of people with this disease.5

Chronic hepatitis B

For chronic hepatitis B, your doctor may prescribe antiviral medicines that slow or stop the virus from further damaging your liver.

Autoimmune hepatitis

Doctors treat autoimmune hepatitis with medicines that suppress, or decrease the activity of, your immune system.

Diseases that damage, destroy, or block bile ducts

Doctors usually treat diseases that damage, destroy, or block bile ducts with medicines such as ursodiol (Actigall, Urso). Doctors may use surgical procedures to open bile ducts that are narrowed or blocked. Diseases that damage, destroy, or block bile ducts include primary biliary cholangitis and primary sclerosing cholangitis.

Inherited liver diseases

Treatment of inherited liver diseases depends on the disease. Treatment most often focuses on managing symptoms and complications.

Long-term use of certain medicines

The only specific treatment for most cases of cirrhosis caused by certain medicines is to stop taking the medicine that caused the problem. Talk with your doctor before you stop taking any medicines.

How do doctors treat the complications of cirrhosis?

Treatments for the complications of cirrhosis include the following.

Portal hypertension

Doctors treat portal hypertension with medicines to lower high blood pressure in the portal vein. Treatments for the complications of portal hypertension include

  • Enlarged veins in your esophagus or stomach, called varices. Your doctor may prescribe medicines to lower the pressure in the veins of your esophagus or stomach. This lowers the chance that the veins become enlarged and burst, causing internal bleeding. If you vomit blood or have black or bloody stools go to a hospital right away. Doctors may perform procedures during upper GI endoscopy or use surgical procedures to stop the internal bleeding.
  • Swelling in your legs, ankles, or feet, called edema. Your doctor may prescribe medicines that remove fluid from your body. Your doctor will recommend limiting the amount of salt in your diet.
  • Buildup of fluid in your abdomen, called ascites. Your doctor may prescribe medicines that remove fluid from your body. Your doctor will recommend limiting the amount of salt in your diet. If you have large amounts of fluid in your abdomen, your doctor may use a needle or tube to drain the fluid. He or she will check the fluid for signs of infection. Your doctor may prescribe medicines to treat infection or prevent infection.
  • Confusion, difficulties thinking, memory loss, personality changes, or sleep disorders, called hepatic encephalopathy. Your doctor may prescribe medicines that help lower the levels of toxins in your brain and improve brain function.

Infections

If you have a bacterial infection, your doctor will prescribe an antibiotic.

Liver cancer

Your doctor may treat liver cancer with the medical procedures that remove or destroy cancer cells, such as surgery, radiation therapy, and chemotherapy. Doctors also treat liver cancer with a liver transplant.

Liver failure

Liver failure, also called end-stage liver disease, happens when the liver stops working. The only treatment for liver failure is a liver transplant.

Other Complications

Your doctor may treat other complications through changes in medicines, diet, or physical activity. Your doctor may also recommend surgery.

What can I do to help keep my cirrhosis from getting worse?

To help keep your cirrhosis from getting worse, you can do the following

Talk with your doctor about your risk for getting liver cancer and how often you should be checked.

When do doctors consider a liver transplant for cirrhosis?

Your doctor will consider a liver transplant when cirrhosis leads to liver failure. Doctors consider liver transplants only after they have ruled out all other treatment options. Talk with your doctor about whether a liver transplant is right for you.

Male doctor talking with male patient.
Talk with your doctor about whether a liver transplant is right for you.

References

Eating, Diet, & Nutrition

What should I eat if I have cirrhosis?

If you have cirrhosis, you should eat a healthy, well-balanced diet. Talk with your doctor, a dietitian, or a nutritionist about healthy eating.

What should I avoid eating and drinking if I have cirrhosis?

You should avoid eating raw or undercooked shellfish, fish, and meat. Bacteria or viruses from these foods may cause severe infections in people with cirrhosis.

Your doctor may recommend limiting salt in your diet and limiting your intake of fats or protein.

You should completely stop drinking alcohol because it can cause more liver damage.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

March 2018
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank Jasmohan S. Bajaj, M.D., Virginia Commonwealth University School of Medicine