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What is Cirrhosis?
Understanding Liver Health & Disease
Christina George
Physician Reviewed
Sep 24, 2025
At its core, cirrhosis is a form of long-term liver damage. The liver is one of the hardest working organs in the body. It processes nutrients from food, helps regulate blood sugar, makes proteins that allow blood to clot, stores vitamins and minerals, breaks down medications, and removes toxins from the bloodstream. Because the liver does so many jobs at once, damage to it can affect nearly every system in the body.
Cirrhosis develops gradually over time. It happens when repeated injury to the liver leads to scarring as the liver tries to repair itself. Just like skin can scar after a deep cut, the liver forms scar tissue in response to chronic damage. The difference is that while skin can continue to function normally with a scar, the liver’s scar tissue does not work like healthy liver tissue. As scar tissue builds up, it changes the structure of the liver and makes it harder for blood to flow through it. Over time, this reduces the liver’s ability to do its work.
Causes of Cirrhosis
There are many different pathways that can lead to cirrhosis. Chronic heavy alcohol use is one of the most well-known causes, but it is far from the only one. In fact, in many parts of the world today, the leading cause of cirrhosis is not alcohol, but a condition called metabolic dysfunction associated steatotic liver disease, often abbreviated MASLD. This condition, formerly called nonalcoholic fatty liver disease (NAFLD), is linked to obesity, insulin resistance, diabetes, and high cholesterol. In MASLD, fat builds up inside the liver and over time can trigger inflammation and scarring.
Viral infections are another major contributor. Hepatitis B and hepatitis C are infections that attack the liver. When these viruses stay in the body for many years, they can cause progressive injury that eventually results in cirrhosis. In many countries, widespread vaccination against hepatitis B and improved treatments for hepatitis C are helping reduce these risks, but viral hepatitis remains a global concern.
Autoimmune conditions can also cause cirrhosis. In autoimmune hepatitis, the body’s immune system mistakenly attacks liver cells. Other related conditions, such as primary biliary cholangitis or primary sclerosing cholangitis, damage the bile ducts, the small tubes that carry bile out of the liver. Over time, this damage creates scarring and loss of function.
There are also less common causes. Some people inherit conditions such as hemochromatosis, which causes the body to store too much iron, or Wilson’s disease, which leads to an abnormal buildup of copper. Certain medications and long-term exposure to toxins can also contribute. While the underlying reasons differ, the end result of all these conditions is the same: repeated injury and the formation of scar tissue that disrupts the normal structure of the liver.
Early Stages Versus Advanced Cirrhosis
Cirrhosis does not happen overnight. In fact, many people live with early stages of cirrhosis for years without realizing it. Usually, cirrhosis is categorized into compensated and decompensated stages.
In compensated cirrhosis, the liver is scarred but still manages to do most of its jobs. People may have no obvious symptoms. Some might feel more tired than usual or notice vague problems like decreased appetite, but nothing that clearly points to the liver. Because the signs are so subtle, compensated cirrhosis is often discovered when bloodwork or imaging is done for another reason.
Decompensated cirrhosis is when the scarring has advanced to the point where the liver can no longer keep up with its responsibilities. This is when complications appear. One of the most common complications is fluid buildup in the abdomen, known as ascites. Another is jaundice, which is when the skin and eyes turn yellow because the liver cannot properly process bilirubin, a substance created when old red blood cells are broken down. Confusion or sleepiness, called hepatic encephalopathy, can happen when toxins that are normally filtered by the liver begin to build up in the bloodstream. Varices, which are swollen veins in the esophagus or stomach, can develop when blood has trouble flowing through the scarred liver and is forced into smaller veins. These varices can rupture and bleed, which is a serious medical emergency.
The progression from compensated to decompensated cirrhosis can take years, but once complications develop, the risks increase significantly. At that stage, liver transplantation may be the only viable option to survive.
Symptoms to Watch For
Because early cirrhosis can be silent, routine checkups are important for people who have risk factors such as chronic alcohol use, obesity, diabetes, or hepatitis. When symptoms do appear, they may include fatigue, weakness, easy bruising, swelling in the legs or abdomen, itchy skin, confusion, or yellowing of the skin and eyes.
It is also important to know that not everyone with cirrhosis experiences the same symptoms in the same way. Some may notice mental changes first, while others may struggle with fluid retention. Because the liver affects so many processes in the body, symptoms can vary widely.
