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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.
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
The doctor will start
with a physical exam and questions about your symptoms and past health. If the
doctor suspects cirrhosis, you may have blood tests and imaging tests, such as
CT scan. These tests can help your doctor find out
what is causing the liver damage and how severe it is.
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 transplant is
expensive, organs are hard to find, and it doesn't always work.
cirrhosis is getting worse, you may choose to get care that focuses on your
comfort and dignity.
Palliative care can provide support and symptom relief
so you can make the most of the time you have left. You may also want to make
important end-of-life decisions, such as writing a
living will. 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 counseling or other types of help. Think about joining a
support group. Talking with other people who have cirrhosis can be a big
Learning about cirrhosis:
Living with cirrhosis:
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:
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
Your doctor will do a physical exam 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.
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
tests can check for tumors 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
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
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.
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.
Liver transplant surgery is
very expensive. 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. Good candidates include those who have not abused alcohol or illegal drugs
for the previous 6 months and those who have a good support system of family and friends.
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
palliative care. This is a kind of care for
people who have illnesses that do not go away and often get worse over time. Palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit.
For more information, see
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 care health
professionals can provide palliative care and comforting surroundings for
someone who is preparing to die.
For more information, see the
Lifestyle changes may reduce symptoms
caused by complications of the disease and may slow new
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 Abuse and Dependence.
You may need to limit the amount of salt or protein you
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 nonsteroidal 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 nonprescription 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
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
Limited research has shown that the herbal supplement
milk thistle may help protect the liver, but other research has not shown a
benefit.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).
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
The American Liver Foundation (ALF) funds research and
informs the public about liver disease. A nationwide network of chapters and
support groups exists to help people who have liver disease and to help their families. ALF
also sponsors a national organ-donor program to increase public awareness of
the continuing need for organs. You can send an email by completing a form on the contact page on the ALF website: www.liverfoundation.org/contact.
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
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.
Talwalkar JA, Lindor KD (2006). Primary biliary
cirrhosis. In M Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 579–587. Philadelphia: Saunders Elsevier.
Bacon BR (2012). Cirrhosis and its
complications. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2592–2602. New York:
Bataller R (2008). Cirrhosis of the liver. In EG Nabel, ed., ACP Medicine, section 4, chap. 9. Hamilton, ON: BC Decker.
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.
January 17, 2012
Adam Husney, MD - Family Medicine & W. Thomas London, MD - Hepatology
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