Frequently Asked Questions - Cirrhosis for Patients
Cirrhosis is the term used to describe a severely scarred liver. Scar tissue forms in the liver when the liver is healing from an injury. For example, heavy alcohol use can cause the liver to become inflamed, which can result in scar tissue developing in the liver. When the injury to the liver is chronic and persistent, scar tissue builds up over time. Eventually, the scarring becomes so severe that the liver is considered "cirrhotic." A person with a severely scarred liver is considered to have cirrhosis.
The liver can have some scar tissue and still perform its usual functions: producing proteins for blood clotting, producing albumin for maintaining fluid balances, and breaking down toxins and medications. However, a cirrhotic liver eventually will be unable to function normally, and the person with cirrhosis will become ill. Many factors can cause cirrhosis, most commonly long-term, heavy alcohol use and chronic hepatitis B and hepatitis C infection.
In the early stages of cirrhosis, you may not have any symptoms. The only way to know for sure is to get examined by your provider. Early diagnosis of cirrhosis can help prevent symptoms from developing.
It's also important to see your provider if you do have symptoms. These can include fluid buildup in the belly, swelling in the lower legs, small spidery-veins on your skin, easy bruising, itching, or shortness of breath. Your provider might be able to diagnose cirrhosis during an office examination. Sometimes, however, it may require blood tests, abdominal ultrasound, or a CT scan.
Cirrhosis is generally not considered to be reversible. However, there are different degrees of cirrhosis. "Compensated" cirrhosis means that a patient has cirrhosis but no complications such as fluid in the abdomen (ascites), disorientation or confusion (hepatic encephalopathy), or bleeding in the stomach or esophagus (variceal bleeding). A patient is considered to have "decompensated" cirrhosis if any of these complications are present.
If you are in a compensated state of cirrhosis, there are ways you can delay progression to a decompensated state:
- If you routinely drink alcohol, stop drinking.
- If you are overweight or obese, lose weight and exercise more.
- If you have hepatitis C or hepatitis B and are eligible for treatment, get started on medications to try to clear the virus.
It is more difficult to go in the reverse direction--from a decompensated state to a compensated state.
- If you drink alcohol, stop completely and permanently. With time, you may reverse to a compensated state.
No, cirrhosis can result from many things, not just heavy drinking. When something attacks and damages the liver, liver cells are killed and scar tissue is formed. When the whole liver is scarred, it shrinks, hardens, and can stop working properly. This is called cirrhosis. Cirrhosis is the most severe stage of liver damage.
Heavy drinking is certainly one cause, but any condition or illness that affects the liver over a long period of time eventually could lead to cirrhosis. That includes hepatitis B, hepatitis C, non-alcoholic steatohepatitis, autoimmune hepatitis, primary biliary cirrhosis (PBC), and other diseases. Some people have more than one of these conditions (for example, alcohol use plus hepatitis B infection). Sometimes those combinations will speed up the development of cirrhosis.
Cirrhosis is advanced scarring (fibrosis) in the liver. Many people who develop cirrhosis show no signs at all--they look exactly the same as they did before. For some people with cirrhosis, the scarring in the liver causes a buildup of bile and increases the level of bilirubin (a brownish-yellow substance found in bile) in the bloodstream. High bilirubin levels can make the skin appear yellow. So, although the skin of some people with cirrhosis may turn yellow, it does not happen to most people.
It is also important to know that a yellowish skin tone may be caused by cirrhosis, but it also could be caused by a different illness such as pancreatic cancer or colon cancer that has spread to the liver.
Acetaminophen (Tylenol) is considered safe in limited doses (a maximum of 2,000 mg, or 2 grams, every 24 hours) and some experts recommend limiting Tylenol to 1,000 mg (1 gram) per day.
Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, naproxen, diclofenac, and piroxicam, should be avoided. These can cause reduced kidney function in patients with cirrhosis. Do not take these without first consulting your provider.
Iron supplements, in general, should be avoided. If you take a multivitamin, it should not contain iron.
There are many other medications with potential for causing liver injury, including certain antibiotics, high blood pressure medications, diabetes medications, hormones, and antiretrovirals. Patients who already have cirrhosis should be particularly cautious when starting to use them. Before taking any new medication--whether prescription or over-the-counter or herbal--discuss it with your health care provider.
Of course, the most important substance to avoid when you have cirrhosis is alcohol.
If you have cirrhosis, you should:
- Get screened for liver cancer (hepatocellular carcinoma). Screening involves an ultrasound of the abdomen every 6 months.
- Get tested for the presence of abnormal blood vessels in the esophagus or stomach that can lead to bleeding. These are called varices. Typically, this involves an EGD (upper GI endoscopy) procedure and it is recommended this test be done, on average, every 2 years.
- Get blood tests 2-3 times per year to evaluate how your liver is doing. Typically, this involves blood cell counts, blood clotting measurements, liver enzyme tests, and tests of kidney function.
- Have your MELD score calculated. Your provider can calculate this using the results of your blood tests. The MELD score represents the severity of your liver disease.