What is cirrhosis of the liver?
Liver cirrhosis happens when your liver gets damaged over many years. This damage causes scar tissue to form in your liver, making it hard and bumpy. These changes affect how well your liver does vital jobs, like removing toxins from your blood, fighting infections and producing a fluid (called bile) that helps break down fat.
The most common causes of cirrhosis are alcoholic liver disease, fatty liver disease and hepatitis C.
If you have cirrhosis, you may feel well for years as your liver can work even when it’s really damaged. But, without treatment, cirrhosis eventually gets so serious that your liver stops working. That’s why early diagnosis and treatment is important for anyone with cirrhosis.
Liver cirrhosis stages
Cirrhosis is sometimes known as end-stage liver disease, because it comes after the other stages of damage, which include inflammation (hepatitis), fatty deposits and mild scarring (liver fibrosis).
It’s also divided into 2 stages:
- compensated cirrhosis – in this early stage, your liver can deal with the damage done to it and still functions properly. You don’t have any symptoms in this stage
- decompensated cirrhosis – your liver is too damaged to work like it should. When you’re at this stage, you usually have serious symptoms and complications, like a build-up of fluid in your tummy (ascites) and high levels of toxins in your blood that affect your brain (known as hepatic encephalopathy)
Read more about the different stages and causes of liver disease and liver fibrosis.
Liver cirrhosis symptoms
In the early stages, you may not know you have cirrhosis, as you may not have any symptoms. But, as the damage gets worse, you’re likely to see more signs. This is because the scar tissue prevents blood from flowing into your liver as it normally would, leading to pressure on your blood vessels. This, in turn, can cause heart problems, swollen legs and other symptoms.
These symptoms may include:
- losing weight without trying to
- feeling sick (nausea) or being sick (vomiting)
- getting tired easily
- rashes, like redness on your palms or red lines that look like small spiders on the skin
- yellowing of the whites of your eyes and skin (jaundice)
- itchy skin
- dark coloured pee
- bleeding and bruising more easily
swollen legs and tummy – from a build-up of fluid (oedema)
When to see a doctor about liver cirrhosis
See a doctor as soon as possible if you have any of the symptoms listed above or you’re worried you may have liver cirrhosis – the earlier it’s diagnosed and treated, the less likely it is to get worse.
Go to a hospital or see a doctor immediately if you:
- are vomiting blood
- have a fever or feel hot and shivery
- have any swelling that’s red or feels hot to the touch
- have difficulty breathing (shortness of breath)
- feel dizzy or like you might faint
- notice your poo looks black or like tar
What causes cirrhosis of the liver?
There are many causes of liver cirrhosis, including:
- drinking too much alcohol over many years (alcohol misuse), which causes alcoholic liver disease, also known as alcohol-related liver disease (ARLD)
- having a long-term infection that causes hepatitis – there are many different types, including hepatitis B, hepatitis C and autoimmune hepatitis (caused by your immune system accidentally attacking your liver cells)
- a serious form of nonalcoholic fatty liver disease (NAFLD) (a build-up of fat in your liver) called nonalcoholic steatohepatitis
- primary biliary cirrhosis and other conditions that affect small channels, called bile ducts, in your liver
- certain medications
- infections caused by bacteria or parasites
- serious heart problems
Then, there are rare inherited (genetic) conditions that also cause it, such as haemochromatosis, where too much iron builds up in your liver, and Wilson’s disease, in which too much copper builds up in your body and causes organ damage.
How is cirrhosis diagnosed?
A doctor will usually ask you about your symptoms and any medical conditions you have. They may also do a physical exam of your tummy and other parts of your body.
You may then need tests, such as:
- blood tests to see how well your liver is working
- imaging scans like a CT scan or MRI scan to look for changes to your liver
- a biopsy of your liver to confirm the diagnosis
If the tests show your liver is damaged, you may be referred to a specialist liver doctor, called a hepatologist, for further advice and treatment.
What is the treatment for liver cirrhosis?
The aim of treatment is to slow down how quickly the disease develops, reverse damage where possible and try to treat any complications. Once you have cirrhosis, any liver damage you have usually can’t be reversed.
