Liver 

Cirrhosis
 National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is cirrhosis? 

Cirrhosis is a condition in which the liver 

slowly deteriorates and malfunctions due to 

chronic injury. Scar tissue replaces healthy 

liver tissue, partially blocking the fl ow of 

blood through the liver. Scarring also impairs 

the liver’s ability to 

• 	 control infections 

• 	remove bacteria and toxins from the 


blood
 

• 	 process nutrients, hormones, and drugs 

• 	 make proteins that regulate blood 


clotting
 

• 	 produce bile to help absorb fats— 

including cholesterol—and fat-soluble 

vitamins 

A healthy liver is able to regenerate most 

of its own cells when they become damaged. With end-stage cirrhosis, the liver can 

no longer effectively replace damaged cells. 

A healthy liver is necessary for survival. 

Cirrhosis is the twelfth leading cause of death 

by disease, accounting for 27,000 deaths each 

year.1 The condition affects men slightly 

more often than women. 

What causes cirrhosis? 

Cirrhosis has various causes. In the United 

States, heavy alcohol consumption and 

chronic hepatitis C have been the most 

1Miniño AM, Heron MP, Murphy SL, Kochanek KD. 

Deaths: Final data for 2004. Centers for Disease 

Control and Prevention Web site. http://www.cdc. 

gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf. Updated 

October 10, 2007. Accessed January 20, 2008. 

The liver and digestive system. 

common causes of cirrhosis. Obesity is 

becoming a common cause of cirrhosis, 

either as the sole cause or in combination 

with alcohol, hepatitis C, or both. Many 

people with cirrhosis have more than one 

cause of liver damage. 
 

 

Cirrhosis is not caused by trauma to the 

liver or other acute, or short-term, causes of 

damage. Usually years of chronic injury are 

required to cause cirrhosis. 

Alcohol-related liver disease. Most people 

who consume alcohol do not suffer damage to the liver. But heavy alcohol use over 

several years can cause chronic injury to 

the liver. The amount of alcohol it takes to 

damage the liver varies greatly from person 

to person. For women, consuming two to 

three drinks—including beer and wine—per 

day and for men, three to four drinks per 

day, can lead to liver damage and cirrhosis. 

In the past, alcohol-related cirrhosis led to 

more deaths than cirrhosis due to any other 

cause. Deaths caused by obesity-related 

cirrhosis are increasing. 

Chronic hepatitis C. The hepatitis C virus 

is a liver infection that is spread by contact 

with an infected person’s blood. Chronic 

hepatitis C causes inflammation and damage 

to the liver over time that can lead to 

cirrhosis. 

Chronic hepatitis B and D. The hepatitis B 

virus is a liver infection that is spread by contact with an infected person’s blood, semen, 

or other body fluid. Hepatitis B, like hepatitis C, causes liver inflammation and injury 

that can lead to cirrhosis. The hepatitis B 

vaccine is given to all infants and many adults 

to prevent the virus. Hepatitis D is another 

virus that infects the liver and can lead to 

cirrhosis, but it occurs only in people who 

already have hepatitis B. 

Nonalcoholic fatty liver disease (NAFLD). 

In NAFLD, fat builds up in the liver and 

eventually causes cirrhosis. This increasingly common liver disease is associated 

with obesity, diabetes, protein malnutrition, 

coronary artery disease, and corticosteroid 

medications. 

Autoimmune hepatitis. This form of hepatitis is caused by the body’s immune system 

attacking liver cells and causing infl ammation, damage, and eventually cirrhosis. 

Researchers believe genetic factors may 

make some people more prone to autoimmune diseases. About 70 percent of those 

with autoimmune hepatitis are female. 

Diseases that damage or destroy bile ducts. 

Several different diseases can damage or 

destroy the ducts that carry bile from the 

liver, causing bile to back up in the liver 

and leading to cirrhosis. In adults, the most 

common condition in this category is primary 

biliary cirrhosis, a disease in which the bile 

ducts become inflamed and damaged and, 

ultimately, disappear. Secondary biliary cirrhosis can happen if the ducts are mistakenly 

tied off or injured during gallbladder surgery. 

Primary sclerosing cholangitis is another 

condition that causes damage and scarring of 

bile ducts. In infants, damaged bile ducts are 

commonly caused by Alagille syndrome or 

biliary atresia, conditions in which the ducts 

are absent or injured. 

