Medically Reviewed by Expert Board

This page was fact checked by our expert Medical Review Board for accuracy and objectivity. Read more about our editorial policy and review process.

This article was last modified on
Learn more about...

What is cirrhosis?

Cirrhosis is severe scarring of the liver caused by chronic liver disease. As healthy liver tissue is damaged over a long period of time, it is replaced by scar tissue, affecting the structure of the liver and decreasing its ability to function. It is linked to approximately 32,000 deaths annually in the United States.

Cirrhosis is seen with a variety of chronic liver diseases and may take years or even decades to develop. Unlike scars in other parts of the body, some of the scarring that occurs in the liver is reversible, even in people with cirrhosis.

The liver is a vital organ located in the upper right-hand side of the abdomen. Among other functions, it helps convert nutrients from food into essential blood components, produces many of the factors necessary for normal blood clotting, metabolizes and detoxifies substances that would otherwise be harmful to the body, and produces bile – a fluid necessary for the digestion of fats.

Liver diseases can affect any of these functions. These diseases may be the result of infection, physical injury, exposure to a toxin, an autoimmune process, or due to a genetic defect that leads to the build-up of substances such as copper or iron. The damage that liver diseases cause can lead to inflammation, obstruction to bile flow, and clotting abnormalities. Prolonged and persistent damage can lead to the accumulation of excess connective tissue, or fibrosis of the liver, which is how cirrhosis develops.

With cirrhosis, the structure of the liver changes, forming nodules of cells surrounded by fibrous tissue. This tissue does not function like healthy liver tissue and can interfere with the flow of blood and bile through the liver. As cirrhosis progresses, it can begin to affect other organs and tissues throughout the body. Some examples of these effects and complications include:

  • An increase in pressure in the vein that carries blood to the liver; this is called portal hypertension.
  • Swelling and bleeding of the veins in the esophagus and/or stomach (esophageal and/or gastric varices) due to the increased pressure from portal hypertension and the redirection of blood into these smaller veins
  • An increase in toxins in the blood, which can cause confusion and other mental changes
  • A build-up of fluid in the abdomen (ascites)
  • Kidney dysfunction
  • Decline in clotting factor production, which can cause easy bleeding and bruising

Individuals with cirrhosis are also at high risk of developing liver cancer. This is estimated to occur in 3-5% of patients with cirrhosis each year, and multiple cancers can form over time.


About Cirrhosis


When injury to the liver is acute or damage is limited, the liver can usually repair itself. However, repeated injury or damage occurring over many years can lead to the development of cirrhosis. Causes are wide-ranging but generally fall into one of several categories:

  • Alcoholic—excessive alcohol use over time can lead to alcoholic liver disease and cirrhosis.
  • Associated with hepatitis, such as viral hepatitis, autoimmune hepatitis and non-alcoholic fatty liver disease (NAFLD)
  • Biliary—obstruction and/or damage to bile ducts
  • Cardiac—congestive heart failure can eventually cause liver damage and cirrhosis
  • Metabolic or inherited—these include diseases such as cystic fibrosishemochromatosis, and Wilson disease
  • Drug or toxin-related (other than alcohol)
  • Unknown—in about 10% of cases of cirrhosis, the cause is not known.

The frequency of these causes varies by population and geographic region. In the United States, about half of the cases of cirrhosis are caused by chronic hepatitis C infection and chronic alcohol abuse (alcoholism).

Chronic hepatitis B infection (sometimes with hepatitis D co-infection) causes a significant number of cases and is a major cause in many parts of the world. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are significant non-infectious causes of cirrhosis, and the frequency of this cause is increasing.

Signs and Symptoms

Many people with cirrhosis have little or no clinical evidence of disease. Symptoms may not emerge until significant scarring of the liver has occurred.

Symptoms may be nonspecific and include:

  • Fatigue
  • Weakness
  • Confusion and difficulty concentrating
  • Abdominal discomfort
  • Itching
  • Abdominal swelling (from ascites, a build-up of fluid in the abdomen)
  • Jaundice
  • Easy bleeding and bruising
  • Leg swelling
  • Nausea
  • Weight loss and loss of appetite


It is important to detect cirrhosis as soon as possible since significant liver damage may occur with few or no symptoms. If the cause of liver damage can be eliminated or controlled, further scarring will stop and some existing scars may actually resolve. While blood tests can detect liver injury, there is no single test that can be used to diagnose cirrhosis. A liver biopsy is considered the “gold standard” for diagnosing cirrhosis, but the procedure is invasive and will not detect every case.

Routine laboratory tests may be done to detect liver damage and/or scarring and to evaluate its severity, particularly if the individual has some risk factor for developing cirrhosis. Additional tests may be performed to help diagnose the underlying cause and to monitor the affected person’s health over time. This can include monitoring for the possible development of hepatocellular carcinoma.

Routine Tests

Liver injury may be first detected by a comprehensive metabolic panel (CMP) or a liver panel. Both panels include the following tests:

  • Alanine aminotransferase (ALT) – an enzyme found mainly in the liver. Values are increased with all types of liver injury, including cirrhosis.
  • Aspartate aminotransferase (AST) – an enzyme found in the liver and other organs. AST is elevated in people with liver injury, including cirrhosis.
  • Alkaline phosphatase (ALP) – an enzyme found along bile ducts. ALP is usually normal or mildly elevated in cirrhosis.
  • Total bilirubin – a substance produced exclusively in the liver. It is increased with many liver diseases. Bilirubin is usually normal or slightly elevated until cirrhosis becomes far advanced.
  • Albumin – a protein made by the liver that is often decreased in cirrhosis.

If any of these tests are abnormal, then they will be further investigated. The pattern of results is more informative than the result of any single test.

