Pronunciation
/sɪˈroʊsɪs/
Specialty Gastroenterology, Hepatology
Symptoms Tiredness, itchiness, swelling in the lower legs, jaundice, easily bruising, fluid build-up in the abdomen[1]
Complications Spontaneous bacterial peritonitis, hepatic encephalopathy, dilated veins in the esophagus, liver cancer[1]
Usual onset Over months or years[1]
Duration Long term[1]
Causes Alcoholic liver disease, hepatitis B, hepatitis C, non-alcoholic steatohepatitis[2][3][4]
Diagnostic method Blood tests, medical imaging, liver biopsy[5][1]
Prevention Vaccination (such as hepatitis B), avoiding alcohol;[1] losing weight, exercising, a low-fat/low-cholesterol diet, and controlling hypertension and diabetes may help in those with NAFLD or NASH
Treatment Depends on underlying cause[6]
Frequency 2.8 million (2015)[7]
Deaths 1.3 million (2015)[8]
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease.[9] Damage causes tissue repair and subsequent formation of scar tissue, which over time can replace normal functioning tissue, leading to the impaired liver function of cirrhosis.[9][10] The disease typically develops slowly over months or years.[1] Early symptoms may include tiredness, weakness, loss of appetite, unexplained weight loss, nausea and vomiting, and discomfort in the right upper quadrant of the abdomen.[2] As the disease worsens, symptoms may include itchiness, swelling in the lower legs, fluid build-up in the abdomen, jaundice, bruising easily, and the development of spider-like blood vessels in the skin.[2] The fluid build-up in the abdomen may become spontaneously infected.[1] More serious complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus, stomach, or intestines, and liver cancer.[11]

Cirrhosis is most commonly caused by alcoholic liver disease, non-alcoholic steatohepatitis (NASH – the progressive form of non-alcoholic fatty liver disease),[12] heroin abuse,[13] chronic hepatitis B, and chronic hepatitis C.[2][4] Heavy drinking over a number of years can cause alcoholic liver disease.[14] Liver damage has also been attributed to heroin usage over an extended period of time as well.[15] NASH has a number of causes, including obesity, high blood pressure, abnormal levels of cholesterol, type 2 diabetes, and metabolic syndrome.[3] Less common causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis that disrupts bile duct function, genetic disorders such as Wilson's disease and hereditary hemochromatosis, and chronic heart failure with liver congestion.[2]

Diagnosis is based on blood tests, medical imaging, and liver biopsy.[5][1]

Hepatitis B vaccine can prevent hepatitis B and the development of cirrhosis, but no vaccination against hepatitis C is available.[1] No specific treatment for cirrhosis is known, but many of the underlying causes may be treated by a number of medications that may slow or prevent worsening of the condition.[6] Avoiding alcohol is recommended in all cases.[1] Hepatitis B and C may be treatable with antiviral medications.[1] Autoimmune hepatitis may be treated with steroid medications.[1] Ursodiol may be useful if the disease is due to blockage of the bile duct.[1] Other medications may be useful for complications such as abdominal or leg swelling, hepatic encephalopathy, and dilated esophageal veins.[1] If cirrhosis leads to liver failure, a liver transplant may be an option.[3]

Cirrhosis affected about 2.8 million people and resulted in 1.3 million deaths in 2015.[7][8] Of these deaths, alcohol caused 348,000, hepatitis C caused 326,000, and hepatitis B caused 371,000.[8] In the United States, more men die of cirrhosis than women.[1] The first known description of the condition is by Hippocrates in the fifth century BCE.[16] The term "cirrhosis" was derived in 1819 from the Greek word "kirrhos," which describes the yellowish color of a diseased liver.[17]


Contents
1 Signs and symptoms
1.1 Liver dysfunction
1.2 Portal hypertension
1.3 Other nonspecific signs
1.4 Advanced disease
2 Causes
2.1 Common causes
2.2 Less common causes
3 Pathophysiology
4 Diagnosis
4.1 Imaging
4.2 Lab findings
4.3 Pathology
5 Grading
6 Prevention
7 Treatment
7.1 Preventing further liver damage
7.2 Lifestyle
7.3 Transplantation
7.4 Decompensated cirrhosis
7.5 Palliative care
7.6 Immunity
7.7 Bleeding and blood clot risk
8 Complications
8.1 Ascites
8.2 Esophageal and gastric variceal bleeding
8.3 Hepatic encephalopathy
8.4 Hepatorenal syndrome
8.5 Spontaneous bacterial peritonitis
8.6 Portal hypertensive gastropathy
8.7 Infection
8.8 Hepatocellular carcinoma
9 Epidemiology
10 Etymology
11 See also
12 References
13 External links
Signs and symptoms

Person with cirrhosis and associated pain in the right upper region of the abdomen
Cirrhosis can take quite a long time to develop, and symptoms may be slow to emerge.[2] Some early symptoms include tiredness, weakness, loss of appetite, weight loss, and nausea.[2] People may also feel discomfort in the right upper abdomen around the liver.[2]

As cirrhosis progresses, symptoms can include neurological changes.[2] This can consist of cognitive impairments, confusion, memory loss, sleep disorders, and personality changes.[2]

Worsening cirrhosis can cause a build-up of fluid in different parts of the body such as the legs (edema) and abdomen (ascites).[2] Other signs of advancing disease include itchy skin, bruising easily, dark urine, and yellowing of the skin.[2]

Liver dysfunction
These features are a direct consequence of liver cells not functioning:

Spider angiomata or spider nevi happen when there is dilatation of vasculature beneath the skin surface.[18] There is a central, red spot with reddish extensions that radiate outward. This creates a visual effect that resembles a spider. It occurs in about one-third of cases.[18] The likely cause is an increase in estrogen.[18] Cirrhosis causes a rise of estrogen due to increased conversion of androgens into estrogen.[19]
Palmar erythema presents as reddish palms below the thumb and little finger. This is seen in about 23% of cirrhosis cases.[20] This is a result of increased estrogen.[21]
Gynecomastia, or the increase of breast size in men, is caused by increased estradiol (a potent type of estrogen).[22] This can occur in up to two-thirds of cases.[23]
Hypogonadism signifies a decreased functionality of the gonads.[24] This can result in impotence, infertility, loss of sexual drive, and testicular atrophy. A swollen scrotum may also be evident.[25]
Liver size can be enlarged, normal, or shrunken in people with cirrhosis.[26] As the disease progresses, the liver will typically shrink due to the result of scarring.[27]
Jaundice is the yellowing of the skin. It can additionally cause yellowing of mucous membranes notably of the white of the eyes. This phenomenon is due to increased levels of bilirubin, which may also cause the urine to be dark-colored.[28]
Portal hypertension
9:31CC
Liver cirrhosis makes it hard for blood to flow in the portal venous system.[29] This resistance creates a backup of blood and increases pressure.[29] This results in portal hypertension. Effects of portal hypertension include:

Ascites is a build-up of fluid in the peritoneal cavity in the abdomen[30]
An enlarged spleen in 35 to 50% of cases[9]
Esophageal varices and gastric varices result from collateral circulation in the esophagus and stomach (a process called portacaval anastomosis).[31] When the blood vessels in this circulation become enlarged, they are called varices. Varices are more likely to rupture at this point.[10] Variceal rupture often leads to severe bleeding, which can be fatal.[31]
Caput medusae are dilated paraumbili