In the early stages of cirrhosis, there may be no symptoms at all, or you may have some symptoms that do not indicate something is wrong.

The classic signs of cirrhosis are:

• Itchy skin
• Yellow skin
• Bruising more than normal or easier than normal
• Low appetite
• Feeling tired
• Feeling weak
• In later stages of the disease symptoms advance to:
  Swelling in the abdomen
• Nausea
• Trouble thinking and remembering
• Anemia
• Weight loss
• Swelling in the legs, feet, and ankles

Contrary to the common belief that cirrhosis is a disease of alcoholism, there are many different causes. Causes of cirrhosis include:

Long-term alcoholism. Long-term heavy drinking is the number one cause of liver cirrhosis. Large amounts of alcohol over a long period of time causes swelling and scarring of the liver.

Hepatitis. Hepatitis B, hepatitis C, and hepatitis D are all known to cause cirrhosis. Hepatitis is the second most common cause of cirrhosis. Statistics show that one out of four people with this virus develop cirrhosis.

Nonalcoholic cirrhosis (steatohepatitis). Steatohepatitis, or fatty liver disease, is caused by a collection of fat on the liver. It causes liver swelling and scarring that is unrelated to alcohol use. People with nonalcoholic cirrhosis are overweight and usually have other health issues such as high cholesterol, diabetes, and an unhealthy diet.

Biliary disease. Diseases of the bile duct (e.g., biliary cirrhosis and sclerosing cholangitis) are very common causes of liver cirrhosis. This is because the liver releases bile into the biliary duct and these diseases block the flow of bile. The accumulation of bile causes liver swelling and damage.

Genetics. There are forms of liver disease that are genetic in nature and present from birth. These include autoimmune hepatitis, Alpha-1 antitrypsin deficiency, Wilson’s disease, and hemochromatosis.

If you have any of the conditions above, plus any of the risk factors below, you may be at higher risk for cirrhosis:

Genetics. Someone in your family has cirrhosis.

Gender. Males are at higher risk for alcoholic cirrhosis. Women are at higher risk for biliary cirrhosis.

Age. Cirrhosis is most common in 30- to 60-year-olds.

Infection. Certain viral, fungal, and bacterial infections can damage the liver.

History of smoking. Smoking increases the risk of cirrhosis.

Chemical exposure. Certain toxins can strain the liver and/or set off an immune reaction in the liver.

If you suspect an issue with your liver, see your doctor. Be sure you let them know your medical history and the medications you are taking. It is very important to be upfront about your social history including alcohol use, drug use, and sexual history. The doctor may run the following tests:

Liver function tests. The doctor can see the health of your liver with a liver function panel. These will show the doctor if your liver is functioning properly.

Antibody levels. People with cirrhosis may have a high level of anti-mitochondrial antibodies. These are a sign the immune system may be attacking the liver.

Liver ultrasound. The doctor may order an ultrasound where they place a doppler on your skin. They can see the outline of the liver and any scarring.

CT/MRI scans. These can give a much more detailed picture of the organs.

Endoscopy. The doctor can look with a scope at the bile ducts.

Liver biopsy. As a last resort, the doctor may opt for a liver biopsy to see what stage the cirrhosis is at.

There is no cure for cirrhosis and the damage cannot be repaired. Some treatments may slow the progression of the disease. If the disease becomes advanced, a liver transplant may be needed. Treatments for cirrhosis include:

• Treat alcoholism
• Lose extra weight
• Medications
• Low-protein diet

If left untreated, cirrhosis can have health complications. These complications and their treatmentsare:

Portal hypertension. When the liver hardens due to cirrhosis, the flow of blood through the veins in the liver slows down. This increases blood pressure in other veins around the liver.

Treatments include blood pressure medications and transjugular intrahepatic portosystemic shunt (TIPS), in which a shunt is placed in the vein to open it up and increase blood flow.

Hepatic encephalopathy. When liver damage becomes severe it cannot do its job to clean toxins out of your blood. This means that your brain is nourished by blood full of toxic substances. This can lead to confusion, trouble thinking, personality changes, and can lead to a coma if left untreated. Treatment for hepatic encephalopathy involves giving medications that can help remove the toxins from the blood.

