Overview

What is cirrhosis? A Mayo Clinic expert explains

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

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Mayo Clinic explains cirrhosis

Sumera I. Ilyas, M.B.B.S., Transplant Hepatologist, Mayo Clinic 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.

What is it?

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.

Who gets it?

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 develop 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.

What are the symptoms?

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.

How is it diagnosed?

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 finds 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.

How is it treated?

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.

What now?

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.

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Cirrhosis is severe scarring of the liver. This serious condition can be caused by many forms of liver diseases and conditions, such as hepatitis or chronic alcoholism.

Each time your liver is injured — whether by excessive alcohol consumption or another cause, such as infection — it tries to repair itself. In the process, scar tissue forms. As cirrhosis gets worse, more and more scar tissue forms, making it difficult for the liver to do its job. Advanced cirrhosis is life-threatening.

The liver damage caused by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the underlying cause is treated, further damage can be limited. In rare cases, it may be reversed.

Symptoms

Cirrhosis often has no symptoms until liver damage is severe. When symptoms do occur, they may include:

  • Fatigue.
  • Easily bleeding or bruising.
  • Loss of appetite.
  • Nausea.
  • Swelling in the legs, feet or ankles, called edema.
  • Weight loss.
  • Itchy skin.
  • Yellow discoloration in the skin and eyes, called jaundice.
  • Fluid accumulation in the abdomen, called ascites (uh-SAHY-teez).
  • Spiderlike blood vessels on the skin.
  • Redness in the palms of the hands.
  • Pale fingernails, especially the thumb and index finger.
  • Clubbing of the fingers, in which the fingertips spread out and become rounder than usual.
  • For women, absence of or loss of periods not related to menopause.
  • For men, loss of sex drive, testicular shrinkage or breast enlargement, known as gynecomastia.
  • Confusion, drowsiness or slurred speech.

When to see a doctor

Make an appointment with your health care provider if you have any of the 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:

  • Long-term alcohol abuse.
  • Ongoing viral hepatitis (hepatitis B, C and D).
  • Nonalcoholic fatty liver disease, a condition in which fat accumulates in the liver.
  • Hemochromatosis, a condition that causes iron buildup in the body.
  • Autoimmune hepatitis, which is a liver disease caused by the body's immune system.
  • Destruction of the bile ducts caused by primary biliary cholangitis.
  • Hardening and scarring of the bile ducts caused by primary sclerosing cholangitis.
  • Wilson's disease, a condition in which copper accumulates in the liver.
  • Cystic fibrosis.
  • Alpha-1 antitrypsin deficiency.
  • Poorly formed bile ducts, a condition known as biliary atresia.
  • Inherited disorders of sugar metabolism, such as galactosemia or glycogen storage disease.
  • Alagille syndrome, a genetic digestive disorder.
  • 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. This condition is known as portal hypertension. Cirrhosis slows the regular flow of blood through the liver. This increases pressure in the vein that brings blood to the liver.
  • Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs, called edema, and in the abdomen, called ascites. Edema and ascites also may happen if the liver can't make enough of certain blood proteins, such as albumin.
  • Enlargement of the spleen. Portal hypertension can cause the spleen to trap white blood cells and platelets. This makes the spleen swell, a condition known as splenomegaly. Fewer 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 also may cause enlarged veins, called varices (VAIR-uh-seez), in the esophagus or the stomach. These varices also may 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 a hard time 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. A liver damaged by cirrhosis can't 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. This is known as hepatic encephalopathy. 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 complication in some people who have cirrhosis. However, they don't fully understand what causes it.

Prevention

Lower 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 not drink alcohol.
  • Eat a healthy diet. Choose a diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Cut down on the amount of fatty and fried foods you eat.
  • Maintain a healthy weight. Too much body fat can damage your liver. Talk to your health care provider 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 provider about hepatitis vaccinations.

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

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Feb. 11, 2023

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