Cirrhosis

Cause

Cirrhosis can have many causes. Some of the main ones include:

• Long-term, heavy use of alcohol.
• Chronic viral hepatitis.
• Autoimmune diseases. These include autoimmune hepatitis and primary sclerosing cholangitis (PSC).
• Metabolic dysfunction-associated steatotic liver disease (MASLD), such as metabolic dysfunction-associated steatohepatitis (MASH). This is the buildup of fat in liver cells.
• Blocked bile ducts. The ducts that carry bile out of the liver can get inflamed and blocked. This causes a disease called primary biliary cholangitis.
• Certain diseases that run in families. These include Wilson's disease, cystic fibrosis, and hemochromatosis.

Less common causes include severe reactions to medicines. Cirrhosis may also be caused by long-term exposure to poisons, such as arsenic. Some people have it without a clear cause.

Symptoms

You may not have symptoms in the early stages of cirrhosis. But as it gets worse, it can cause a number of symptoms. These include:

• Fatigue.
• Small red spots and tiny lines on the skin, called spider angiomas.
• Bleeding problems, such as bruising easily or heavy nosebleeds.
• Weight loss.
• A yellow tint to the skin and whites of the eyes (jaundice).
• Itching.
• Swelling from fluid buildup in the legs (edema) and the belly (ascites).
• Bleeding from enlarged veins in the digestive tract, so you may vomit blood.
• Confusion, poor concentration, or memory problems.

Scar tissue from cirrhosis may block the proper flow of blood from the intestines through the liver. The scarring can lead to increased pressure in the veins that supply this area. This is called portal hypertension. It can lead to other health problems.

When to Call for Help

Call 911 anytime you think you may need emergency care. For example, call if:

• You have trouble breathing.
• You vomit blood or what looks like coffee grounds.

Contact your doctor now or seek immediate medical care if:

• You feel very sleepy or confused.
• You have new or worse belly pain.
• You have a fever.
• There is a new or increasing yellow tint to your skin or the whites of your eyes.
• You have any abnormal bleeding, such as:
  • Nosebleeds.
  • Vaginal bleeding that is different (heavier, more frequent, at a different time of the month) than what you are used to.
  • Bloody or black stools, or rectal bleeding.
  • Bloody or pink urine.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You have any problems.
• Your belly is getting bigger.
• You are gaining weight.

Exams and Tests

Your doctor will do a physical exam and ask about your medical history to see if you have symptoms of liver disease and to help find out possible causes of liver damage.

If your doctor thinks that you might have cirrhosis, you may have blood and imaging tests.

Blood tests to check liver function

Measuring the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:

• Albumin and total serum protein. Albumin is a type of protein. Liver disease can cause a decrease in protein levels in the blood.
• Partial thromboplastin time or prothrombin time/INR. These tests measure blood-clotting factors that are produced in the liver.
• Bilirubin. This is produced when the liver breaks down hemoglobin, the substance in red blood cells that carries oxygen. Cirrhosis may cause high bilirubin levels, which causes jaundice.

Blood tests to check for inflammation of the liver

You may have blood tests to check your liver enzymes. These can help show if you've had liver inflammation for a long time. These blood tests include:

• Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH). An increased level of these enzymes may mean injury to the liver.
• Alkaline phosphatase (ALP). An increased ALP level may mean that the bile ducts are blocked.
• Gamma glutamyl transferase (GGT), also called gamma-glutamyl transpeptidase (GGTP). An increased level can happen because of alcohol use or diseases of the bile ducts.

Some people with cirrhosis have normal liver enzymes.

Tests that show an image of the liver

Imaging tests can check for tumors and blocked bile ducts. They also can be used to look at the size of the liver and to see how blood flows through the liver. These tests include:

• Abdominal ultrasound.
• CT scan of the abdomen.
• MRI scan of the abdomen.
• Liver and spleen scan.

You also may have a liver biopsy. This test can show for sure if you have cirrhosis.

Treatment Overview

Treatment may include medicines, lifestyle changes, and regular doctor visits. In some cases, you may need surgery to treat complications from cirrhosis. Your treatment depends on the cause of your cirrhosis and what other problems it is causing.

Treatment can't cure cirrhosis. But it can sometimes prevent or delay more liver damage.

Lifestyle changes

Your doctor will recommend some lifestyle changes to help prevent more liver damage.

