Hepatic Cirrhosis

Hepatic cirrhosis is a serious condition where the liver becomes permanently scarred and damaged over many years. While it cannot be cured or reversed, understanding the condition and getting proper treatment can help slow its progression and manage complications, allowing many people to live well for years.

Table of contents

• What is Hepatic Cirrhosis?
• How Common is Cirrhosis?
• Symptoms of Hepatic Cirrhosis
• What Causes Hepatic Cirrhosis?
• Stages of Cirrhosis
• Possible Complications
• How Doctors Diagnose Cirrhosis
• Treatment and Management
• Lifestyle Changes and Self-Care
• Preventing Cirrhosis from Getting Worse

• Liver

What is Hepatic Cirrhosis?

Hepatic cirrhosis is a late stage of chronic liver disease where healthy liver tissue is replaced by scar tissue. The liver is the biggest organ in your body and performs hundreds of important functions every day^[1]. When you have cirrhosis, a significant amount of your healthy liver tissue has turned to scar tissue through a process called fibrosis, which is the formation of scar tissue in response to long-term damage^[1].

The liver normally repairs itself when injured, forming scar tissue without losing its function. However, after long-standing injury, most of the liver tissue becomes fibrotic, leading to loss of function and the development of cirrhosis^[3]. This scarring typically develops slowly over months, years, or even decades^[5].

The scarring in your liver blocks blood and oxygen from flowing through your liver tissues. This reduces your liver’s ability to filter toxins, process nutrients, and produce bile and essential proteins. Scar tissue can also compress important blood vessels, including the portal vein, leading to a condition called portal hypertension, which is increased blood pressure in the blood vessels that carry blood to the liver^[1].

How Common is Cirrhosis?

Cirrhosis is relatively common and represents a significant cause of hospitalization and death, especially after middle age. In the United States, it affects about 0.25% of all adults and about 0.50% of adults between the ages of 45 and 54^[1]. Each year, about 26,000 deaths in the United States are attributed to cirrhosis, and these rates are rising^[1]. Cirrhosis is a global health concern, with worldwide prevalence estimated to be between 0.15% and 0.27%^[3].

Symptoms of Hepatic Cirrhosis

Many people who have cirrhosis do not have symptoms, especially early on. In the beginning stages, your body compensates for the damage, and you might not notice any symptoms^[1]. This is one reason why many people only know they have a liver condition if it is found by accident during other health checks, or when they become very unwell^[8].

Early symptoms of cirrhosis may include^[1][6]:

• Nausea or loss of appetite
• Feeling weak and tired
• Feeling generally unwell all the time
• Upper abdominal pain or tummy pain
• Visible blood vessels that look like spiders on the skin
• Redness on the palms of your hands, which may be harder to see on brown or black skin
• Losing weight without trying

As the disease worsens and liver function declines, later symptoms may include^[1][6]:

• Jaundice, which is a yellow tint to your skin and eyes (yellowing may be harder to see on brown or black skin)
• Dark-colored urine and light-colored stools
• Itchy skin (but with no visible rash)
• Small, yellow bumps of fat deposits on your skin or eyelids
• Unexplained weight loss and muscle loss
• Irregular periods in women
• Swelling in your abdomen (called ascites), legs, ankles, or feet
• Easy bleeding and bruising
• Changes to your fingers, such as them getting wider and curved (clubbed), or white nails
• Trembling hands
• Slurred speech
• Feeling confused or difficulty concentrating
• Vomiting blood
• Very dark or black stools

Men may also have bigger breasts than usual or their testicles may get smaller^[6].

What Causes Hepatic Cirrhosis?

Cirrhosis is a gradual scarring process that is triggered by chronic inflammation in your liver. Any chronic liver disease that causes inflammation can lead to cirrhosis^[1]. The disease is caused by long-term damage to your liver^[6].

Common causes include^[1][3]:

• Alcohol-induced hepatitis: This is liver damage from long-term, heavy alcohol use. Alcohol may be the most well-known cause of liver cirrhosis, but nonalcoholic causes are also common.
• Metabolic dysfunction-associated steatohepatitis (MASH): This is chronic damage from excess fat storage in your liver. It is related to metabolic factors like high blood lipids, blood sugar, and blood pressure. Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in Australia^[9].
• Chronic hepatitis C infection: Hepatitis C is a viral infection that becomes chronic in most people. It is now curable with antivirals, but many people don’t realize they have it.
• Chronic hepatitis B infection: Hepatitis B is a viral infection that may become chronic in a minority of people. If it does, you will have it for life. It is treatable, but not curable. In the developing world, hepatitis B virus and hepatitis C are the most common causes^[3].

Less common causes include^[1][6]:

• Autoimmune disorders where the body’s immune system begins attacking the liver, such as autoimmune hepatitis, primary biliary cholangitis, or primary sclerosing cholangitis
• Genetic conditions, such as hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, or cystic fibrosis
• Chronic right-sided heart failure
• Drug-induced liver cirrhosis
• Budd-Chiari syndrome

Stages of Cirrhosis

Cirrhosis worsens as scar tissue builds up in your liver. Doctors recognize two main stages^[1][5]:

Compensated cirrhosis: In the beginning, your body compensates for the damage, and you might not notice any symptoms. During this stage, the liver can still perform many of its functions despite the scarring.

