Cirrhosis of the Liver

Cirrhosis is a late stage of chronic liver disease. About one in three people with liver disease do not know they have it because it usually has no signs or symptoms until it reaches advanced stages.

If you are worried about liver damage or have been told you have liver disease or elevated liver enymes, Banner Health can help. Our liver and digestive health teams use the latest tools to diagnose liver disease as early as possible and develop a plan tailored to you. We want to help you feel better and protect your liver as much as possible.

What is cirrhosis of the liver?

Cirrhosis is a general term that describes advanced liver disease which has developed over a long period of time. The most common causes of liver disease are alcohol use and fatty liver, although autoimmune and genetic conditions, infections, and drug interactions can also play a role. 

Your liver is one of the most important organs in your body and plays a role in many of the body’s functions. It helps clean toxins from your blood, makes important proteins, controls your metabolism and stores energy, supports your immune system and stops bleeding. 

Inflammation within the liver over time can cause scar tissue to form within the liver. When there is enough scar, it is called cirrhosis, and the liver loses its capacity to regenerate and heal itself. This scarring within the liver causes the liver to become stiffer, which can lead to fluid accumulation in the belly and put you at higher risk of major bleeding. Cirrhosis can also cause you to develop confusion or brain fog because the liver is unable to clear certain toxins as efficiently. 

In some case, cirrhosis can progress to the point that a liver transplant may be required. Patients with cirrhosis are also at a higher risk of developing liver cancer. 

Cirrhosis is sometimes called end-stage liver disease, but severity levels vary with cirrhosis. When cirrhosis develops, the damage is usually permanent. But with early care, you may be able to slow or prevent the development of more scarring. 

What causes cirrhosis?

Cirrhosis usually develops slowly. It is often caused by long-term liver damage. Common causes of cirrhosis include:

  • Chronic alcohol use
  • Hepatitis B or hepatitis C infections
  • Fatty liver disease, including metabolic dysfunction-associated steatotic liver disease (MASLD)

Other conditions that may lead to cirrhosis include:

  • Type 2 diabetes
  • Obesity
  • Autoimmune diseases that affect the liver
  • Inherited diseases that affect the liver (cystic fibrosis, Wilson’s disease, hemochromatosis)
  • Conditions that limit blood flow to and from the liver (heart failure, Budd-Chiari syndrome)
  • Use of certain medications 

Fatty liver disease is now one of the leading causes of cirrhosis in the U.S. This type of liver disease can develop even if you do not drink alcohol. 

Signs and symptoms of cirrhosis

In the early stages, you may not have symptoms. Many people feel fine at first. As liver damage gets worse, symptoms often become more recognizable.

Early symptoms (compensated cirrhosis)

In the early stages, your liver is still working well. Symptoms may be mild or easy to miss. Common early signs include:

  • Feeling tired or weak
  • Loss of appetite (hunger)
  • Mild nausea
  • Unexplained weight loss
  • Feeling full or bloated in your belly

These early symptoms are signs your liver is under stress. Even if your symptoms are minor, see a health care provider. Early diagnosis can slow liver damage and protect your health. 

Late-stage symptoms (decompensated cirrhosis)

As cirrhosis progresses, the liver cannot keep up with its normal work. More serious symptoms can appear, including:

  • Yellowing the skin or eyes (jaundice)
  • Swelling in the legs, feet or belly 
  • Itchy skin
  • Easy bruising or bleeding
  • Confusion, forgetfulness or trouble thinking clearly 
  • Vomiting blood or black stools 
  • Fatigue that does not improve

If you notice any of these symptoms, see a health care provider right away. 

Complications of cirrhosis

Complications are health problems that result from long-term liver damage. Not everyone with cirrhosis will get these problems, but knowing about them can help you stay safe.

Complications include:

  • Ascites: Fluid collects in the belly and may need treatment.
  • Portal hypertension: High blood pressure in the liver that can cause veins in the stomach or esophagus to swell. This swelling can increase the risk of these veins breaking open and causing dangerous bleeding.
  • Bleeding in the stomach or esophagus: This is a serious medical emergency.
  • Infections: Cirrhosis can weaken the immune system, increasing the risk of infections.
  • Hepatic encephalopathy: Confusion, forgetfulness or trouble thinking clearly caused by the accumulation of liver toxins.
  • Liver cancer: People with cirrhosis are at higher risk and need regular check-ups.
  • Liver failure: When the liver stops working, a liver transplant might be needed.

