Overview

What is cirrhosis? A Mayo Clinic expert explains

Learn more about cirrhosis from transplant hepatologist Sumera Ilyas, M.B.B.S.

I'm Dr. Sumera Ilyas, a transplant hepatologist at Mayo Clinic. In this video, we'll cover the basics of cirrhosis. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Put simply, cirrhosis is scarring of the liver. Any time an organ is injured, it tries to repair itself. And when this happens, scar tissue forms. As more scar tissue forms in the liver, it becomes harder for it to function. Cirrhosis is usually a result of liver damage from conditions such as hepatitis B or C, or chronic alcohol use. The damage done by cirrhosis typically cannot be undone. But if caught early enough and depending on the cause, there is a chance of slowing it with treatment. And even in the most severe cases, liver transplants and new treatments provide those suffering from cirrhosis with hope.

Any kind of disease or condition that harms the liver can lead to cirrhosis over time. About 2% of American adults have liver disease, and therefore are at risk of developing cirrhosis. However, those who drink too much alcohol, those who are overweight and those with viral hepatitis are at a greater risk. Not everyone with these risk factors develops cirrhosis. These are the leading causes of liver disease. A wide range of other conditions and diseases can cause cirrhosis as well. Some include inflammation and scarring of the bile ducts, known as primary sclerosing cholangitis; iron buildup in the body - what we call hemochromatosis; Copper accumulation in the liver, which is a rare condition called Wilson's disease; and inflammation from the body's own immune system harming liver cells, known as autoimmune hepatitis.

Often, cirrhosis shows no signs or symptoms until liver damage is extensive. When symptoms do occur, they may first include fatigue, weakness and weight loss, nausea, bruising or bleeding easily, swelling in your legs, feet or ankles, itchy skin, redness on the palms of your hands, and spider-like blood vessels on your skin. During later stages, you might develop jaundice, which is yellowing of the eyes or skin; gastrointestinal bleeding; abdominal swelling from fluid building up in the belly; and confusion or drowsiness. If you notice any of these symptoms, you should speak to your doctor.

Since you may not have any symptoms in the early stages of the disease, cirrhosis is often detected through routine blood tests or checkups. If your doctor find something suspicious, further blood tests may be necessary. These can help identify how extensive your cirrhosis is by checking for liver malfunction, liver damage, or screening for causes of cirrhosis such as hepatitis viruses. Based on the results, your doctor maybe able to diagnose the underlying cause of cirrhosis. They may also recommend imaging tests like an MR elastogram that checks for scarring in the liver, or an MRI of the abdomen, CT scan or an ultrasound. A biopsy may also be required to identify the severity, extent and cause of liver damage.

Although the damage caused by cirrhosis is not reversible, treatment can slow the progression of the disease, alleviate symptoms, and prevent complications. In cases of early cirrhosis, it is possible to minimize damage to the liver by tackling the underlying causes. For instance, treating alcohol addiction, losing weight, and using medications to treat viral hepatitis and other conditions can limit damage to the liver. Once the liver stops functioning, an organ transplant may be an option. During a transplant, surgeons remove the damaged liver and replace it with a healthy working liver. In fact, cirrhosis is one of the most common reasons for a liver transplant. You and your medical team will need to assess if you are an appropriate candidate through a transplant evaluation. Surgery is a big undertaking, one that brings its own risks and complications. And it should always be a decision between you, your family, and your doctors.

If you're concerned about your risk of cirrhosis, talk to your doctor. Life with cirrhosis can be challenging, but with the right information, the right medical team and the right treatment, there's reason to be encouraged. Health professionals learn more and more every day about the conditions and diseases that damage our livers. Studies investigating new treatments that can slow and even reverse the scarring that leads to cirrhosis are currently underway. For those with cirrhosis, the future is brighter than ever before. If you'd like to learn even more about cirrhosis, watch our other related videos or visit mayoclinic.org. We wish you well.

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 alcoholism.

Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

Symptoms

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

  • Fatigue
  • Easily bleeding or bruising
  • Loss of appetite
  • Nausea
  • Swelling in your legs, feet or ankles (edema)
  • Weight loss
  • Itchy skin
  • Yellow discoloration in the skin and eyes (jaundice)
  • Fluid accumulation in your abdomen (ascites)
  • Spiderlike blood vessels on your skin
  • Redness in the palms of the hands
  • For women, absent or loss of periods not related to menopause
  • For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)

When to see a doctor

Make an appointment with your doctor if you have any of the signs or symptoms listed above.

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Causes

A wide range of diseases and conditions can damage the liver and lead to cirrhosis.

Some of the causes include:

  • Chronic alcohol abuse
  • Chronic viral hepatitis (hepatitis B, C and D)
  • Fat accumulating in the liver (nonalcoholic fatty liver disease)
  • Iron buildup in the body (hemochromatosis)
  • Cystic fibrosis
  • Copper accumulated in the liver (Wilson's disease)
  • Poorly formed bile ducts (biliary atresia)
  • Alpha-1 antitrypsin deficiency
  • 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)
  • Destruction of the bile ducts (primary biliary cirrhosis)
  • Hardening and scarring of the bile ducts (primary sclerosing cholangitis
  • Infection, such as syphilis or brucellosis
  • Medications, including methotrexate or isoniazid

Risk factors

  • Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
  • Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
  • Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it's one of the world's leading causes of liver disease.

Complications

Complications of cirrhosis can include:

  • 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 to the liver from the intestines and spleen.
  • Swelling in the legs and abdomen. The increased pressure in the portal vein 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 and swelling of the spleen, and trapping of white blood cells and platelets. 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 pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can't make enough clotting factors, this also can contribute to continued bleeding.
  • 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.
  • Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
  • 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.

Prevention

Reduce your risk of cirrhosis by taking these steps to care for your liver:

  • Do not drink alcohol if you have cirrhosis. If you have liver disease, you should avoid alcohol.
  • 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.

Cirrhosis care at Mayo Clinic

Feb. 06, 2021
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