Cirrhosis – Symptoms and Causes

Cirrhosis is scarring of the liver that develops over time as the organ attempts to repair itself after injury. When liver tissue is damaged, it forms scar tissue as part of the healing process.

As more scarring occurs, liver function becomes increasingly impaired. About 2% of American adults have liver disease, putting them at risk for developing cirrhosis.

Symptoms

Cirrhosis may not cause noticeable symptoms in its early stages. Signs typically appear only after significant liver damage has occurred. When symptoms do develop, they may include:

Early Symptoms

• Fatigue and weakness
• Unexplained weight loss
• Decreased appetite
• Nausea or feeling sick to your stomach
• Easy bruising or bleeding
• Swollen legs, feet, or ankles (edema)
• Itchy skin
• Redness on the palms
• Spider-like blood vessels visible on the skin

Advanced Symptoms

• Yellowing of the skin and eyes (jaundice)
• Fluid accumulation in the abdomen (ascites)
• Pale fingernails, especially on the thumb and index finger
• Clubbing of the fingertips (rounded, wider tips)
• Gastrointestinal bleeding
• Increased risk of infections
• Mental confusion, drowsiness, or unclear speech

In addition, cirrhosis may cause hormonal changes. Women might experience irregular or absent periods, even before menopause. Men may develop reduced sexual desire, smaller testicles, or enlarged breasts (gynecomastia).

Causes

Cirrhosis develops when long-term damage leads to liver scarring. Various conditions and factors contribute to this damage, including:

Chronic Alcohol Use

Excessive, long-term alcohol consumption is a leading cause of cirrhosis, as it directly damages liver cells and promotes scarring.

Viral Hepatitis

Hepatitis B, C, and D infections cause persistent liver inflammation, which can lead to cirrhosis over time.

Fatty Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, results from fat buildup in the liver, often linked to obesity and metabolic conditions.

Autoimmune Disorders

Some immune system disorders mistakenly attack liver cells, causing chronic inflammation and scarring. These include:

• Autoimmune Hepatitis – The immune system attacks liver tissue.
• Primary Biliary Cholangitis – Progressive damage to bile ducts.
• Primary Sclerosing Cholangitis – Inflammation and hardening of bile ducts.

Genetic and Metabolic Conditions

Certain inherited disorders affect liver function, increasing the risk of cirrhosis:

• Hemochromatosis – Excess iron accumulation in the body.
• Wilson’s Disease – Copper buildup in the liver.
• Alpha-1 Antitrypsin Deficiency – Affects liver and lung function.
• Cystic Fibrosis – Can cause liver complications.
• Alagille Syndrome – A genetic disorder affecting bile ducts.
• Biliary Atresia – A condition in newborns where bile ducts do not develop properly.
• Certain Metabolic Disorders – Affect sugar processing and can lead to liver scarring.

Other Causes

• Infections – Diseases such as syphilis and brucellosis can contribute to liver damage.
• Medications and Toxins – Long-term use of drugs like methotrexate and isoniazid can cause liver injury, leading to cirrhosis over time.

Cirrhosis is often the result of multiple factors working together. Identifying and managing the underlying cause is key to slowing its progression.

Risk Factors

While cirrhosis is caused by specific liver diseases and conditions, certain factors can increase the likelihood of developing it. These risk factors do not directly cause cirrhosis but contribute to liver damage over time.

Heavy Alcohol Use

• Regular, excessive alcohol consumption accelerates liver damage and increases the risk of cirrhosis, especially when combined with other risk factors.

Obesity and Metabolic Conditions

• Being overweight increases the likelihood of developing metabolic dysfunction-associated steatotic liver disease (MASLD), which can progress to cirrhosis if not managed.
• Obesity is often linked to other metabolic disorders, such as diabetes, that further strain liver health.

Chronic Viral Infections

• Individuals with hepatitis B, C, or D infections are at greater risk of cirrhosis, particularly if the infection remains untreated for years.

Age and Duration of Exposure

• The longer the liver is exposed to harmful substances (such as alcohol, viruses, or toxins), the greater the risk of cirrhosis.
• Older adults with long-term health conditions that affect the liver are at an increased risk.

Genetic Predisposition

• A family history of liver disease, particularly genetic disorders like hemochromatosis or Wilson’s disease, raises the likelihood of developing cirrhosis.
• Some individuals inherit conditions that make their liver more susceptible to damage even without external triggers.

Long-Term Medication Use and Toxin Exposure

• Certain medications (such as methotrexate and isoniazid) can gradually cause liver injury, making cirrhosis more likely over time.
• Exposure to industrial toxins or environmental pollutants may also contribute to liver damage.

