Liver cirrhosis: symptoms, causes and treatment

By Cristiano Antonino Last updated Mar 6, 2023

Cirrhosis of the liver refers to the advanced stage of fibrosis (scarring) of the liver, which can be caused by many other diseases, such as hepatitis and chronic alcoholism

Whenever the liver suffers damage, whether from a disease, excessive alcohol consumption or another cause, it tries to repair itself. In this process, however, scar tissue forms.

As cirrhosis progresses, more and more scar tissue forms, which makes it difficult for the liver to function (this is referred to as decompensated cirrhosis).

The liver damage caused by cirrhosis is generally irreversible, but if cirrhosis is diagnosed early and the cause is treated, the progression of the disease can be halted.

Advanced cirrhosis is life-threatening.

Liver cirrhosis

Cirrhosis is a widespread alteration of the liver structure, with the appearance of nodules and fibrosis (scarring), which may also be associated with cellular inflammation.

In practice, in this disease, not only is the normal cellular architecture of the liver subverted, but there is also a replacement of normal liver tissue with nodules and fibrotic, non-viable scars.

This transformation of liver tissue, in the long run, if left untreated, can damage the functionality of the liver itself, destroy its cells and prevent regular blood circulation within it.

Liver cirrhosis causes

A wide range of diseases and conditions can damage the liver and lead to cirrhosis.

Some of the causes of the condition include:

chronic alcohol abuse
chronic viral hepatitis (hepatitis B, C or D);
hepatic steatosis, i.e. accumulation of fat in the liver;
haemochromatosis, i.e. accumulation of iron in the body;
cystic fibrosis;
Wilson’s disease, which causes an accumulation of copper in the liver;
biliary atresia, which consists of poorly formed bile ducts;
alpha-1 antitrypsin deficiency;
galactosemia or glycogenosis, which are hereditary disorders of sugar metabolism;
Alagille syndrome, which is a genetic disorder of digestion;
autoimmune hepatitis caused by a malfunction of the body’s immune system;
primary biliary cirrhosis, which consists of a destruction of the biliary tract;
primary sclerosing cholangitis, characterised by hardening and scarring of the biliary tract;
infection, such as syphilis or brucellosis;
use of certain drugs, such as methotrexate or isoniazid.

Liver cirrhosis symptoms

Liver cirrhosis often gives no signs or symptoms until the liver damage is extensive.

When they do appear, signs and symptoms may include:

tiredness and fatigue;
easy bleeding;
easy bruising;
loss of appetite;
nausea;
swelling of the legs, feet or ankles (oedema);
loss of weight;
itchy skin;
yellowing of the skin and eyes (jaundice);
accumulation of fluid in the abdomen (ascites);
appearance of spider-like blood vessels on the skin;
redness in the palms of the hands;
confusion;
drowsiness;
in women, absence of menstrual flow;
in men: loss of sexual desire, breast enlargement (gynaecomastia) or testicular atrophy.

Risk factors for liver cirrhosis

The risk of developing the disease is greater in those who

drink a lot of alcohol: excessive alcohol consumption is a risk factor for cirrhosis;
are overweight: excessive weight increases the risk of conditions that can lead to cirrhosis, such as non-alcoholic hepatic steatosis and non-alcoholic steatohepatitis;
has viral hepatitis: not everyone who suffers from chronic hepatitis will develop cirrhosis, but this infection is one of the world’s leading causes of liver disease.

Cirrhosis of the liver, complications

Complications of cirrhosis can include:

elevated blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows down the normal flow of blood through the liver, thus increasing pressure in the portal vein, the vein that brings blood to the liver from the intestine and spleen;
swelling in the legs and abdomen. Increased pressure in the portal vein can cause fluid to accumulate in the legs (oedema) and abdomen (ascites). Oedema and ascites can also result from the liver’s inability to produce enough blood proteins, such as albumin;
enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes and swelling of the spleen and a decrease in white blood cells and platelets in the blood, which may be the first sign of cirrhosis;
bleeding. Portal hypertension can cause the redirection of blood to smaller veins. Put under strain by the extra pressure, these smaller veins can burst, causing severe bleeding. Portal hypertension can also cause enlarged veins (varices) in the oesophagus (oesophageal varices) or stomach (gastric varices) and lead to life-threatening haemorrhages. Continuous bleeding may also occur if the liver fails to produce enough clotting factors;
infections. In the presence of cirrhosis, the body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection;
malnutrition. Cirrhosis can make it more difficult for the body to process nutrients, leading to weakness and weight loss;
jaundice: jaundice occurs when the diseased liver does not remove enough bilirubin, a waste product of the blood, from the blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of the urine;
bone disease: some people with cirrhosis lose bone strength and are at increased risk of fractures;
increased risk of liver cancer: a large percentage of people who develop liver cancer have pre-existing cirrhosis;
multi-organ failure: some people end up experiencing this serious condition.

In some cases, an accumulation of toxins in the brain may occur (hepatic encephalopathy).

A liver damaged by cirrhosis is not able to eliminate toxins from the blood as a healthy liver can.

These toxins can then accumulate in the brain and cause mental confusion and difficulty concentrating.

Over time, hepatic encephalopathy can progress to insensibility or coma;

Cirrhosis, prevention

To reduce the risk of developing cirrhosis, it is good to

do not drink alcohol if you have liver disease,
follow a healthy diet that favours plant foods, whole grains and lean sources of protein. Reduce the amount of fatty and fried foods;
maintain a healthy weight: too much body fat can damage the liver. If necessary, consult a nutritionist;
to reduce the risk of hepatitis, do not share needles or have unprotected sex. Also, take the available vaccines against hepatitis.

Cirrhosis, treatment

If cirrhosis is detected and treated early, the consequences are generally less severe. The first step is to treat the underlying cause, e.g. stop drinking (if necessary also following a treatment programme for alcohol addiction), lose weight, control blood sugar levels, take antiviral hepatitis medication.

In some cases, the doctor may prescribe specific drugs, such as those to slow down early-diagnosed primary biliary cirrhosis and those to relieve itching, fatigue and pain.

In addition, he or she may prescribe food supplements to counteract the malnutrition associated with cirrhosis and to prevent bone weakening (osteoporosis).

Other treatments for cirrhosis

To limit the consequences of cirrhosis, one can resort to:

a low-sodium diet and diuretic drugs to prevent fluid accumulation in the body, which can help control ascites and swelling. More severe fluid accumulation may require procedures to drain the fluid or surgery to relieve the pressure;
certain blood pressure medications, which can control increased pressure in the veins that supply the liver (portal hypertension) and prevent severe bleeding;
drugs to reduce the risk of bleeding. If you have signs of varices bleeding or are likely to bleed, procedures (such as banding) may be necessary to stop the bleeding or reduce the risk of further bleeding;
antibiotics or other treatments for infection. Your doctor is also likely to recommend vaccinations for influenza, pneumonia and hepatitis;
administration of albumin in cases of marked deficiency due to reduced production;
laxatives and other drugs to prevent constipation and reduce the possibility of intestinal toxins ‘bypassing’ the liver and reaching the brain, causing drowsiness, confusion and coma (hepatic encephalopathy).

In advanced cases of cirrhosis, when the liver stops functioning, a liver transplant may be the only treatment option.

A liver transplant is a procedure to replace the liver with a healthy liver from a deceased donor or a part of a liver from a living donor.

Cirrhosis is one of the most common reasons for a liver transplant.

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