Decompensated cirrhosis: As liver function declines, symptoms develop. This is a more advanced stage where the liver can no longer compensate for the damage, and complications begin to appear.

Possible Complications

Cirrhosis can cause complications which can be serious or life-threatening^[6]. Many people with cirrhosis can feel well and live for many years, but the disease can lead to various complications.

Complications include^[6][1]:

• Not getting enough nutrients (malnutrition)
• Weakened and fragile bones (osteoporosis)
• Infections, such as urinary tract infections and pneumonia
• Sepsis, which is a serious body-wide response to infection
• Jaundice
• A condition that causes fluid to build up in the tummy (called ascites)
• Changes in the brain that can cause problems like confusion (hepatic encephalopathy)
• Internal bleeding from varices, which are dilated veins in the esophagus or stomach
• Liver failure
• A blood clot in the blood vessel that brings blood to the liver
• Liver cancer

How Doctors Diagnose Cirrhosis

Cirrhosis is usually diagnosed using blood tests and scans^[8]. Your doctor will use several methods to determine if you have cirrhosis and assess its severity.

Diagnostic tests may include^[1][3]:

• Blood tests: These check liver function and look for signs of liver damage
• Imaging tests: These may include ultrasound, CT scans, or MRI scans to look at the liver’s structure and detect scarring
• Liver biopsy: In some cases, doctors may take a small sample of liver tissue to examine under a microscope to confirm the diagnosis and determine the extent of scarring

Treatment and Management

Cirrhosis cannot be cured, and the damage done by cirrhosis typically cannot be undone. However, there are treatments that can help slow it down or stop it getting worse^[6][1]. If caught early enough and depending on the cause, there is a chance of slowing it with treatment^[2].

Treatment usually involves^[6][12]:

Treating the cause: This is essential to prevent further liver damage. Treatment depends on what caused the cirrhosis:

• For alcohol-associated liver disease: Doctors will recommend that you completely stop drinking alcohol and may refer you for alcohol treatment^[12]
• For chronic hepatitis C: Antiviral medicines that can cure more than 95% of people with chronic hepatitis C in 8 to 12 weeks^[12]
• For chronic hepatitis B: Antiviral medicines that slow or stop the virus from further damaging your liver^[12]
• For metabolic dysfunction-associated steatohepatitis (MASH): Weight loss can help reduce fat in the liver, inflammation, and scarring. For people who have overweight or obesity, weight loss through healthy meal planning, regular physical activity, and sometimes medicines or surgery^[12]
• For autoimmune hepatitis: Medicines that suppress, or decrease the activity of, the immune system^[12]

Preventing and treating complications: This may include^[6]:

• Laxative medicine to help remove toxins from your body
• Medicines such as beta blockers to reduce bleeding
• Medicine to make you urinate more and help reduce swelling
• Antibiotics to help treat or prevent infections and treat internal bleeding
• Treatment for weakened bones

Liver transplant: In severe cases where cirrhosis is very advanced, a liver transplant may be considered. For people with cirrhosis, a liver transplant can add years to their life expectancy^[6][22].

You will be supported by different healthcare professionals. This may include a liver specialist (hepatologist), digestive system specialist (gastroenterologist), nutrition specialists (nutritionist or dietician), and alcohol support services^[6].

Lifestyle Changes and Self-Care

There are some things you can do that may help stop your cirrhosis getting worse and help you to stay healthy^[6][13]:

Do:

• Have a healthy, balanced diet
• Exercise regularly
• Try to keep to a healthy weight
• Check with a pharmacist or doctor before taking any medicines, including herbal medicines, as they may not be suitable if you have cirrhosis
• Stay up to date with vaccinations, such as the flu vaccine and pneumococcal vaccine

Don’t:

• Do not drink alcohol. No amount of alcohol is considered safe in patients with cirrhosis^[10]
• Do not smoke

Diet considerations: If you have cirrhosis or advanced liver disease, you may need to follow special advice to make sure you get enough energy (calories) and protein, and not too much salt. This is important to stop you from becoming malnourished and losing muscle mass^[17]. People who have cirrhosis often eat “little and often,” a style of eating that involves frequent small meals throughout the day^[17].

Preventing Cirrhosis from Getting Worse

Treatment aims to halt liver damage, manage the symptoms, and reduce the risk of complications^[9]. While cirrhosis cannot be reversed, doctors recommend that people with cirrhosis stop activities that may have caused cirrhosis or can make cirrhosis worse^[12].

Key prevention strategies include^[1][6]:

• Vaccination, such as for hepatitis B
• Avoiding alcohol
• Losing weight if you have overweight or obesity
• Exercising regularly
• Following a low-carbohydrate diet if recommended
• Controlling high blood pressure and diabetes, as this may help in those with metabolic dysfunction-associated fatty liver disease