Cirrhosis Symptoms, Causes & Treatment Options

Cirrhosis is a term that refers to chronic scarring of the liver. Many different diseases and conditions can cause cirrhosis, and they all result in the same outcome — a liver that struggles to function properly.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Cirrhosis?

Summary

Cirrhosis of the liver occurs when disease transforms normal liver tissue into hard, scarred tissue. This process can happen over months to years, and over time, the cirrhotic liver develops abnormal, fibrotic nodules that disrupt normal function.

This disruption of normal liver function can lead to symptoms that range from weakness and fatigue to internal bleeding and severe infection. The more advanced the cirrhosis, the more serious the complications.

Treatment involves symptom and complication management. A liver transplant is necessary for people with end-stage liver disease to avoid liver failure or death.

Recommended care

Cirrhosis Symptoms

Main symptoms

The symptoms of cirrhosis develop over time, and often the first signs are generalized/vague or do not present at all (asymptomatic). These generalized symptoms may include:

  • Fatigue
  • Weight loss
  • Loss of appetite
  • Muscle weakness
  • Swelling

Skin-related symptoms

There are also many skin manifestations that may signal liver damage, including the following [1,2].

  • Jaundice: Jaundice is a yellowing of the skin that occurs due to the buildup of a product called bilirubin. The liver is supposed to process bilirubin so it can be excreted; when the liver is not functioning properly, bilirubin builds up.

  • Telangiectasia: Telangiectasia are lesions of the blood vessels that occur when the skin becomes very thin and fragile. They look like thin red veins throughout the skin.

  • Spider angiomas: Angiomas are an abnormal collection of blood vessels at the surface of the skin that can look like a spider’s web.

  • Palmar erythema: Palmar erythema describes darkening of the palms of the hands.

Other symptoms

Symptoms that often bring cirrhosis to a patient’s attention are more serious and often signal advanced diseases [1].

  • Portal hypertension: The portal vein is the main blood vessel of the liver. It brings blood to the liver from the intestines and spleen. When the liver is not properly functioning, swelling can occur in the portal vein and lead to high pressures. This can cause the liver to enlarge, as well as abdominal pain.

  • Ascites: Ascites is abnormal fluid buildup in the abdomen and is the most common complication of chronic liver failure [3]. The abdomen may increase in size and look bigger and patients may gain weight and feel significant discomfort. This fluid can often become infected as well.

  • Hepatic encephalopathy: Hepatic encephalopathy is a serious complication of cirrhosis that involves symptoms that affect the brain. Symptoms of hepatic encephalopathy include mild problems with memory, concentration, and coordination, to serious problems, such as coma or marked confusion. It is hypothesized that hepatic encephalopathy is precipitated by the buildup of a toxin called ammonia in the body that reaches the brain.

Cirrhosis Causes

Many different diseases and conditions can cause cirrhosis. There are two broad categories of causes for cirrhosis — inflammatory and environmental. Within these categories, there are certain risk factors and groups of people that are more likely to develop cirrhosis. Cirrhosis most often occurs in adults and rarely happens in children.

Furthermore, conditions within these broad categories can be acquired or inherited. Inherited causes of cirrhosis are usually in the inflammatory category, whereas acquired causes are generally environmental.

Inflammatory causes

Inflammatory causes include any conditions or pathogens that cause your body to mount an immune response to protect itself from infection or injury. If this response becomes chronic, it can cause permanent damage to the liver and result in cirrhosis.

  • Infectious: There are many pathogens that specifically infect the liver. They are known as hepatitis viruses. One strain of the virus, called hepatitis C, affects patients chronically and is strongly associated with the development of cirrhosis. Hepatitis C is transmitted via contaminated blood.

  • Autoimmune: Autoimmune diseases are inflammatory conditions that result in the body attacking itself. There are primary and secondary autoimmune conditions that can result in cirrhosis. Primary conditions such as primary biliary cirrhosis and autoimmune hepatitis start in the liver, whereas secondary diseases such as Wilson’s disease or sarcoidosis can affect other organs or body parts.

