Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.

Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

  • Fatigue
  • Bleeding easily
  • Bruising easily
  • Itchy skin
  • Yellow discoloration in the skin and eyes (jaundice)
  • Fluid accumulation in your abdomen (ascites)
  • Loss of appetite
  • Nausea
  • Swelling in your legs
  • Weight loss
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)
  • Spider-like blood vessels on your skin

When to see a doctor

Make an appointment with your doctor if you have persistent signs or symptoms of cirrhosis.

Cirrhosis is caused by scar tissue that forms in your liver in response to damage occurring over many years. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As the scar tissue builds up, liver function worsens. In advanced cirrhosis, the liver no longer works very well.

It's important to determine the cause of cirrhosis because treating that underlying cause can help prevent further liver damage. A wide range of diseases and conditions can damage the liver and lead to cirrhosis.

Some of the causes of cirrhosis are inherited or thought to be inherited:

  • Iron buildup in the body (hemochromatosis)
  • Cystic fibrosis
  • Copper accumulated in the liver (Wilson's disease)
  • Poorly formed bile ducts (biliary atresia)
  • Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
  • Genetic digestive disorder (Alagille syndrome)
  • Liver disease caused by your body's immune system (autoimmune hepatitis)

Others occur later in life:

  • Chronic alcohol abuse
  • Hepatitis C
  • Hepatitis B
  • Fat accumulating in the liver (nonalcoholic fatty liver disease)
  • Destruction of the bile ducts (primary biliary cirrhosis)
  • Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
  • Infection by a parasite common in developing countries (schistosomiasis)
Some people may have more than one cause for cirrhosis, such as alcohol abuse and viral hepatitis. If doctors cannot find a cause for your condition, it's called cryptogenic cirrhosis. Up to 20 percent of people with cirrhosis have cryptogenic cirrhosis.

Complications of cirrhosis can include:

Complications related to blood flow:

  • High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
  • Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
  • Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
  • Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may cause enlarged veins (varices) and lead to life-threatening bleeding in the esophagus (esophageal varices) or the stomach (gastric varices). If the liver can't make enough clotting factors, this also can contribute to continued bleeding.

Other complications:

  • Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
  • Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
  • Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
  • Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
  • Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
  • Gallstones and bile duct stones. Blocked flow of bile can lead to irritation, infection and the creation of stones.
  • Increased risk of liver cancer.
  • Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.

If you have cirrhosis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist) or the liver (hepatologist).

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions, such as diet restrictions on the day before your appointment.
  • Write down your symptoms, including when they started and how they may have changed or worsened over time.
  • Take a list of all your medications, as well as any vitamins or supplements.
  • Write down your key medical information, including other diagnosed conditions.
  • Bring results of medical tests done so far, including digital copies of CT, MRI or ultrasound images and biopsy slides if a liver biopsy has been done.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Take a family member or friend along to help you remember things.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. Some basic questions to ask your doctor include:

  • What is most likely causing my cirrhosis?
  • Is there a way to slow or stop my liver damage?
  • What are my treatment options?
  • How can I protect my liver from further damage?
  • Are there medications that can hurt my liver?
  • What signs and symptoms of complications should I watch for?
  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be prepared to answer questions your doctor is likely to ask, including:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How often do you drink alcohol?
  • Have you been exposed to or taken toxic drugs?
  • Do you have a family history of liver disease, hemochromatosis or obesity?
  • Have you ever had viral hepatitis?
  • Have you ever had a blood transfusion or used injection drugs?
  • Do you have any tattoos?

People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Your doctor may order one or more tests or procedures to diagnose cirrhosis.

Laboratory tests:

  • Liver function. Your blood is checked for excess bilirubin and certain enzymes that may indicate liver damage.
  • Kidney function. Your blood is checked for creatinine.
  • Tests for hepatitis B and C. Your blood is checked for the hepatitis viruses.
  • Clotting. Your international normalized ratio (INR) is checked for your blood's ability to clot.

Imaging and other tests:

  • Magnetic resonance elastography (MRE). This noninvasive advanced imaging testdetects hardening or stiffening of the liver.
  • Other imaging tests. MRI, CT and ultrasound can image the liver.
  • Biopsy. A tissue sample (biopsy) is not necessarily needed for diagnosis. However, your doctor may use it to identify the severity, extent and cause of liver damage.

If you have cirrhosis, your doctor is likely to recommend regular diagnostic tests to monitor for signs of disease progression or complications, especially esophageal varices and liver cancer. Noninvasive tests are becoming more widely available for monitoring.

Treatment for cirrhosis depends on the cause and extent of your liver damage. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. You may need to be hospitalized if you have severe liver damage.

Treatment for the underlying cause of cirrhosis

In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include:

  • Treatment for alcohol dependency. People with cirrhosis caused by alcohol abuse should try to stop drinking. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.
  • Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease may become healthier if they lose weight and control their blood sugar levels.
  • Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.
  • Medications to control other causes and symptoms of cirrhosis. Medications may slow the progression of certain types of liver cirrhosis. For example, people with primary biliary cirrhosis that is diagnosed and treated early may never experience symptoms.

