Cirrhosis Of Liver

Cirrhosis of Liver is a disease in which healthy tissues in the liver get replaced by fibrous scar tissues. Cirrhosis eventually results in liver failure, which prevents the liver from functioning adequately. It is estimated that Cirrhosis of Liver is the 12th leading cause of death due to a medical condition. In this article, we will read in detail about the various causes, symptoms, and treatment of treatments, and if there is any way that we can prevent Cirrhosis of Liver.

Cirrhosis Of Liver

How Is Cirrhosis Of Liver Defined?

  • Functions of Liver-
    • Protein Synthesis-Cirrhosis causes low protein synthesis.
      • Low Albumin- Lowers blood osmotic pressure.
      • Low Globulin- Weakens immune system.
      • Low Clotting Factor- Abnormal clotting.
    • Excess Nutrients Management- Nutrient storage is decreased in cirrhosis.
    • Bile Synthesis- Bile deficiency causes inadequate absorption of Vitamin A and D, as well as absorption of fat, protein and carbohydrate is compromised.
    • Glycogen Storage- Liver cirrhosis has less functional cells, thus glycogen storage is less efficient.
    • Metabolism- Inefficient metabolism of medications and toxic substances results in encephalopathy.
  • End Stage Condition Of Several Liver Diseases- Cirrhosis is basically a complication of numerous diseases of the liver, which is characterized by abnormal function and structure of liver.
  • Scarring of Liver Tissue1- The medical conditions causing Cirrhosis basically kills healthy liver cells after which inflammation and repair in association with dying liver cells results in scar tissue formation.
  • Fibrous Tissue Replaces Normal Liver Tissue- Normal liver tissue is replaced with fibrous tissue.2
  • Regenerative Nodule- Liver following cirrhosis consists of regenerative nodules, which is seen as irregular elevated areas over the surface of liver.3

Causes Of Cirrhosis Of Liver

  • Chronic Viral Infections-
    • Liver inflammation following hepatitis B and C viral infection results in cirrhosis in 20 to 30% patient.1
    • Liver infection causes slow liver damage spread over several years.
    • Hepatitis C infection is the second most common cause of liver cirrhosis.
  • Blockage of Bile Duct- Common bile duct or hepatic duct blockade by bile stone or secondary to biliary atresia causes retention of bile in liver. Prolonged collection of bile in liver tissue causes liver damage, which results in cirrhosis.
  • Autoimmune Hepatitis- Autoimmune hyperactivity causes immunologic injuries of the liver tissue, which results in hepatitis.4 Repeated inflammation causes repeated scarring of liver tissue and ends in cirrhosis.
  • Fatty Liver- Fatty liver is often seen in obese patient or patient with history of diabetes. Fatty liver is reversible disease, if ignored then may result in cirrhosis.5
  • Congestive Heart Failure (CHF)- Heart failure causes collection of fluid in liver. Repeated episodes of heart failure causes repeated retention of fluid in liver and liver enlargement. The repeated expansion of venous system causes injuries of surrounding liver cells, which heals by forming fibrosis and scar tissue.
  • Alcoholic Liver Cirrhosis6-
    • Alcoholic cirrhosis develops in 10 to 20% of alcoholic patients.
    • Alcohol is metabolized to acetaldehyde, which injures liver cells.
    • Alcohol also causes inflammatory liver disease or hepatitis.
    • Persistent drinking of alcohol causes repeated liver damage resulting in cirrhosis.
  • Cystic Fibrosis- Cystic fibrosis is seen in infants and young children. A persistent symptom in 10 to 20% patient is associated with liver cirrhosis.
  • Glycogen Storage Diseases- Glycogen storage disease causes increased glycogen deposits in liver tissue, which follows inflammation and scarring. Glycogen storage disease is reversible.
  • Wilson's Disease- Increased copper content in liver causes injuries of surrounding hepatic cells.
  • Liver Toxicity- Liver toxic drugs and chemicals cause liver tissue damage. Prolonged toxic effect results in liver damage and cirrhosis.

