Cirrhosis

What Is Cirrhosis?

Cirrhosis is the final stage of chronic liver damage, where healthy liver tissue is gradually replaced by scar tissue (fibrosis). This scarring disrupts normal liver structure and function, making it harder for the liver to filter toxins, produce important proteins, regulate blood flow, and support metabolism. Cirrhosis develops slowly over many years and often remains silent until significant liver damage has occurred.

The liver is remarkably resilient, capable of repairing itself after injury. However, repeated or long-term damage—whether from alcohol, viral infections, fatty liver disease, or other causes—eventually overwhelms this regenerative ability. Cirrhosis is considered irreversible, but early treatment can prevent worsening and reduce complications.

Causes of Cirrhosis

Cirrhosis can develop from any condition that causes chronic inflammation or injury to the liver. The most common causes include:

1. Chronic Alcohol Use

Excessive drinking is one of the leading causes of cirrhosis worldwide. Alcohol damages liver cells, leading to inflammation, fat buildup, and eventually scarring. Risk increases with the amount and duration of alcohol use.

2. Chronic Viral Hepatitis (Hepatitis B and C)

Long-term infection with hepatitis B or C can trigger inflammation that progressively damages the liver. Hepatitis C is a major cause of cirrhosis in many countries, although modern antiviral therapies can cure the infection and reduce progression.

3. Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD is caused by fat accumulation in the liver unrelated to alcohol use. When inflammation accompanies fat buildup (a condition called non-alcoholic steatohepatitis or NASH), scarring can develop and progress to cirrhosis. Risk factors include obesity, insulin resistance, and type 2 diabetes.

4. Autoimmune Hepatitis

This occurs when the immune system mistakenly attacks liver cells, causing chronic inflammation and scarring if untreated.

5. Genetic and Metabolic Disorders

These include:

• Hemochromatosis (iron overload)
• Wilson's disease (copper overload)
• Alpha-1 antitrypsin deficiency

Such conditions can injure the liver over time.

6. Other Causes

Other contributors include chronic biliary disease, repeated heart failure, long-term medication toxicity, and certain infections or inflammatory conditions.

Stages of Cirrhosis

Cirrhosis progresses gradually, often undetected until advanced. The stages typically include:

1. Compensated Cirrhosis

The liver is scarred but still able to perform most functions. Many people have no symptoms at this stage. Early diagnosis can significantly slow disease progression.

2. Decompensated Cirrhosis

The liver can no longer function properly, leading to serious complications such as fluid retention, jaundice, internal bleeding, confusion, and increased infection risk. This stage can be life-threatening and may require a liver transplant in severe cases.

Symptoms of Cirrhosis

Early Symptoms (Often Mild or Absent)

• Fatigue and weakness
• Loss of appetite
• Nausea
• Unexplained weight loss
• Discomfort in the upper right abdomen

Advanced Symptoms

• Jaundice (yellowing of skin and eyes)
• Easy bruising or bleeding
• Fluid buildup (usually in the abdomen or legs)
• Confusion or memory problems
• Itchy skin
• Dark urine or pale stools
• Visible blood vessels under the skin

Complications of Cirrhosis

Cirrhosis increases the risk of many serious health issues, including:

• Portal hypertension
• Fluid accumulation in the abdomen
• Internal bleeding from swollen veins
• Kidney dysfunction
• Infections
• Liver cancer
• Malnutrition

Diagnosis

Diagnosis combines physical exams, blood tests, imaging studies, and sometimes liver biopsy. Common tests include:

• Liver function tests
• Ultrasound or CT scan
• FibroScan (measures liver stiffness)
• Endoscopy (to check for enlarged veins)

Treatment

Cirrhosis is not reversible, but treatments can slow progression, manage symptoms, and prevent complications.

Common Treatment Approaches

• Stopping alcohol completely
• Treating hepatitis B or C
• Managing fatty liver disease through lifestyle changes
• Medications for complications (fluid retention, infections, confusion)
• Nutrition support

Liver Transplant

In severe cases, a liver transplant may be needed. Transplants have excellent survival rates when performed at specialized centers.

Prevention

• Avoid excessive alcohol
• Maintain a healthy weight
• Control diabetes and cholesterol
• Get vaccinated against hepatitis
• Limit exposure to toxins
• Follow medical treatment for chronic liver conditions