Treatment is usually focused on treating the cause of cirrhosis to stop further damage, if possible. A doctor may give you:
- antiviral medicines that can be used to treat viral hepatitis infections
- steroid medicines if the cause is an autoimmune disease
You can also make lifestyle and diet changes to help manage your symptoms and reduce your risk of complications. These changes include:
- drinking less alcohol (or none at all) – speak to a doctor first, so they can help you make a plan to cut down safely. Don’t try to stop suddenly on your own, as this can be dangerous. Read more about getting support for alcohol misuse and about how much alcohol is too much
- losing weight if you’re overweight or obese – speak to a doctor or dietitian for advice on how to safely do this
- quitting smoking
- doing regular exercise to make sure you’re a healthy weight and don’t lose muscle – get guidance from a doctor on how to do this safely
- eating a healthy, balanced diet – malnutrition is common if you have cirrhosis, so you may need to make an effort to get all the nutrients you need. Read more about what a balanced diet looks like and foods that are good for your liver
- cutting down on salt in your diet to help with fluid build-up in your feet, legs and tummy
- practising good hygiene to make sure you don’t get any infections
- getting vaccinations you may need, such as a yearly flu vaccine or travel vaccines – speak to a doctor about this
If your liver is badly damaged, doctors may recommend a liver transplant – but this happens in rare cases and only when all treatments haven’t worked. A liver transplant involves surgery to replace your damaged liver with a healthy liver from someone else.
Read more about how a liver transplant is performed.
Can you prevent cirrhosis of the liver?
Your ability to prevent liver cirrhosis depends on its cause. Liver cirrhosis caused by many years of alcohol misuse or being overweight can be prevented by making changes in the early stages of the disease.
But it’s hard to prevent liver cirrhosis that’s caused by an inherited condition or a problem with your immune system.
And once you reach a stage where your liver is very damaged and scarred, you can’t reverse the damage.
What can you expect after being diagnosed with liver cirrhosis?
It often takes years for liver damage to lead to cirrhosis. If the damage is picked up early, this progression can often be slowed down by making lifestyle changes and getting treatment for the problem that led to the damage.
If you develop liver cirrhosis it’s a serious condition that can be life-threatening and usually can’t be reversed. There are lots of treatments to help with your symptoms and slow down how quickly cirrhosis progresses. However, some people will end up needing a liver transplant.
Also, you may have an increased chance of getting liver cancer – but, not everyone who gets cirrhosis will get this cancer.
You’ll usually need regular check-ups with a liver specialist to manage cirrhosis and its treatment. You may also have your care monitored in a specialist liver centre.
Dealing with cirrhosis can be difficult, so speak to a doctor if you’re finding it hard to cope. You can also contact support groups like the British Liver Trust’s support groups (UK) or the American Liver Foundation’s Inspire support community (US) for additional support.
Your questions answered
What are the early warning signs of cirrhosis of the liver?
There are usually no symptoms of liver damage before someone has developed cirrhosis, and even once you've developed it, the symptoms are often vague and easy to miss. While liver cirrhosis can happen to anyone, some people – like those who drink too much alcohol or have a liver infection such as hepatitis B or C – are at a greater risk. So, if you think you're at risk of cirrhosis, speak to a doctor, even if you don't have any symptoms, as you could still prevent it from developing. – Answered by Dr Shailen Sutaria from the Healthily Medical Team
How long can a person live with liver cirrhosis?
If you have liver cirrhosis, you can feel quite well and usually live for many years without needing a liver transplant, depending on how advanced your liver disease is and how well treatment is working. Your liver can usually manage to keep doing what it needs to do even when it’s seriously damaged, as long as you’re getting the treatment you need. But it can be life-threatening if there are complications, such as liver failure and liver cancer.
Can cirrhosis of the liver be cured?
If you have liver disease, a doctor will help you manage the symptoms and slow down any damage that is happening to your liver, but it can’t usually be cured. If the cause is, for example, alcohol, then you’d need to cut down on it, or lose weight if you have fatty liver disease. Research into new treatments that may help heal a scarred liver is ongoing, so reversing the damage caused to a liver may be possible in the future.
- cirrhosis of the liver happens when your liver gets damaged over many years, leading to scarring of this important organ
- in the early stages of cirrhosis of the liver, you may not know you have it, as you may not have any symptoms
- there are many causes of cirrhosis, including alcoholic liver disease, hepatitis C and nonalcoholic fatty liver disease (NAFLD)
- the earlier cirrhosis of the liver is diagnosed and treated, the more likely you’ll be able to stop it from getting worse
- if your liver is badly damaged from cirrhosis, doctors may recommend a liver transplant – but this happens in rare cases and when all other treatments have failed