What Is Cirrhosis?

Cirrhosis is the permanent scarring of the liver. It can be life-threatening. There are several causes of cirrhosis. However, one major cause is the hepatitis C virus (HCV).^1-3

The liver has the ability to repair itself in response to damage. But there is a limit to how much damage it can recover from before it begins to scar. Scarring that can be reversed is called fibrosis. Over time, scarring can become permanent. Scarring that cannot be reversed is called cirrhosis.^1-3

Cirrhosis has two types, compensated and decompensated. Some people go back and forth between compensated and decompensated cirrhosis for years.^1-3

In compensated cirrhosis, the scarring is not severe enough to stop the liver from working. In decompensated cirrhosis, the liver is not able to perform its normal jobs. This can lead to severe complications.^1-3

Causes of cirrhosis

Liver damage leading to cirrhosis can be caused by a variety of things. Cirrhosis may also be the result of certain liver conditions. Causes of cirrhosis include:^1-4

• Hepatitis viruses (like HCV or hepatitis B)
• Nonalcoholic fatty liver disease (fat buildup in the liver)
• Alcoholic liver disease (from long-term, heavy alcohol use)
• Inherited liver issues
• Autoimmune conditions
• Heart failure

These are not all of the causes of cirrhosis. Many different health conditions or exposures can cause damage to the liver over time.

Cirrhosis and HCV

HCV is one of the most common causes of cirrhosis in the United States. HCV reproduces in the liver. As HCV grows and divides, it causes damage. The liver tries to keep up and repair itself, but after years of HCV, it cannot. Eventually the damage turns to fibrosis and then cirrhosis. This process can take decades.^1-4

It is hard to know exactly how many people with HCV will develop cirrhosis. Some think about 20 percent of all people with chronic HCV will have cirrhosis. Others think the risk may be as high as 50 percent.⁵

Doctors do not know why people move toward cirrhosis at different rates. They do know that the risk of cirrhosis decreases if a person is treated for HCV.⁶

What are the symptoms of cirrhosis?

Cirrhosis can develop slowly and without symptoms for a long time. Common early symptoms of cirrhosis include:^1,2

• Weakness
• Fatigue
• Weight loss
• Loss of appetite

As cirrhosis continues, symptoms may worsen. Signs of advanced damage include:^1-3

• Yellowing of the skin or whites of eyes (jaundice)
• Itchy skin (pruritus)
• Muscle cramps
• Nausea
• Swelling of the legs and feet (peripheral edema)
• Trouble taking a full breath
• Trouble thinking

These are not all the possible signs of cirrhosis. The liver has many important jobs. When the liver is not working well, that can create problems throughout the body.

Complications of cirrhosis

Blood flowing through the body passes through the liver. The liver plays a role in processing nutrients and getting rid of toxins. When cirrhosis has scarred the liver, blood cannot travel through it as easily.

This causes a backup of blood called portal hypertension. The portal system is the liver’s blood vessels. Hypertension means high blood pressure. Portal hypertension can cause many issues, including:^1-3

• Life-threatening bleeding
• Ascites (buildup of fluid in the belly)
• Spontaneous bacterial peritonitis (SBP, an infection in the belly fluid)
• Kidney failure
• Problems breathing or fluid in the lungs
• Heart problems or heart failure

Because the liver is not removing waste and toxins as well as it should, these can build up. Over time, the buildup can impact brain functioning. This is called hepatic encephalopathy and can cause changes in:^1-3

• Concentration
• Memory
• Consciousness

Hepatocellular carcinoma (HCC) is a type of liver cancer that is also a complication of cirrhosis. Liver cells that are constantly trying to repair themselves are at higher risk of developing errors (mutations). These mutations can lead to cancer.^1-3

Other potential complications of cirrhosis are:²

• Poor blood clotting
• Bone disease
• Difficulty getting enough nutrition
• Infections
• Complete liver failure

Treatment of cirrhosis

Although cirrhosis is permanent, there are ways to slow it down. Doctors do this by treating the underlying cause of the cirrhosis. They will encourage you to avoid or limit any liver-damaging factors. They may ask you to:^2,3

• Reduce alcohol intake
• Eat a healthy diet
• Adjust the medicines you take
• Lose weight
• Treat your HCV or hepatitis B

The complications of cirrhosis can be managed as well. Eating a low-salt diet and draining belly fluid can help with ascites. Some drugs may help reduce portal hypertension and its complications. Others might lower infection risk. There are also drugs available for hepatic encephalopathy.²

If cirrhosis is severe enough to cause liver failure, you may need a liver transplant surgery. You and your doctor can work together to figure out the best treatment approach for you.^2,3