Cirrhosis (say "suh-ROH-sus") is a very serious condition in which scarring damages the liver. The liver is a large organ that is part of the digestive system. It does a wide range of complex jobs that are vital for life. For example, the liver:
When a person has cirrhosis, scar tissue (fibrosis) replaces healthy tissue. This scar tissue prevents the liver from working as it should. For example, the liver may stop producing enough clotting factors, which can lead to bleeding and bruising. Bile and poisons may build up in the blood. Scarring can also cause high blood pressure in the vein that carries blood from the intestines through the liver (portal hypertension). This can lead to severe bleeding in the digestive tract and other serious problems.
Cirrhosis can be deadly. But early treatment can help stop damage to the liver.
Cirrhosis can have many causes. Some of the main ones include:
Less common causes of cirrhosis include severe reactions to medicines or long-term exposure to poisons, such as arsenic. Some people have cirrhosis without an obvious cause.
You may not have symptoms in the early stages of cirrhosis. As it gets worse, it can cause a number of symptoms, including:
The doctor will start with a physical examination and questions about your symptoms and past health. If the doctor suspects cirrhosis, you may have blood tests and imaging tests, such as an ultrasound or CT scan. These tests can help your doctor find out what is causing the liver damage and how severe it is.
To confirm that you have cirrhosis, the doctor may do a liver biopsy. This means that he or she will use a needle to take a sample of liver tissue for testing.
Treatment may include medicines, surgery, or other options, depending on the cause of your cirrhosis and what problems it is causing. It is important to get treated for cirrhosis as soon as possible. Treatment cannot cure cirrhosis. But it can sometimes prevent or delay further liver damage.
There are things you can do to help limit the damage to your liver and control the symptoms:
Symptoms may not appear until a problem is severe. So it's important to see your doctor for regular checkups and lab tests. You may also need testing to check for possible problems such as enlarged veins in your digestive tract or liver cancer.
If cirrhosis becomes life-threatening, then a liver transplant may be an option. But a organs are hard to find, and it doesn't always work. And the cost of travel and the medicines needed after a transplant can be expensive.
Hospice palliative care
is a kind of care for people who have serious illnesses. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
If your cirrhosis is getting worse, you may choose to get care that focuses on your comfort and dignity. You may also want to make important end-of-life decisions, such as writing an advance care plan. It can be comforting to know that you will get the type of care you want.
It can be hard to face having cirrhosis. If you feel very sad or hopeless, be sure to tell your doctor. You may be able to get counselling or other types of help. Think about joining a support group. Talking with other people who have cirrhosis can be a big help.
Health Tools help you make wise health decisions or take action to improve your health.
People who have cirrhosis sometimes don't have symptoms until liver damage is extensive. Symptoms of cirrhosis and its complications may include:
Scar tissue from cirrhosis may block the proper flow of blood from the intestines through the liver. The scarring can lead to increased pressure in the veins that supply this area. This is called portal hypertension. It can lead to other complications, which may include:
People who have cirrhosis also are at increased risk of getting liver cancer, mainly hepatocellular carcinoma.
Your doctor will do a physical examination and ask about your medical history to see if you have symptoms of liver disease and to help find out possible causes of liver damage.
If your doctor thinks you may have cirrhosis, you may have blood and imaging tests. You also may have a liver biopsy. This test can show for sure if you have cirrhosis.
Measuring the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:
You may have blood tests to check your liver enzymes. These can help show whether you have had liver inflammation for a long time. These blood tests include:
Some people with cirrhosis have normal liver enzymes.
Tests to check for conditions that may cause cirrhosis include:
Imaging tests can check for tumours and blocked bile ducts. They also can be used to look at liver size and blood flow through the liver. These tests include:
Other tests also may be done to confirm cirrhosis or to look for possible complications. These include:
No treatment will cure cirrhosis or repair scarring in the liver that has already occurred. But treatment can sometimes prevent or delay further liver damage. Treatment involves lifestyle changes, medicines, and regular doctor visits. In some cases, you may need surgery for treatment of complications from cirrhosis.
Your doctor will recommend some lifestyle changes to help prevent further liver damage.
Cirrhosis can cause other problems (complications) that need treatment with medicines or procedures. Complications include:
It's important to work with your doctor to watch your condition, especially because symptoms may not start until a problem has become severe. In addition to regular checkups and lab tests, you will also need periodic screening for enlarged veins (varices) and liver cancer (hepatocellular carcinoma).
Receiving a liver from an organ donor (liver transplant) is the only treatment that will restore normal liver function and cure portal hypertension. A liver transplant is usually considered only when liver damage is severe and threatening your life.