Other medications can relieve certain symptoms, such as itching, fatigue and pain. Nutritional supplements may be prescribed to counter malnutrition associated with cirrhosis and to prevent osteoporosis (weak bones).

Treatment for complications of cirrhosis

Your doctor will work to treat any complications of cirrhosis, including:

  • Excess fluid in your body. Edema or ascites may be managed with a low-sodium diet and medication to prevent fluid buildup in the body. More severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure.
  • Portal hypertension. Blood pressure medications may control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding. Your doctor will perform an upper endoscopy at regular intervals to look for enlarged veins in the esophagus or stomach (varices) that may bleed.

    If you develop varices, you likely will need medication to reduce the risk of bleeding. If you are not able to tolerate medication and have signs that the varices are bleeding or are likely to bleed, you may need a procedure (band ligation) to stop the bleeding. In severe cases, you may need a small tube — a transjugular intrahepatic portosystemic shunt (TIPS) — placed in your vein to reduce blood pressure in your liver.

  • Infections. You may receive antibiotics or other treatments for infections. Your doctor also is likely to recommend vaccinations for influenza, pneumonia and hepatitis.
  • Increased liver cancer risk. Your doctor will likely recommend periodic blood tests and ultrasound exams to look for signs of liver cancer.
  • Hepatic encephalopathy. You may be prescribed medications to help reduce the buildup of toxins in your blood due to poor liver function.

Liver transplant surgery

In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace your liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.

Extensive testing is needed before a liver transplant to ensure that a candidate is in good enough health to have the transplant operation. Additionally, transplant centers typically require some period of abstinence from alcohol, often at least six months, before transplantation for people with alcohol-related liver disease.

If you have cirrhosis, be careful to limit additional liver damage:

  • Don't drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
  • Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
  • Eat a healthy diet. People with cirrhosis can experience malnutrition. Combat this with a healthy plant-based diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
  • Avoid infections. Cirrhosis make sit more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
  • Use over-the-counter medications carefully. Cirrhosis makes it more difficult for your liver to process drugs. For this reason, ask your doctor before taking any medications, including nonprescription drugs. Avoid drugs such as aspirin and ibuprofen (Advil, Motrin IB). If you have liver damage, your doctor may recommend you avoid acetaminophen (Tylenol, others) or take it in low doses for pain relief.

A number of alternative medicines have been used to treat liver diseases. Milk thistle (silymarin) is the most widely used and best studied. Other herbs used include licorice root (glycyrrhizin), schisandra and astragalus. However, there is not enough evidence of benefit from clinical trials to recommend use of any herbal products to treat liver cirrhosis. In addition, some alternative medications may harm the liver. Talk with your doctor if you're interested in trying alternative medicine to help you cope with cirrhosis.

Reduce your risk of cirrhosis by taking care of your liver:

  • Drink alcohol in moderation, if at all. If you choose to drink alcohol and don't have liver disease or cirrhosis, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men over age 65, and up to two drinks a day for men age 65 and younger.
  • Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
  • Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
  • Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.

If you're concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.

  • Expertise and experience. Mayo Clinic doctors have expertise and experience in evaluating and treating people who have cirrhosis. Doctors treat more than 6,000 people each year who have cirrhosis.
  • Experience in liver transplants. Mayo Clinic researchers developed the model for end-stage liver disease (MELD) now used nationwide to assess people's disease progression and allocate organs for transplant. Between mid-2012 and mid-2013, Mayo Clinic specialists performed 336 liver transplants.
  • Team approach. Specialists in gastroenterology and liver disease (hepatology) work together to provide the best possible treatment.
  • Latest technology. State-of-the-art imaging developed at Mayo Clinic helps Mayo specialists find liver disease early.
  • Research leader. Mayo Clinic specialists are working to improve treatment of cirrhosis. People being treated at Mayo are among the first to benefit from new findings made at Mayo.

Mayo Clinic in Rochester, Minn., ranks #1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals and Mayo Clinic in Jacksonville, Fla., is ranked high performing for digestive disorders by U.S. News & World Report.

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

Why Choose Mayo Clinic

What Sets Mayo Clinic Apart

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Specialists in gastroenterology and hepatology usually manage care for adults who have cirrhosis.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology and hepatology usually manage care for adults who have cirrhosis.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology and hepatology usually manage care for adults who have cirrhosis. Treatment may be provided by specialists in the Hepatobiliary Clinic. Chemical dependency treatment is available.

Specialists in pediatric gastroenterology and hepatology usually manage care for children who have cirrhosis.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic researchers are committed to improving diagnosis and treatment of cirrhosis of the liver. Mayo researchers were among the first to identify nonalcoholic fatty liver disease and primary sclerosing cholangitis. Mayo researchers are also making significant contributions to understanding the causes of liver cirrhosis and developing new treatments. Specific efforts include evaluating the effectiveness of advanced imaging of liver scarring and identifying markers for cirrhosis.

See a list of publications by Mayo Clinic doctors on cirrhosis of the liver on PubMed, a service of the National Library of Medicine.

Aug. 16, 2014