Cirrhosis of the Liver: Early Symptoms, Causes and Tests

What it involves

MedlinePlus explains that cirrhosis is scarring of the liver that results in poor liver function, and that it is the last stage of chronic liver disease. Scar tissue cannot make proteins, help fight infection, clean the blood or help digest food the way healthy liver tissue does. In most cases the liver cannot return to normal function once the damage is severe.

Who this is for

• Adults with hepatitis B or hepatitis C who want to know whether the liver has been affected
• Patients who drink alcohol regularly and have fatigue, poor appetite or belly discomfort
• People with fatty liver, diabetes, high blood pressure, high cholesterol or extra weight
• Anyone with yellow skin or eyes, easy bruising, or swelling in the legs or belly

What to expect

• Questions about alcohol use, hepatitis exposure, medicines and supplements, and family history of liver disease
• An exam for yellow skin or eyes, swelling in the belly or legs, small red spider-like vessels and an enlarged liver
• Blood work, which can include liver function tests, a blood count and hepatitis B and C testing
• A referral for an abdominal ultrasound, a FibroScan or a liver specialist when the findings call for it

Common causes in the United States

MedlinePlus says cirrhosis is most often the end result of long-term liver damage from hepatitis B or hepatitis C infection, alcohol overuse, or a buildup of fat in the liver that is not caused by alcohol. That fat buildup is closely related to being overweight, high blood pressure, diabetes or prediabetes, and high cholesterol. Less common causes include autoimmune hepatitis, bile duct disorders, some medicines and inherited liver diseases. The fatty liver disease guide and the metabolic syndrome guide explain the common starting points.

Early symptoms

The encyclopedia says there may be no symptoms, or they may come on slowly depending on how well the liver is working, and that cirrhosis is often found by chance during an abdominal ultrasound or a blood test for another reason. Early symptoms include fatigue and loss of energy, poor appetite and weight loss, nausea or belly pain, and small red spider-like blood vessels on the skin. The fatigue guide describes how a provider sorts out tiredness that has many possible causes.

Later signs

As liver function worsens, MedlinePlus lists fluid buildup in the legs or in the abdomen, yellow color in the skin and eyes, redness on the palms, easy bruising and abnormal bleeding, confusion or trouble thinking, and pale or clay-colored stools. The jaundice guide, the leg swelling guide and the easy bruising guide each explain one of these signs on its own, and a new combination of them is a reason to be seen promptly.

How cirrhosis is found

A provider examines for an enlarged liver or spleen, a swollen abdomen, swollen legs, reddened palms and yellow eyes or skin. MedlinePlus lists tests for the cause, including hepatitis virus testing, and tests of liver function such as a blood count, prothrombin time, liver function tests and a blood albumin level. Serenity By A Dr. Sareen lists blood work among its services, and the liver function tests guide and the hepatitis C screening guide explain two of the first steps. Ultrasound, CT, MRI, FibroScan and biopsy are arranged by referral.

Treatment and protecting the liver

MedlinePlus says nothing will make the scar tissue disappear, but treating the cause can keep it from getting worse. It advises no alcohol, a healthy diet low in salt, fat and simple carbohydrates, exercise, and getting vaccinated for diseases such as influenza, COVID-19, hepatitis A and B, and pneumococcal disease. Tell your provider about all medicines, herbs and supplements. Controlling blood pressure, diabetes and cholesterol matters too, and the practice lists diabetes management and blood pressure care among its services. Adults with long-term liver disease can have their other conditions and medicines followed by an internist, such as at the Loxahatchee internal medicine office.

Complications that need attention

The encyclopedia lists bleeding disorders, fluid in the abdomen that can become infected, enlarged veins in the esophagus or stomach that can bleed, kidney failure, and confusion or a change in alertness. A small number of people with cirrhosis get liver cancer. When cirrhosis reaches end-stage liver disease, a liver transplant may be needed. Regular follow-up, honest talk about alcohol, which the alcohol screening guide describes, and hepatitis testing are the parts of care a primary care office can keep on schedule. Inherited iron overload is one cause of liver damage that people often do not know they have, and the hemochromatosis guide explains it. Advanced liver disease is one of the causes of fluid collecting around the lungs, and the pleural effusion guide explains the symptoms and how that fluid is checked.

Sources

• MedlinePlus: Cirrhosis (health topic)
• MedlinePlus: Cirrhosis (medical encyclopedia)