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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.

Accordion Title
About cirrhosis
  • Causes

    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 fibrosis, hemochromatosis, 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
  • Tests

    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 RadiologyInfo.org.

  • Treatment

    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 Pages section of this article.

View Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

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(August 24, 2016) U.S. Department of Veterans Affairs. Fibrosis and Cirrhosis. Available online at http://www.hepatitis.va.gov/patient/basics/fibrosis-cirrhosis.asp. Accessed October 2016.

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