Inherited diseases. Cystic fi brosis, alpha-1 

antitrypsin defi ciency, hemochromatosis, 

Wilson disease, galactosemia, and glycogen 

storage diseases are inherited diseases that 

interfere with how the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to 

function properly. Cirrhosis can result from 

these conditions. 

Drugs, toxins, and infections. Other causes 

of cirrhosis include drug reactions, prolonged 

exposure to toxic chemicals, parasitic 

infections, and repeated bouts of heart 

failure with liver congestion. 

2 Cirrhosis 
What are the symptoms of 

cirrhosis? 

Many people with cirrhosis have no symptoms in the early stages of the disease. However, as the disease progresses, a person may 

experience the following symptoms: 

• 	 weakness 

• 	 fatigue 

• 	 loss of appetite 

• 	 nausea 

• 	 vomiting 

• 	 weight loss 

• 	 abdominal pain and bloating when fl uid 

accumulates in the abdomen 

• 	 itching 

• 	spiderlike blood vessels on the skin 

What are the complications 

of cirrhosis? 

As liver function deteriorates, one or more 

complications may develop. In some people, 

complications may be the first signs of the 

disease. 

Edema and ascites. When liver damage progresses to an advanced stage, fluid collects in 

the legs, called edema, and in the abdomen, 

called ascites. Ascites can lead to bacterial 

peritonitis, a serious infection. 

Bruising and bleeding. When the liver slows 

or stops producing the proteins needed for 

blood clotting, a person will bruise or bleed 

easily. 

Portal hypertension. Normally, blood from 

the intestines and spleen is carried to the 

liver through the portal vein. But cirrhosis 

slows the normal flow of blood, which 

increases the pressure in the portal vein. 

This condition is called portal hypertension. 

Esophageal varices and gastropathy. When 

portal hypertension occurs, it may cause 

enlarged blood vessels in the esophagus, 

called varices, or in the stomach, called 

gastropathy, or both. Enlarged blood vessels are more likely to burst due to thin walls 

and increased pressure. If they burst, serious bleeding can occur in the esophagus or 

upper stomach, requiring immediate medical 

attention. 

Splenomegaly. When portal hypertension 

occurs, the spleen frequently enlarges and 

holds white blood cells and platelets, reducing the numbers of these cells in the blood. 

A low platelet count may be the fi rst evidence that a person has developed cirrhosis. 

Jaundice. Jaundice occurs when the diseased liver does not remove enough bilirubin 

from the blood, causing yellowing of the skin 

and whites of the eyes and darkening of the 

urine. Bilirubin is the pigment that gives bile 

its reddish-yellow color. 

Gallstones. If cirrhosis prevents bile from 

flowing freely to and from the gallbladder, 

the bile hardens as gallstones. 

Sensitivity to medications. Cirrhosis slows 

the liver’s ability to filter medications from 

the blood. When this occurs, medications 

act longer than expected and build up in the 

body. This causes a person to be more sensitive to medications and their side effects. 

Hepatic encephalopathy. A failing liver 

cannot remove toxins from the blood, and 

they eventually accumulate in the brain. The 

buildup of toxins in the brain—called hepatic 

encephalopathy—can decrease mental function and cause coma. Signs of decreased 

mental function include confusion, personality changes, memory loss, trouble concentrating, and a change in sleep habits. 

3 	 Cirrhosis 
Insulin resistance and type 2 diabetes. 

Cirrhosis causes resistance to insulin—a 

hormone produced by the pancreas that 

enables the body to use glucose as energy. 

With insulin resistance, the body’s muscle, 

fat, and liver cells do not use insulin properly. 

The pancreas tries to keep up with the 

demand for insulin by producing more, but 

excess glucose builds up in the bloodstream 

causing type 2 diabetes. 

Liver cancer. Hepatocellular carcinoma is a 

type of liver cancer that can occur in people 

with cirrhosis. Hepatocellular carcinoma has 

a high mortality rate, but several treatment 

options are available. 

Other problems. Cirrhosis can cause 

immune system dysfunction, leading to the 

risk of infection. Cirrhosis can also cause 

kidney and lung failure, known as hepatorenal and hepatopulmonary syndromes. 

How is cirrhosis diagnosed? 

The diagnosis of cirrhosis is usually based 

on the presence of a risk factor for cirrhosis, 

such as alcohol use or obesity, and is confirmed by physical examination, blood tests, 

and imaging. The doctor will ask about the 

person’s medical history and symptoms and 

perform a thorough physical examination to 

observe for clinical signs of the disease. For 

example, on abdominal examination, the 

liver may feel hard or enlarged with signs 

of ascites. The doctor will order blood tests 

that may be helpful in evaluating the liver 

and increasing the suspicion of cirrhosis. 