Before your condition becomes severe, you may want to talk to your doctor about whether you will be a good candidate for a liver transplant if your disease becomes advanced.
You may have to wait a long time for a transplant, because so few organs are available. Even if a transplant occurs, it may not work. With these things in mind, doctors must decide who will benefit most from receiving a liver. Candidates will need to have a support person with them for all their appointments and during the transplant process. If you have an active drug and alcohol habit, you will not be able to have a transplant. You will be asked to attend a rehab facility and prove that you have not taken drugs or alcohol for a period of time. The transplant team will let you know how long that period of time is.
Talk to your doctor about what steps you can take now to improve your overall health so that you can increase your chances of being considered a good candidate.
If your cirrhosis gets worse, you may want to think about hospice palliative care. This is a kind of care for people who have illnesses that do not go away and often get worse over time. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
Hospice palliative care providers will work to help manage pain and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in hospice palliative care, talk to your doctor.
If you have not already made decisions about the issues that may arise at the end of life, consider doing so now. Many people find it helpful and comforting to state their health care choices in writing (with an advance directive such as a living will) while they are still able to make and communicate these decisions. You may also think about who you would choose as your health care agent to make and carry out decisions about your care if you were unable to speak for yourself.
A time may come when your goals change from treating or curing an illness to maintaining comfort and dignity. Hospice palliative care health professionals can provide hospice palliative care and comforting surroundings for someone who is preparing to die.
Lifestyle changes may reduce symptoms caused by complications of the disease and may slow new liver damage.
If you are diagnosed with cirrhosis, it is extremely important that you stop drinking alcohol completely, even if alcohol was not the cause of your cirrhosis. If you don't stop, liver damage may quickly become worse. For information about how to quit drinking, see Alcohol: Drinking and Your Health.
You may need to limit the amount of salt or protein you eat.
If your body is retaining fluid, the most important dietary change you need to make is to reduce your sodium intake. You do this by reducing the amount of salt in your diet. People with liver damage tend to retain sodium. This can make fluid build up in your belly (ascites).
If you are at risk for altered mental function (encephalopathy) because of advanced liver disease, your doctor may want you to limit the amount of protein you eat for a while. You will still need protein in your diet to be well nourished. But you may need to get most of your protein from vegetable sources (rather than animal sources). And you may need to avoid eating large amounts of protein at one time.
Some medicines should be used carefully or not taken by people who have cirrhosis. For example, acetaminophen (such as Tylenol) can speed up liver damage. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)—for example, ibuprofen (such as Motrin or Advil) and naproxen (Aleve)—increase the risk of variceal bleeding if you have enlarged veins (varices) in the digestive tract. NSAIDs can also raise your risk for ascites. Talk to your doctor or pharmacist about what medicines are safe for you.
Certain prescription medicines used to treat other conditions may be harmful if you have cirrhosis. Make sure your doctor knows all the medicines (including all non-prescription medicines, vitamins, herbs, and supplements) that you are taking.
Taking other steps to improve your overall health may help you cope with the symptoms of cirrhosis.
In general, you should avoid most herbal and other supplements, which may make liver disease worse. Kava is particularly bad for people who have liver problems.
Limited research has shown that the herbal supplement milk thistle may help protect the liver, but other research has not shown a benefit.footnote 2 Milk thistle will not reverse existing liver damage, and it will not cure infection with the hepatitis B or hepatitis C virus. Milk thistle should not be used by people who have complications from cirrhosis (such as variceal bleeding or ascites). Talk to your doctor about whether you should try milk thistle (or any other alternative treatment).
Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086–2102.
Milk thistle (2005). Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted
Angulo P, Lindor KD (2010). Primary biliary cirrhosis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1477–1488. Philadelphia: Saunders.
Bacon BR (2015). Cirrhosis and its complications. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 2, pp. 2058–2067. New York: McGraw-Hill Education.
Carithers RL, McClain CJ (2010). Alcoholic liver disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1383–1400. Philadelphia: Saunders.
ByHealthwise StaffPrimary Medical ReviewerAdam Husney, MD - Family MedicineBrian O'Brien, MD, FRCPC - Internal MedicineE. Gregory Thompson, MD - Internal MedicineKathleen Romito, MD - Family MedicineW. Thomas London, MD - Internal Medicine, Hepatology
Current as ofMarch 28, 2018
Current as of: March 28, 2018
Adam Husney, MD - Family Medicine
& Brian O'Brien, MD, FRCPC - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & W. Thomas London, MD - Internal Medicine, Hepatology
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