How cirrhosis is diagnosed

To diagnose cirrhosis, your provider will start with your health history and a physical exam. They might ask about alcohol use, past infections and family history.

Tests used to diagnose cirrhosis may include:

  • Blood tests to check liver function
  • Imaging tests like ultrasound, CT scan or MRI
  • Fibrosis tests, like elastography (FibroScan), to measure liver scarring
  • Liver biopsy in some cases

Can cirrhosis be reversed?

Cirrhosis typically cannot be reversed. Although the liver has strong healing abilities, it typically loses this ability when the extent of liver damage has progressed to cirrhosis. Still, treating the cause can help slow or stop further damage.

For example:

  • Stopping alcohol use can protect your liver
  • Treating hepatitis infections can reduce further scarring
  • Managing weight and blood sugar can help fatty liver disease
  • The earlier you start, the better your outlook.

Treatment for cirrhosis of the liver

There is no single cure for cirrhosis. Treatment focuses on slowing liver damage, easing symptoms and preventing problems. 

Your treatment plan may include:

Stopping alcohol use completely

If you have cirrhosis, you should not drink alcohol at all as this can accelerate how quickly your liver gets worse or you develop complications. If quitting feels hard, your provider can help connect you with recovery programs, counseling or treatment support. Even small amounts of alcohol can be harmful once cirrhosis is present.

Nutrition and diet support

Many people with cirrhosis are malnourished, even if they do not appear underweight. Liver disease can make it harder for your body to absorb nutrients.

Your provider might recommend:

  • A balanced diet with high amounts of protein
  • Vitamin or mineral supplements if you have deficiencies
  • Limiting sodium (salt) to help reduce swelling and fluid buildup
  • Vaccinating against hepatitis A and B, flu and pneumonia 
  • Staying physically active as tolerated

Medications to manage symptoms and complications

There is no single medicine that cures cirrhosis. However, medications are often used to treat symptoms and prevent serious problems. 

Depending on your condition, your provider may prescribe:

  • Diuretics (water pills) to reduce swelling in the legs or fluid in the belly
  • Beta blockers to lower pressure in the portal vein and reduce the risk of bleeding form enlarged veins in the esophagus
  • Lactulose or rifaximin to help manage confusion, brain fog, or memory problems caused by hepatic encephalopathy
  • Antiviral medicines for hepatitis B or hepatitis C
  • Antibiotics for infections
  • Autoimmune hepatitis treatment to calm the immune system

Procedures and regular monitoring

People with cirrhosis need ongoing testing to watch for complications and catch problems early. Common procedures and screenings include:

  • Upper endoscopy (EGD) every one or two years to check for esophageal varices
  • Paracentesis, if needed to drain fluid from the belly
  • Liver ultrasound (or CT scan or MRI) every six months to screen for liver cancer

These tests help your care team adjust treatment and respond quickly to changes in your liver health. 

Liver transplant

When liver disease gets severe and causes liver failure, the only option is a liver transplant.

Your care team will check if you are a good candidate for the surgery. They will test your health to see if you are strong enough for the operation and if you can handle lifelong care afterward. If your cirrhosis is caused by alcohol, transplant programs require you to stay sober.

Your health care providers use scoring systems, like the Child-Turcotte-Pugh (CTP) and MELD scores, to predict how your disease will progress and to decide your place on the waiting list for a transplant.

Learn more about Banner Health’s liver transplant program.

Support groups 

You can often ease the stress of illness by joining a support group where members share similar experiences and problems.   

Learn more about Banner Health’s virtual liver disease support group

Living with cirrhosis 

Cirrhosis is a serious condition, but it does not always limit your life span if caught early and appropriately managed. Depending on the severity of cirrhosis, people can have an expected life span of months to many years. Your outlook depends on several factors, including the cause of cirrhosis, how much liver damage you have and how well you follow your treatment plan.

You can take steps to protect your liver and improve your long-term health:

  • Avoid drinking alcohol and smoking
  • Get treatment for the cause of cirrhosis
  • Follow your nutrition and medication plans
  • Keep regular follow-up appointments
  • Report new or worsening symptoms

Choose Banner Health for liver care

At Banner Health, you receive expert care close to home. Our team has liver specialists, surgeons, digestive health experts, dietitians, care coordinators and transplant teams. We work together to help you stay healthy, control your symptoms and avoid complications.