To view the liver for signs of enlargement, 

reduced blood flow, or ascites, the doctor 

may order a computerized tomography (CT) 

scan, ultrasound, magnetic resonance imaging (MRI), or liver scan. The doctor may 

look at the liver directly by inserting a laparoscope into the abdomen. A laparoscope 

is an instrument with a camera that relays 

pictures to a computer screen. 

A liver biopsy can confirm the diagnosis 

of cirrhosis but is not always necessary. A 

biopsy is usually done if the result might 

have an impact on treatment. The biopsy is 

performed with a needle inserted between 

the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A 

tiny sample of liver tissue is examined with 

a microscope for scarring or other signs of 

cirrhosis. Sometimes a cause of liver damage 

other than cirrhosis is found during biopsy. 

How is the severity of 

cirrhosis measured? 

The model for end-stage liver disease 

(MELD) score measures the severity of 

cirrhosis. The MELD score was developed 

to predict the 90-day survival of people with 

advanced cirrhosis. The MELD score is 

based on three blood tests: 

• 	 international normalized ratio (INR)— 

tests the clotting tendency of blood 

• 	 bilirubin—tests the amount of bile 


pigment in the blood
 

• 	 creatinine—tests kidney function 

MELD scores usually range between 6 and 

40, with a score of 6 indicating the best likelihood of 90-day survival. 

How is cirrhosis treated? 

Treatment for cirrhosis depends on the cause 

of the disease and whether complications 

are present. The goals of treatment are to 

slow the progression of scar tissue in the liver 

and prevent or treat the complications of the 

disease. Hospitalization may be necessary 

for cirrhosis with complications. 

4 	 Cirrhosis 
 

Eating a nutritious diet. Because malnutrition is common in people with cirrhosis, a 

healthy diet is important in all stages of the 

disease. Health care providers recommend 

a meal plan that is well balanced. If ascites 

develops, a sodium-restricted diet is recommended. A person with cirrhosis should 

not eat raw shellfish, which can contain a 

bacterium that causes serious infection. To 

improve nutrition, the doctor may add a liquid supplement taken by mouth or through 

a nasogastric tube—a tiny tube inserted 

through the nose and throat that reaches into 

the stomach. 

Avoiding alcohol and other substances. 

People with cirrhosis are encouraged not to 

consume any alcohol or illicit substances, 

as both will cause more liver damage. 

Because many vitamins and medications— 

prescription and over-the-counter—can 

affect liver function, a doctor should be 

consulted before taking them. 

Treatment for cirrhosis also addresses specific complications. For edema and ascites, 

the doctor will recommend diuretics— 

medications that remove fluid from the 

body. Large amounts of ascitic fluid may be 

removed from the abdomen and checked for 

bacterial peritonitis. Oral antibiotics may 

be prescribed to prevent infection. Severe 

infection with ascites will require intravenous (IV) antibiotics. 

The doctor may prescribe a beta-blocker 

or nitrate for portal hypertension. Betablockers can lower the pressure in the varices 

and reduce the risk of bleeding. Gastrointestinal bleeding requires an immediate upper 

endoscopy to look for esophageal varices. 

The doctor may perform a band-ligation 

using a special device to compress the varices 

and stop the bleeding. People who have had 

varices in the past may need to take medicine 

to prevent future episodes. 

Hepatic encephalopathy is treated by cleansing the bowel with lactulose—a laxative given 

orally or in enemas. Antibiotics are added 

to the treatment if necessary. Patients may 

be asked to reduce dietary protein intake. 

Hepatic encephalopathy may improve 

as other complications of cirrhosis are 

controlled. 

Some people with cirrhosis who develop 

hepatorenal failure must undergo regular 

hemodialysis treatment, which uses a 

machine to clean wastes from the blood. 

Medications are also given to improve blood 

flow through the kidneys. 

Other treatments address the specifi c causes 

of cirrhosis. Treatment for cirrhosis caused 

by hepatitis depends on the specifi c type 

of hepatitis. For example, interferon and 

other antiviral drugs are prescribed for viral 

hepatitis, and autoimmune hepatitis requires 

corticosteroids and other drugs that suppress 

the immune system. 

Medications are given to treat various 

symptoms of cirrhosis, such as itching and 

abdominal pain. 

When is a liver transplant 

indicated for cirrhosis? 

A liver transplant is considered when complications cannot be controlled by treatment. 

