Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

• Fatigue
• Bleeding easily
• Easy bruising
• Fluid accumulation in your abdomen
• Loss of appetite
• Nausea
• Swelling in your legs
• Weight loss

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Cirrhosis is caused by scar tissue that forms in your liver in response to damage that occurs repeatedly over many years.

Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms in the liver. As the scar tissue builds up, it becomes increasingly difficult for the liver to function. In advanced cirrhosis, the liver no longer works. Because the liver is a vital organ that you can't live without, if it fails it must be replaced with a liver transplant.

A number of causes of liver damage
A wide variety of diseases and conditions can damage the liver and lead to cirrhosis, including:

• Chronic alcohol abuse
• Hepatitis B
• Hepatitis C
• Cystic fibrosis
• Destruction of the bile ducts (primary biliary cirrhosis)
• Fat that accumulates in the liver (nonalcoholic fatty liver disease)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
• Inability to process sugars in milk (galactosemia)
• Iron buildup in the body (hemochromatosis)
• Liver disease caused by your body's immune system (autoimmune hepatitis)
• Parasite common in developing countries (schistosomiasis)
• Poorly formed bile ducts in babies (biliary atresia)
• Problems storing and releasing energy your cells need to function (glycogen storage disease)
• Too much copper accumulated in the liver (Wilson's disease)

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Complications of cirrhosis can include:

• More frequent infections. If you have cirrhosis, your body may have difficulty fighting infections.
• Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients. This can lead to weakness and weight loss.
• High levels of toxins in the blood (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. Toxins in the blood can cause confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
• Increasing pressure in the main vein bringing blood to the liver (portal hypertension). Scar tissue can make it difficult for blood to flow freely through the liver. This causes increased pressure in the portal vein, which causes blood to be redirected to smaller veins near the liver. Those smaller veins may become overwhelmed by the pressure and can burst, causing serious bleeding. Building pressure in the veins of your esophagus is called esophageal varices. In the stomach this is called gastric varices.
• Increased risk of liver cancer. Cirrhosis can increase your risk of liver cancer. For this reason, your doctor may recommend regular ultrasound examinations of your liver to look for abnormalities.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You're likely to start by first seeing your family doctor or a general practitioner. If it's determined that you may have cirrhosis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist) or the liver (hepatologist).

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Bring copies of your medical records, including results of recent tests done by other doctors.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For cirrhosis, some basic questions to ask your doctor include:

• What is likely causing my cirrhosis?
• Is there a way to slow or stop my liver damage?
• Will I eventually need a liver transplant?
• What are my treatment options?
• How can I protect my liver from further damage?
• Is it OK to drink a small amount of alcohol if I have cirrhosis?
• Are there medications that can hurt my liver?
• What signs and symptoms of complications should I be alert for?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Tests and procedures used to diagnose cirrhosis include:

• Blood tests such as a complete blood count, bilirubin test and specific tests to determine the cause of cirrhosis
• Imaging procedures such as computerized tomography (CT), ultrasound and magnetic resonance imaging (MRI)
• Examination of a sample of liver tissue (liver biopsy), which is typically done using a needle guided by ultrasound imaging

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatments for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. For example:

• Treatment for alcohol dependency. People with cirrhosis caused by alcohol use need to stop drinking. If stopping alcohol use is difficult, your doctor may recommend a treatment program for alcohol addiction.
• Medications to control hepatitis. Medications may control damage to liver cells caused by hepatitis B or C.

Treatments for complications of cirrhosis
Your health care team will work to treat any complications of cirrhosis, such as:

• Excess fluid in your body. Fluid that accumulates in your abdomen (ascites) or your legs (edema) may be managed with a low-sodium diet and water pills. More severe fluid buildup may require procedures to drain the fluid or surgery to relieve pressure.
• Increased pressure in the portal vein and surrounding small veins. Blood pressure medications may control increasing pressure in the veins around your liver. This may prevent severe bleeding. Surgery to place a stent to hold open the portal vein also may be necessary. Your doctor may recommend an endoscopy procedure to examine the veins in your esophagus and stomach for signs of bleeding.
• Infections. You may receive antibiotics or other treatments for infections.
• Liver cancer screening. Your doctor may recommend periodic blood tests and ultrasound exams to look for signs of liver cancer.
• High levels of toxins in the blood (hepatic encephalopathy). Your doctor may instruct you to watch for signs and symptoms of hepatic encephalopathy, which can range from confusion and mild changes in your thinking to coma. Medications can help treat hepatic encephalopathy.

Liver transplant surgery
People with advanced cirrhosis may require liver transplants if their livers are no longer functioning (liver failure). Liver transplant is a procedure to remove your liver and replace it with a whole liver from a deceased donor or with part of a liver from a living donor.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If you have cirrhosis, take precautions to limit additional liver damage. For instance:

• Don't drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
• Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
• Choose a healthy diet full of fruits and vegetables. People with cirrhosis can experience malnutrition. Combat this with a healthy plant-based diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
• Avoid infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
• Use over-the-counter medications carefully. Liver cirrhosis makes it more difficult for your liver to remove drugs from your system. For this reason, ask your doctor before taking any medications, including nonprescription drugs. In general, avoid aspirin and other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). If you have liver damage, your doctor may recommend acetaminophen (Tylenol, others) for pain relief.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

No alternative medicine treatments have been proved to treat liver cirrhosis. Many alternative therapies are promoted as liver cleansing or liver flushing treatments, but there is no evidence to support this. Talk with your doctor if you're interested in trying alternative medicine to help you cope with cirrhosis.

Alternative treatments that are generally safe
Some alternative treatments have had some limited testing in people with liver disease. While none has shown any clear evidence that it can help people with liver disease, the treatments are relatively safe when discussed with your doctor and used as directed. Examples include:

• Milk thistle
• SAMe

Other alternative treatments that haven't been tested in people with cirrhosis may be helpful based on their use in people with other diseases and conditions, such as:

• Meditation
• Tai chi
• Yoga

Alternative treatments that are unsafe
A number of herbal supplements have been found to cause liver damage, including:

• Black cohosh
• Chapparal
• Comfrey
• Kava
• Mistletoe
• Pennyroyal
• Skullcap
• Some Chinese herbs, such as ma-huang
• Valerian

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Reduce your risk of cirrhosis by taking care of your liver. For instance:

• Drink alcohol in moderation, if at all. If you're a man, drink no more than two drinks a day. If you're a woman or anyone 65 or older, drink no more than one drink a day.
• Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
• Maintain a healthy weight. An excess amount of body fat can damage your liver. Lose weight if you are obese or overweight.
• Use chemicals sparingly and carefully. Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process.
• Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Protect yourself by abstaining from sex or using a condom if you choose to have sex. Ask your doctor whether you should be vaccinated for hepatitis B.

If you're concerned about your risk of liver cirrhosis, talk to your doctor about ways you can reduce your risk.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.