Edema and ascites. When the portal vein cannot carry blood properly through the abdominal cavity, fluid begins to build up in the lower legs, ankles, and abdomen (ascites). One reason this happens is that there are low albumin levels from the liver. Treatments for edema and ascites include a low-salt diet, diuretic medications, and if necessary, draining fluid from the abdomen with a needle (paracentesis).

Bleeding. The liver makes certain proteins that help your blood to clot. Cirrhosis reduces the production of these proteins and can lead to bleeding and anemia. Another bleeding condition common in cirrhosis is varices. Portal hypertension causes smaller veins to become engorged and burst, leading to bleeding. This is most common in the esophagus and abdomen. Treatments for this complication include; (1) medications such as beta-blockers to control bleeding; (2) banding to “tie-off” the varices to prevent them from getting blood flow; (3) a distal splenorenal shunt may be placed to divert blood flow away from the varices, (4) devascularization, which is complete removal of the varices; (5) the doctor may perform an esophageal transection. This means that they will cut into the esophagus and tie-off the varices.

Peritonitis. Fluid buildup in the abdomen can lead to infection in the lining of the abdominal cavity. This is treated with antibiotics and then the fluid is drained.

Liver failure. In the later stages of the disease, complete liver failure usually occurs. Once this happens, the only treatment is a liver transplant.

There are some alternative remedies that natural medicine practitioners may offer. These include:

• Licorice root
• Astralagus
• Milk thistle

Most doctors are wary of herbal supplements for liver disease because of the risk of more liver damage from some herbs. If you want to try an herbal supplement, talk to your doctor first.

The most common occurrences of cirrhosis are very preventable if you take the following precautions:

Limit alcohol use. If you do not have liver disease but do have risk factors for cirrhosis, limit alcohol use. Remember that some people can develop cirrhosis with very little alcohol use. Avoid daily drinking and only allow yourself one or two drinks per week.

Use caution with medications. Some medications can be toxic to the liver, such asacetaminophen. If you take this medication, do not drink with it as this can double the effects on the liver.

Protect yourself from chemical exposure. Some chemicals can be absorbed by breathing them in or touching them. When they enter your bloodstream, the liver must filter them out. Over time, this can damage the liver.

Protect yourself from hepatitis. If you use intravenous street drugs, do not share needles. Use a condom during sex with multiple partners and get your hepatitis B vaccinations.

If you have been diagnosed with cirrhosis, certain lifestyle changes can help reduce liver damage and symptoms. These include:

• Quit drinking alcohol completely
• Eat a healthy diet low in salt and protein
• Make sure you get vaccinated for Hepatitis A, Hepatitis B, Influenza, and pneumonia

Check with your doctor before taking any new medications or herbal supplements.

Clinical trials are the most current research studies available to patients who are willing to volunteer for treatment that has yet to be released to the general public. The Mayo Clinic and the National Institute of Health are actively educating the general public aboutseveral clinical trials for people suffering from cirrhosis of the liver.

Cleveland Clinic. (2020). Cirrhosis of the liver. Retrieved from Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

Fornari, F. (1990, November). Cirrhosis of the liver. Digestive Diseases and Sciences, 35, 1403-1408.Retrieved from:https://link.springer.com/article/10.1007/BF01536748

Heidelbauch, J., Bruderly, M. (2006, September 01). Cirrhosis and chronic liver failure: Part I diagnosis and evaluation. American Family Physician, 74(5). Retrieved from: http://hdl.handle.net/10234/187818

Mayo Clinic. Cirrhosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

Perz, J. et al. (2006).The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. Journal of Hepatology, 45(4), 529-538.Retrieved from:https://www.journal-of-hepatology.eu/article/S0168-8278(06)00297-2/fulltext

Ratnoff, O., Patek, A. J. Jr.(1942, September). The natural history of Laennec’s cirrhosis of the liver an analysis of 386 cases. Medicine, 21(3), 207-268. Retrieved from: https://journals.lww.com/md-journal/Citation/1942/09010/THE_NATURAL_HISTORY_OF_LAENNEC_S_CIRRHOSIS_OF_THE.1.aspx