Other routine testing may include:

  • Complete blood count (CBC) – may be ordered to evaluate a person’s red and white blood cells and platelets; anemia may be present if bleeding has occurred, and platelets are often decreased with cirrhosis.
  • Prothrombin time (PT/INR) – most clotting factors are produced by the liver. This test evaluates clotting function and results may be prolonged with cirrhosis.

Many of the tests listed above are used to monitor the progression of cirrhosis. As the condition worsens, results may become increasingly abnormal.

Additional Testing

  • Hepatitis B and hepatitis C testing may be ordered to help diagnose the underlying cause of chronic liver disease.
  • If ascites is present, peritoneal fluid analysis may be performed.
  • Liver biopsy involves taking a sample of liver tissue to evaluate the structure and cells of the liver. It can clearly indicate the presence of cirrhosis, but since the sample is tiny, a negative result may not rule cirrhosis out.

Depending on the suspected cause, one or more specialized tests may be performed:

Some tests may be ordered to monitor for the development of complications:

Sometimes Ordered
Calculations based upon panels of specific tests may be used to evaluate prognosis or likely cirrhosis:

  • Child-Turcotte-Pugh (CTP) scoring system for cirrhosis – may be used to help evaluate life expectancy in those with advanced cirrhosis
  • MELD (model of end-stage liver disease) – used to help determine those who are at a high risk of mortality, to consider for liver transplant
  • Several commercially developed calculations (algorithms) are available to help recognize the presence and severity of scarring in the liver.

Non-Laboratory Tests

Other procedures and imaging tests may be useful:

  • Ultrasound – sometimes ordered to help diagnose nonalcoholic fatty liver disease (NAFLD). Periodic ultrasounds are done for some patients to monitor for development of hepatocellular carcinoma.
  • Magnetic or transient elastography – to evaluate degree of liver fibrosis by measuring liver stiffness

For more on these tests, visit


For individuals diagnosed with cirrhosis, treatment usually includes:

  • Addressing and treating the underlying cause of the liver disease, where possible. This may involve, for example, treating chronic hepatitis C with medications.
  • Maintaining remaining liver function—to help take care of their liver, people with cirrhosis should should not drink alcohol and should avoid substances that can harm the liver. They may need to modify or supplement their diet to ensure adequate nutrition and work with their healthcare provider on medication dosage since their liver may not be able to process drugs at a normal rate.
  • Treating complications—for example, endoscopy is sometimes needed to look for varices (dilated veins) and to address bleeding varices. In advanced cases of cirrhosis, a liver transplantation may be indicated.

For more on treatment, see the links in the Related Content section.

View Sources

Sources Used in Current Review

(April 2014) Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Available online at Accessed October 2016.

(August 24, 2016) U.S. Department of Veterans Affairs. Fibrosis and Cirrhosis. Available online at Accessed October 2016.

(April 6, 2016) Cirrhosis. Mayo Clinic. Available online at Accessed October 2016.

(June 2, 2016) University of California San Francisco. UCSF News Center. Researchers Convert Cirrhosis-Causing Cells to Healthy Liver Cells in Mice. Available online at Accessed October 2016.

Sources Used in Previous Reviews

(Updated 2012 April 30). What I need to know about Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases [On-line information]. Available online at Accessed August 2012.

Wolf, D. (2012 June 4). Cirrhosis. Medscape Reference [On-line information]. Available online at Accessed August 2012.

Rahimi, R. and Rockey, D. (2012 May 18). Complications of Cirrhosis. Medscape Today News from Curr Opin Gastroenterol. 2012;28(3):223-229 [On-line information]. Available online at Accessed August 2012.

Fleming, K. et. al. (2011 March 1). The Rate of Decompensation and Clinical Progression of Disease in People with Cirrhosis. Medscape Today News from Alimentary Pharmacology & Therapeutics. 2010;32(11):1343-1350 [On-line information]. Available online at Accessed August 2012.

Germani, G. et. al. (2011 June 24). Assessment of Fibrosis and Cirrhosis in Liver Biopsies An Update. Medscape Today News from Semin Liver Dis. 2011;31(1):82-90. [On-line information]. Available online at Accessed August 2012.

Melville, N. (2012 January 12) Cirrhosis Patients Have High Disability, Caregiving Needs. Medscape Medical News [On-line information]. Available online at Accessed August 2012.

Pyrsopoulos, N. and Reddy, K. (Updated 2012 January 4). Primary Biliary Cirrhosis. Medscape Reference [On-line information]. Available online at Accessed August 2012.

Grenache, D. and Roberts, W. (Updated 2012 April). Cirrhosis. ARUP Consult [On-line information]. Available online at Accessed August 2012.

Grenache, D. and Jarboe, E. (Updated 2011 May) Hepatocellular Carcinoma. ARUP Consult [On-line information]. Available online at Accessed August 2012.

Mayo Clinic Staff (2011 January 22) Cirrhosis. [On-line information]. Available online at Accessed August 2012.

(Updated 2010 July) Cirrhosis and Portal Hypertension. [On-line information]. Available online at Accessed August 2012.

Shaffer, E. (Revised 2007 August). Fibrosis and Cirrhosis. Merck Manual for Healthcare Professionals [On-line information]. Available online at Accessed August 2012.

Longstreth, G. (Updated 2011 October 16). Cirrhosis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at Accessed August 2012.

(Update 2011 October 4) Cirrhosis. American Liver Foundation [On-line information]. Available online at Accessed August 2012.

Granito, A. et. al. (2012 January 31). Antinuclear Antibodies as Ancillary Markers in Primary Biliary Cirrhosis. Medscape Today News from Expert Rev Mol Diagn. 2012;12(1):65-74. [On-line information]. Available online at Accessed August 2012.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 320-321.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds (2005). Harrison’s Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 1858-1864.