Cirrhosis
Also called: Liver cirrhosis
Advanced scarring of the liver after years of injury. Nodules and scar tissue replace normal liver, impairing its functions and raising pressure in the portal vein.
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What happens in the body
Repeated injury activates hepatic stellate cells, which lay down collagen; regenerating nodules distort blood flow, causing portal hypertension and liver failure.
Causes
- Alcohol-related liver disease
- Fatty liver disease (MASLD)
- Chronic hepatitis B and C
- Autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
- Haemochromatosis and Wilson disease
Risk factors
- Heavy drinking
- Obesity and diabetes
- Viral hepatitis
Symptoms
- Often none until late (compensated)
- Fatigue, weight loss, itching
- Jaundice
- Swollen abdomen (ascites) and legs
- Easy bruising
- Vomiting blood from varices
- Confusion (hepatic encephalopathy)
Diagnosis — tests and examinations
- Blood tests (albumin, bilirubin, INR, platelets)
- Elastography
- Ultrasound
- Endoscopy for varices
- Child–Pugh and MELD scores
Treatment
Medicines and medical treatment
- Treat the cause (abstinence, antivirals, weight loss)
- Beta-blockers to prevent variceal bleeding
- Diuretics (spironolactone) for ascites
- Lactulose and rifaximin for encephalopathy
- Six-monthly liver cancer surveillance
Operations and procedures
- Band ligation of varices
- Paracentesis for ascites
- TIPS shunt
- Liver transplantation
Self-care, home remedies and lifestyle
- No alcohol at all
- Low-salt diet with adequate protein
- Vaccination against hepatitis A, B, flu and pneumococcus
- Avoid NSAIDs
Possible complications
- Variceal bleeding
- Ascites and spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Liver cancer
- Kidney failure (hepatorenal syndrome)
Prevention
- Moderate drinking, healthy weight, hepatitis B vaccination, safe injecting and screening for hepatitis C
Outlook
Compensated cirrhosis may be stable for years; decompensation markedly shortens survival without transplant.
When to see a doctor
Seek emergency care for vomiting blood, black stools, confusion or rapid abdominal swelling.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
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