Diagnosis of Cirrhosis
Cirrhosis is diagnosed using a combination of medical history, physical examination, blood tests, imaging studies, and sometimes liver biopsy. Blood tests can show whether the liver is making proteins properly, how well it is processing toxins, and whether enzymes that suggest liver cell injury are elevated. Imaging techniques like ultrasound, CT scan, or MRI can show changes in the size and shape of the liver and can measure stiffness, which often increases as scarring worsens.
In some cases, a liver biopsy is performed. This involves taking a small sample of liver tissue with a needle and looking at it under a microscope. Biopsy remains the most direct way to measure the degree of scarring, although newer noninvasive tests are reducing the need for it.
Treatment and Management
There is no single cure for cirrhosis once scarring has developed, but treatment focuses on slowing its progression, managing symptoms, and preventing complications.
The first step is always addressing the underlying cause. If cirrhosis is related to alcohol, stopping drinking is essential. For MASLD, weight loss, exercise, and control of diabetes or cholesterol can make a huge difference. For hepatitis B and C, antiviral medications can suppress or eliminate the virus and reduce further damage. For autoimmune conditions, medications that calm down the immune system may help.
Prescription medications may be used to manage specific complications. Diuretics, sometimes called water pills, can help reduce fluid buildup. Lactulose, a medication that changes how toxins are processed in the gut, can improve confusion from encephalopathy. Procedures such as endoscopy can be used to treat or prevent bleeding from varices. In certain cases, a procedure called TIPS, which creates a new pathway for blood flow through the liver, can help relieve pressure in the veins.
For some patients, when cirrhosis is advanced and the liver is failing, liver transplantation is the best option. Transplant can replace a damaged liver with a healthy one, offering the chance for long-term recovery. However, not everyone is eligible, and the process requires careful evaluation and commitment.
Lifestyle and Cirrhosis
Alongside medical treatment, lifestyle choices play a major role in managing cirrhosis. Avoiding alcohol entirely is one of the most important steps, regardless of the original cause. Eating a balanced diet rich in protein and nutrients can help maintain strength and prevent muscle loss, which is a common problem in advanced liver disease. People with cirrhosis are often advised to limit salt to reduce fluid retention.
Vaccinations against hepatitis A and B, flu, and pneumonia are important because infections can be more dangerous in someone with cirrhosis. Using medications only as directed is also essential. Many drugs are processed by the liver, so patients should always check with their healthcare team before taking over-the-counter medicines, supplements, or herbal products.
The Emotional Side of Cirrhosis
Cirrhosis does not only affect the body. It can have a deep emotional impact as well. Living with a chronic condition can cause anxiety, depression, and stress, especially when symptoms are unpredictable. Patients may feel frustrated about dietary restrictions or lifestyle changes, or fearful about the possibility of needing a transplant.
Support from family, friends, and healthcare teams is vital. Counseling, support groups, and patient education can help people feel less alone and more empowered to manage their condition. Many liver clinics now offer multidisciplinary care, meaning that doctors, nurses, dietitians, and social workers all work together to support patients and families.
Looking Ahead
The outlook for people with cirrhosis depends on its cause, how early it is detected, and how well complications are managed. The good news is that modern medicine has improved the ability to slow or even stop the progression of cirrhosis in many cases. New treatments for viral hepatitis, better understanding of metabolic liver disease, and advances in transplantation have changed the landscape dramatically compared to just a few decades ago. There are even promising treatments on the horizon. Several drugs are in development and are being tested in ongoing clinical trials.
Prevention is also key. Maintaining a healthy weight, limiting alcohol, getting vaccinated against hepatitis, and practicing safe habits to avoid viral infections can all reduce the risk of cirrhosis. Regular medical checkups and early treatment of liver conditions can catch problems before they reach the stage of irreversible scarring.
Cirrhosis is not a single disease but the result of many possible injuries to the liver. It represents a stage where scarring has changed the structure and function of this vital organ. While cirrhosis can be a serious and life-altering diagnosis, it is not without hope. With medical care, lifestyle changes, and support, many people live for years with cirrhosis and maintain a good quality of life.
Education is one of the most powerful tools patients and families have. By understanding what cirrhosis is, what causes it, and how it can be managed, people can take an active role in protecting their liver health and making informed choices. The liver is remarkably resilient, and even in the face of cirrhosis, there are steps that can help preserve its function and support overall well-being.