  • Medical: Medical conditions such as diabetes, high cholesterol, and even heart failure can damage the liver and cause cirrhosis.

Environmental causes

The liver is a powerhouse organ, but it is easily affected and injured by ingestion of toxins.

  • Alcohol: Alcohol is a primary toxin to the liver. People who chronically abuse alcohol develop a progressive liver injury that often results in cirrhosis. After Hepatitis C infection, alcohol is the second most common cause of cirrhosis [1].

  • Medications: The liver is a primary processor of many different drugs and medications. Overdoses of medication can cause severe overload to the liver and lead to acute injury that can result in long-term, chronic results.

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Treatment Options, Relief, and Prevention for Cirrhosis

Treatment

Cirrhosis is a chronic condition that does not have a cure. Treatment is focused on the management of symptoms and complications and has a multi-tiered, multi-disciplinary approach. The main symptoms and complications of cirrhosis that must be managed include the following.

  • Ascites: Ascites is the buildup of fluid in the abdominal space. It is essential to manage this fluid because it can lead to complications such as infection, hernia, and weight gain. The goal is to reduce this fluid buildup and prevent it from recurring. Medications such as diuretics can expel this extra fluid. At times, providers must remove the fluid with a shunt or tube. Removing the fluid can also help providers diagnose an infection or other cause for the ascites.
  • Portal hypertension: Increased pressure in the portal system of the liver can lead to complications such as internal bleeding. The goal is to stop any bleeding and prevent its recurrence. The treatment of complications of portal hypertension also involves shunting.
  • Hepatic encephalopathy: The way cirrhosis can affect the brain is a medical emergency. Hepatic encephalopathy is treated with lactulose, a carbohydrate that helps expel the toxin (ammonia) from the body, as well as antibiotic treatment [1].

Treatment for end-stage liver disease

The medical management above is often not enough for patients with severe disease, also known as end-stage liver disease. In those cases, a liver transplant is often the only viable option for saving a patient from total liver failure and death [4].

Prevention

Cirrhosis prevention starts by properly protecting and caring for the liver. Once the processes underlying cirrhosis begin, there is no turning back. Take the following steps below to help prevent cirrhosis.

  • Limit alcohol use: Alcohol abuse is the primary cause of cirrhosis. Chronic alcohol use alone can result in the disease, but your risk increases if you drink alcohol on top of already having a liver condition. Avoid alcohol completely if you already have cirrhosis, this will only make your condition worse [4].
  • Reduce your risk for hepatitis: Hepatitis is transmitted via contaminated blood. Dirty needles and sexual intercourse with a contaminated partner are both ways of transmitting the virus. Have protected sex and do not share needles to reduce your risk of contamination. There are also vaccinations for hepatitis viruses.
  • Eat well and maintain a healthy weight: Work with your healthcare provider to create a balanced diet that includes fruits, vegetables, whole grains, and protein. Limit the consumption of fatty or fried foods. Diet is associated with diabetes and fatty disease of the liver. Obesity and excess weight can also result in damage to the liver, so eating healthy can also help you maintain a healthy weight.

When to Seek Further Consultation for Cirrhosis

If you have cirrhosis, know the warning signs for complications related to ascites, portal hypertension, and hepatic encephalopathy, and seek medical attention immediately. These symptoms include signs such as:

  • Vomiting or coughing up large quantities of blood
  • Experiencing stools that are black or tarry: This symptom also indicates internal bleeding.
  • Confusion
  • A short attention span
  • Lightheadedness or loss of consciousness
  • Severe abdominal pain
  • Fever

References

  1. Starr SP, Raines D. Cirrhosis: Diagnosis, Management, and Prevention. Am Fam Physician. 2011 Dec 15;84(12):1353-1359. AAFP Link

  2. Cirrhosis and Liver Damage. Am Fam Physician. 2011 Dec 15;84(12):1360. AAFP Link

  3. Pedersen JS, Bendtsen F, Møller S. Management of cirrhotic ascites. Ther Adv Chronic Dis. 2015;6(3):124–137. NCBI Link

  4. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–851. NCBI Link