Complications

Cirrhosis leads to several serious health problems as the liver becomes more damaged. These complications can affect many parts of the body.

Blood Pressure Problems

When cirrhosis develops, blood flow through the liver slows down. This creates high pressure in the portal vein (portal hypertension), which brings blood to the liver.

Fluid Buildup

Portal hypertension can cause fluid to collect in the:

• Legs (edema)
• Abdomen (ascites)

This swelling also happens when the liver can’t make enough albumin and other blood proteins.

Enlarged Spleen

The increased pressure from portal hypertension can trap white blood cells and platelets in the spleen, causing it to swell (splenomegaly). Lower blood cell counts may be an early sign of cirrhosis.

Dangerous Bleeding

High pressure in the portal vein forces blood into smaller veins that can burst. It can also create enlarged veins (varices) in the:

• Esophagus
• Stomach

These varices can rupture and cause life-threatening bleeding. Poor production of clotting factors worsens this problem.

Weakened Immune System

People with cirrhosis get infections more easily. The fluid buildup in the abdomen (ascites) can lead to bacterial peritonitis, a serious infection.

Nutritional Problems

The damaged liver struggles to process nutrients properly, which can cause:

• Weakness
• Weight loss
• Muscle wasting

Brain Function Changes

Toxins normally filtered by the liver build up in the blood and reach the brain, causing hepatic encephalopathy. This leads to:

• Confusion
• Trouble concentrating
• Personality changes
• In severe cases, coma

Jaundice

When the liver can’t remove enough bilirubin from the blood, jaundice develops. Signs include:

• Yellow skin and eyes
• Dark urine

Bone Problems

Cirrhosis can weaken bones, increasing the risk of fractures.

Cancer Risk

Many people who develop liver cancer have pre-existing cirrhosis, making regular screening important.

Multi-Organ Failure

Some patients develop acute-on-chronic liver failure, which can affect multiple organ systems. Scientists are still studying why this happens in certain individuals with cirrhosis.

Diagnosis

Since early cirrhosis often lacks symptoms, it’s frequently discovered during routine medical tests.

Doctors use several methods to diagnose cirrhosis:

1. Blood tests – These can detect liver function problems, identify specific damage markers, and screen for underlying causes like hepatitis.

2. Imaging tests including:

   • MR elastogram (measures liver stiffness)
   • MRI of the abdomen
   • CT scan
   • Ultrasound

3. Liver biopsy – A small tissue sample is removed and examined to confirm cirrhosis, determine its severity, and possibly identify the cause.

Treatment Approaches

While cirrhosis damage generally isn’t reversible, proper treatment can slow progression, relieve symptoms, and prevent complications.

Managing Underlying Causes:

• Treating alcohol dependency
• Weight loss for nonalcoholic fatty liver disease
• Antiviral medications for hepatitis
• Medications for autoimmune conditions

Treating Complications:

• Medications to reduce fluid buildup
• Blood pressure medications for certain complications
• Antibiotics for infections
• Dietary changes to manage specific symptoms

Liver Transplantation:

For advanced cases where the liver no longer functions adequately, transplantation may be considered.

Cirrhosis is one of the most common reasons for liver transplants. This major surgery replaces the damaged liver with a healthy donor organ. Candidates undergo thorough evaluation to determine suitability.

Research Progress

Researchers continue investigating new treatments that could slow or potentially reverse liver scarring.

Ongoing clinical trials are exploring medications that might improve liver regeneration and reduce fibrosis. For those with cirrhosis, medical advancements offer increasing hope for better outcomes.

Prevention

Taking steps to protect your liver can lower your risk of cirrhosis. Here are important ways to keep your liver healthy:

• Avoid alcohol completely if you already have liver disease. Even small amounts can cause further damage.
• Choose healthy foods in your daily diet:
  • Plenty of fruits and vegetables
  • Whole grain breads and cereals
  • Lean proteins like fish and chicken
  • Less fried and fatty foods
• Control your weight since excess body fat can harm the liver. If you need to lose weight, speak with a healthcare provider about creating a safe plan.
• Prevent hepatitis infection by:
  • Avoiding needle sharing
  • Practicing safe sex
  • Getting recommended vaccinations

Living with Cirrhosis

With proper medical care and lifestyle adjustments, many people with cirrhosis can maintain quality of life:

• Regular monitoring – Frequent check-ups and tests to track liver function.
• Medication management – Taking prescribed treatments consistently.
• Dietary changes – Following nutrition plans designed for liver health.
• Avoiding liver toxins – Eliminating alcohol and certain medications.
• Vaccination – Getting protected against hepatitis A and B, pneumonia, and influenza.