Symptoms Of Cirrhosis Of Liver

Non-Specific Symptoms of Liver Cirrhosis-

  • Loss of Appetite
  • Fatigue and generalized weakness
  • Loss of weight
  • Fever

Specific Symptoms of Liver Cirrhosis-

  • Pain-
    • Right upper quadrant, mild to severe pain.
  • Eyes-
    • Yellow discoloration
  • Skin-
    • Easy bruising
    • Pruritus- itching
    • Jaundice
  • Central Nervous System
    • Personality changes
    • Confusion
    • Coma
  • Fluid Retention-
    • Edema and swelling of lower extremities
  • Liver-
    • Pain during palpation and percussion over liver
    • Hepatomegaly- Enlarged liver
  • Skeletal System-
    • Osteoporosis- Secondary to calcium deficiency caused by deficiency of fat soluble vitamin like Vitamin D and E.
  • Gastrointestinal System-
    • Esophageal varices7

Diagnosis Of Cirrhosis Of Liver

Specific Findings During Clinical Examination-

  • Enlarged and irregular liver
  • Yellow urine
  • Stool- Pale and may show blood in stool
  • Jaundice

Lab Studies To Diagnose Cirrhosis of Liver-

Urine Examination-

  • Color- Yellow
  • Bilirubin- present

Stool Examination-

  • Stool- Pale and may show blood in stool

Blood Examination-

  • Complete Blood Count-
    • Thrombocytopenia- Low platelet count seen in alcoholic cirrhosis because of bone marrow suppression by alcohol.
  • Liver Enzymes- SGOT and SGPT elevated
  • Alkaline Phosphatase- Elevated.
  • Cholesterol- Elevated
  • Bilirubin- Elevated
  • Blood (serum) Albumin- Decreased.
  • Anti-mitochondrial Antibodies is elevated if the cause of cirrhosis is autoimmune disease.
  • Non-specific immunoglobulin- Elevated

Radiological Studies To Diagnose Cirrhosis of Liver:

  • Ultrasound Examination
    • Shows nodular liver surface
    • Caudate lobe
    • Liver fissures- wide
  • MRI
    • Changes of cirrhosis are observed.
    • Biliary atresia (narrowing of bile duct)- is seen.
  • CT Scan
    • Changes of cirrhosis are observed.
  • Contrast Cholangiography
    • Dye flow is examined from liver to intestine. Diagnostic test for bile duct stenosis or atrophy.


  • Esophageal varieces are seen at the lower end of esophagus.
  • Primary sclerosing cholangitis- Bile duct narrowing or atrophy is seen following ERCP examination.

Liver Biopsy

  • Diagnostic pathological study.

Treatment For Cirrhosis Of Liver

  • Alcohol Abstinence- Discontinue alcohol intake
  • Autoimmune Disease Causing Cirrhosis-
    • Corticosteroids- prednisolone
    • Cyclophosphamide
    • Azathioprine
  • Viral Infection-
    • Antiviral medications
  • Fluid Retention-
    • Diuretics
    • Reduced salt intake
    • Balanced water intake
  • Chelation Therapy
    • Wilson's Disease- Indicated when cirrhosis is caused by copper retention in liver
    • Penicillamine
  • Vitamin Supplement
    • Vitamin A and D are often inadequately absorbed within intestine and results in deficiency.
    • Vitamin A and D supplement is advised.
  • Liver Transplant 8-
    • When all other treatments fail, patient is considered for liver transplant.

Complications Of Cirrhosis Of Liver

  • Respiratory tract infection
  • Peritonitis
  • Ascites8
  • Encephalopathy8
  • Esophageal varieces7
  • Hepatocellular carcinoma


1. Advanced liver disease: what every hepatitis C virus treater should know.

Sherman KE

Top Antivir Med. 2011 Aug-Sep;19(3):121-5.

2. Liver fibrosis.

Wallace K1, Burt AD, Wright MC.

Biochem J. 2008 Apr 1;411(1):1-18.

3. Diagnosis and epidemiology of cirrhosis.

Lefton HB1, Rosa A, Cohen M.

Med Clin North Am. 2009 Jul;93(4):787-99,

4. Liver transplantation and autoimmune liver diseases.

Liberal R1, Zen Y, Mieli-Vergani G, Vergani D.

Liver Transpl. 2013 Oct;19(10):1065-77.

5. Non-alcoholic fatty liver disease: factors associated with its presence and onset.

Miyake T1, Kumagi T, Furukawa S, Tokumoto Y, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M.

J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:71-8.

6. Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis.

Vlachogiannakos J1, Viazis N, Vasianopoulou P, Vafiadis I, Karamanolis DG, Ladas SD.

J Gastroenterol Hepatol. 2013 Mar;28(3):450-5. doi: 10.1111/jgh.12070.

7. Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011.

Orloff MJ.

J. AMA Surg. 2014 Feb;149(2):155-69.

8. Management of end-stage liver disease.

Liou IW.

Med Clin North Am. 2014 Jan;98(1):119-52.

Written, Edited or Reviewed By:


Last Modified On: June 11, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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