Cirrhosis: Causes, Symptoms, and Treatment Options

Cirrhosis is severe, long-lasting scarring of the liver. Scar tissue replaces healthy liver tissue, blocks blood flow through the liver, and keeps it from working normally. Cirrhosis develops slowly over years of liver injury, and early treatment can stop it from getting worse.

What the liver does

The liver sits in the upper right belly under the ribs and weighs about three pounds. It turns food into energy, makes proteins that help blood clot, makes bile to digest fat, and clears medicines, alcohol, and toxins from the body.

Causes of cirrhosis

• Fatty liver disease (MASLD, formerly NAFLD), and its inflammatory form, MASH (formerly NASH). It is linked to excess weight, diabetes, and high cholesterol and is now one of the most common causes. See fatty liver disease.
• Alcohol use over many years.
• Chronic viral hepatitis: hepatitis B and hepatitis C. Hepatitis B is common in people born in Asia.
• Autoimmune and bile duct diseases: autoimmune hepatitis, primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). See autoimmune and cholestatic liver disease.
• Inherited diseases: hemochromatosis (too much iron) and Wilson disease (too much copper).
• Less common causes, such as long-term heart failure, some medicines, and biliary atresia in infants.

Symptoms

Early cirrhosis often causes no symptoms. When symptoms appear, they may include:

• Tiredness and weakness
• Poor appetite, nausea, and weight or muscle loss
• Easy bruising or bleeding
• Itching
• Small spider-like blood vessels on the skin and red palms
• Missed periods in women; low sex drive or breast enlargement in men

Signs of advanced cirrhosis need prompt care:

• Yellow skin or eyes (jaundice)
• Fluid in the belly (ascites) or swollen legs
• Confusion, sleepiness, or trouble concentrating (hepatic encephalopathy)
• Vomiting blood or black, tarry stools from bleeding veins (varices)

Go to the emergency room for vomiting blood, black stools, confusion, or fever with belly pain.

Diagnosis

• Blood tests: liver tests, platelet count, clotting (INR), albumin, kidney function, and tests for the cause, such as hepatitis B and C
• Imaging: ultrasound, CT, or MRI
• Liver elastography (FibroScan-type testing), which measures liver stiffness without a needle. We perform it in our office with the Mindray Hepatus 5. MR elastography is another option.
• Liver biopsy, only when the cause or stage is unclear

Treatment options

1. Treat the cause

• Hepatitis C: 8 to 12 weeks of antiviral pills cure more than 95% of people.
• Hepatitis B: daily antivirals such as entecavir or tenofovir keep the virus under control.
• Alcohol: stop drinking completely. Counseling, support groups, and medicines can help.
• Fatty liver: weight loss of 7 to 10%, exercise, and control of diabetes and cholesterol. For MASH with moderate to advanced scarring before cirrhosis, the FDA has approved resmetirom (Rezdiffra) and semaglutide (Wegovy).
• Autoimmune hepatitis: steroids and immune-suppressing medicines such as azathioprine.
• PBC: ursodiol, with newer medicines if needed.
• Hemochromatosis: regular blood removal (phlebotomy). Wilson disease: medicines that remove copper or zinc that blocks it.

2. Prevent and treat complications

• Ascites and swelling: a low-sodium diet (less than 2 grams of sodium a day), water pills (diuretics such as spironolactone and furosemide), draining fluid with a needle (paracentesis), or a TIPS shunt.
• Varices: a beta blocker such as carvedilol, and upper endoscopy to check for and band large varices.
• Hepatic encephalopathy: lactulose and rifaximin.
• Liver cancer: ultrasound, often with an AFP blood test, every 6 months. See liver cancer screening.

3. Protect your liver every day

• Do not drink alcohol.
• Use acetaminophen (Tylenol) only in limited doses, usually no more than 2 grams a day. Avoid NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve).
• Check with us before taking new medicines, herbs, or supplements.
• Get vaccinated for hepatitis A and B (if not immune), flu, pneumonia, and COVID-19.
• Eat enough protein to prevent muscle loss, and have a bedtime snack. Do not eat raw oysters or other raw shellfish, which can carry a bacterium (Vibrio) that causes life-threatening infections in people with liver disease.

4. Liver transplant

If cirrhosis advances to liver failure, a liver transplant can be life-saving. Transplants are done at specialized centers, and we refer patients for evaluation when the time is right. Afterward, patients take anti-rejection medicine for life. Survival after transplant is high today.

Living with cirrhosis

Many people with cirrhosis live full lives when the cause is treated and they follow up regularly. Keep your appointments, get your 6-month liver cancer screening, and call us early if new symptoms appear.

Make an appointment

Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.

This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.