• Do not drink any alcohol. If you don't stop completely, liver damage may quickly get worse. Tell your doctor if you need help to quit. Counseling, support groups, and sometimes medicines can help.
• Talk to your doctor before you take any prescription or over-the-counter medicines, vitamins, supplements, or herbal remedies. Medicines that can hurt your liver include acetaminophen (such as Tylenol) and other pain medicines such as aspirin, ibuprofen (such as Advil or Motrin), and naproxen (Aleve). Be careful when taking over-the-counter cold or flu medicines. Many of these medicines have acetaminophen in them.
• Follow a low-sodium and low-fat diet. Cutting back on sodium can help prevent fluid buildup in your belly and chest.

Vaccinations

• Stay up-to-date on your vaccines. This includes vaccines against hepatitis A and hepatitis B, influenza (flu), shingles, pneumonia, and COVID-19.

Treatment for complications of cirrhosis

Cirrhosis can cause other problems (complications) that may need treatment. They include:

• Fluid buildup in the belly (ascites). This can be serious if it isn't controlled. Treatment may include:
  • Following a low-sodium diet.
  • Taking medicines.
  • Removing fluid or placing a shunt (stent) to move fluid away from the belly.
• Bleeding from enlarged veins. Variceal bleeding in the digestive tract can be treated with:
  • Medicines.
  • Shunts to move blood or other fluid away from the belly.
  • Bands or small balloons inserted and inflated to stop the bleeding.
• Changes in mental function. Encephalopathy may occur when the liver can't filter poisons (toxins) from the bloodstream. As these toxins build up in your blood, they can affect your brain function. You may need to:
  • Take lactulose to prevent the buildup of ammonia and other toxins in the large intestine.
  • Avoid medicines for sleep, medicines for anxiety, and opioids. These can make symptoms of encephalopathy worse.

Liver transplant

Receiving a liver from an organ donor (liver transplant) is the only treatment that will restore normal liver function. A liver transplant is usually an option only when liver damage is severe and threatening your life.

Before your condition becomes severe, you may want to talk to your doctor about whether you'll be a good candidate for a liver transplant if your disease gets worse.

Talk to your doctor about what steps you can take now to improve your overall health. That way you can increase your chances of being considered a good candidate.

Self-Care

Lifestyle changes may reduce symptoms caused by complications of cirrhosis. These changes may also help to slow liver damage.

Giving up alcohol

If you have cirrhosis, it's important that you stop drinking alcohol completely, even if alcohol wasn't the cause of the cirrhosis. If you don't stop, liver damage may quickly get worse. Tell your doctor if you need help to quit. Counseling, support groups, and sometimes medicines can help.

Changing your diet

Work with your doctor or a dietitian to be sure you eat the right amount of carbohydrate, protein, fat, and sodium (salt). It's very important to choose the best foods for the health of your liver.

If your body is retaining fluid, you may need to limit the amount of sodium you eat. People with liver damage tend to retain sodium. This can make fluid buildup in your belly (ascites) or chest.

If your doctor recommends it, limit how much fluid you drink.

Avoiding harmful medicines

Talk to your doctor before you take any prescription or over-the-counter medicines, vitamins, supplements, or herbal remedies. Medicines that can hurt your liver include acetaminophen (such as Tylenol) and other pain medicines such as aspirin, ibuprofen (such as Advil or Motrin), and naproxen (Aleve). Be careful when taking over-the-counter cold or flu medicines. Many of these medicines have acetaminophen in them. Certain prescription medicines used to treat other conditions may be harmful if you have cirrhosis.

Improving your general health

Taking other steps to improve your overall health may help you manage the symptoms of cirrhosis.

• Don’t smoke, vape, or use other tobacco or nicotine products. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Take a multivitamin if your doctor recommends it. Don't take one that contains extra iron unless your doctor tells you to. And don't take an iron supplement unless your doctor recommends it.
• Brush and floss your teeth daily. This helps avoid dental problems that could lead to infection. Be gentle when you floss so you don't make your gums bleed.
• Make sure you stay up-to-date on vaccines for.
  • Influenza (flu). Get a flu shot every year. People with cirrhosis are at increased risk for serious problems from the flu.
  • COVID-19.
  • Hepatitis A and hepatitis B.
  • Pneumococcus, which causes pneumonia. Ask your doctor how often you should be revaccinated.
  • Shingles.

Using complementary and alternative medicines wisely

In general, you should avoid most supplements and herbal remedies. They may make liver disease worse.

Talk to your doctor about whether you should try any alternative treatment.