Liver transplantation is a major operation 

in which the diseased liver is removed and 

replaced with a healthy one from an organ 

donor. A team of health professionals 

determines the risks and benefits of the procedure for each patient. Survival rates have 

improved over the past several years because 

of drugs that suppress the immune system 

and keep it from attacking and damaging the 

new liver. 

5 Cirrhosis 
The number of people who need a liver 

transplant far exceeds the number of available organs. A person needing a transplant 

must go through a complicated evaluation 

process before being added to a long transplant waiting list. Generally, organs are 

given to people with the best chance of living 

the longest after a transplant. Survival after 

a transplant requires intensive follow-up and 

cooperation on the part of the patient and 

caregiver. 

Points to Remember 

• 	 Cirrhosis is a condition in which the 

liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue 

replaces normal, healthy liver tissue, 

preventing the liver from working as it 

should. 

• 	In the United States, heavy alcohol 

consumption and chronic hepatitis C 

have been the most common causes of 

cirrhosis. Obesity is becoming a common cause of cirrhosis, either as the sole 

cause or in combination with alcohol, 

hepatitis C, or both. Many people with 

cirrhosis have more than one cause of 

liver damage. 

• 	 Other causes of cirrhosis include 

hepatitis B, hepatitis D, and autoimmune hepatitis; diseases that damage 

or destroy bile ducts, inherited diseases, 

and nonalcoholic fatty liver disease; and 

drugs, toxins, and infections. 

• 	 Many people with cirrhosis have no 

symptoms in the early stages of the disease. As the disease progresses, symptoms may include weakness, fatigue, loss 

of appetite, nausea, vomiting, weight 

loss, abdominal pain and bloating, itching, and spiderlike blood vessels on the 

skin. 

• 	 As liver function deteriorates, one or 

more complications may develop. In 

some people, complications may be the 

first signs of the disease. 

• 	 The goals of treatment are to stop the 

progression of scar tissue in the liver 

and prevent or treat complications. 

• 	 Treatment for cirrhosis includes avoidance of alcohol and other drugs, nutrition therapy, and other therapies that 

treat specific complications or causes of 

the disease. 

• 	 Hospitalization may be necessary for 

cirrhosis with complications. 

• 	 A liver transplant is considered when 

complications of cirrhosis cannot be 

controlled by treatment. 

6 	 Cirrhosis 
Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases’ Division 

of Digestive Diseases and Nutrition 

supports basic and clinical research into 

liver diseases—including cirrhosis—and 

liver transplantation. Researchers are also 

studying 

• 	 the mechanisms of cirrhosis reversal in 

the early stages of the disease 

• 	 potential new approaches to the management of complications of cirrhosis 

• 	 the long-term outcome of new drugs to 

treat portal hypertension 

• 	 the development of therapies to prevent 

and treat the recurrence of hepatitis C 

after liver transplantation 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

American Liver Foundation 

75 Maiden Lane, Suite 603 

New York, NY 10038–4810 

Phone: 1–800–GO–LIVER (465–4837) 

 or 212–668–1000 

Fax: 212–483–8179 

Email: info@liverfoundation.org 

Internet: www.liverfoundation.org 

Hepatitis Foundation International 

504 Blick Drive 

Silver Spring, MD 20904–2901 

Phone: 1–800–891–0707 or 301–622–4200 

Fax: 301–622–4702 

Email: hfi @comcast.net 

Internet: www.hepfi .org 

United Network for Organ Sharing 

P.O. Box 2484 

Richmond, VA 23218 

Phone: 1–888–894–6361 or 804–782–4800 

Fax: 804–782–4817 

Internet: www.unos.org 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This publication 

was reviewed by Bruce A. Runyon, M.D., 

Loma Linda University Medical Center. 

You may also find additional information about this 

topic by 

• searching the NIDDK Reference Collection at 

www.catalog.niddk.nih.gov/resources

• visiting MedlinePlus at www.medlineplus.gov

This publication may contain information about medications. When prepared, this publication included 

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information. 

7 	 Cirrhosis 
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TTY: 1–866–569–1162
 

Fax: 703–738–4929
 

Email: nddic@info.niddk.nih.gov
 

Internet: www.digestive.niddk.nih.gov
 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK 

is part of the National Institutes of Health of 

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Services. Established in 1980, the Clearinghouse 

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This publication is not copyrighted. The Clearinghouse 

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distribute as many copies as desired. 

This fact sheet is also available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 09–1134 

December 2008