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Cirrhosis refers to the long-term, progressive scarring of the liver tissue that interferes with the liver’s ability to function properly. The liver has two primary sources of blood: the hepatic artery, which provides oxygen-rich blood, and the hepatic portal vein, which carries blood from the digestive system that contains nutrients and toxins. When cirrhosis develops, the liver shrinks and becomes hardened, which disrupts the flow of blood and causes pressure in the portal vein, known as portal hypertension. This can lead to several complications that impact liver health and overall well-being.

Compensated vs. Decompensated Cirrhosis

Cirrhosis is often categorized into two types: compensated and decompensated.

Compensated cirrhosis refers to the early stages of cirrhosis, where the liver is still able to function despite the scarring. Individuals with compensated cirrhosis may not experience noticeable symptoms, though the liver is already damaged.
Decompensated cirrhosis occurs when the liver’s ability to function deteriorates and portal hypertension develops (which is congested blood flow in the abdominal blood vessels due to scarring of the liver) leading to severe complications such as ascites (fluid buildup in the abdomen), varices (enlarged veins in the wall of the esophagus and stomach that may rupture and cause bleeding), and encephalopathy (confusion or coma due to toxin buildup).

Symptoms of Cirrhosis

In the early stages, cirrhosis may not present with noticeable symptoms. However, as the disease progresses to decompensated cirrhosis, veterans may experience:

Ascites (fluid buildup in the abdomen causing discomfort)
Jaundice (yellowing of the skin and eyes due to bilirubin buildup)
Fatigue and general weakness
Pain or discomfort in the upper abdomen
Swelling in the legs and feet
Confusion or memory issues (due to hepatic encephalopathy)
Vomiting blood or passing black, tarry stools (if varices rupture)

Veterans with these symptoms should seek immediate medical attention to avoid complications.

Diagnosis of Cirrhosis

The diagnosis of cirrhosis is typically made through a combination of physical exams, blood tests, imaging (such as ultrasound, CT scans, or MRI), and sometimes liver biopsy. Regular screenings and liver function tests are critical for veterans, especially those with risk factors like hepatitis, heavy alcohol use, or metabolic conditions. Early detection allows for better management and the prevention of further liver damage.

Management and Treatment of Cirrhosis

There is no cure for cirrhosis, but it is possible to slow its progression and manage symptoms effectively. Veterans with cirrhosis are at increased risk of hepatocellular carcinoma, or liver cancer. Laboratory tests and liver imaging every 6 months are needed to see how the liver is functioning and to monitor for liver cancer. With some of these labs we calculate a score to estimate if the liver is getting worse. This score is called MELD 3.0 and it is also used to select which patients are sickest and need a liver transplant.

Treatment is aimed at addressing the underlying cause of cirrhosis and preventing further liver damage. For veterans, this may involve:

Managing conditions like hepatitis B and C, diabetes, hypertension, high cholesterol, and obesity to prevent worsening of cirrhosis
Avoiding alcohol (beer, liquor, and wine) and other substances that may further damage the liver
Medications to reduce portal hypertension, manage ascites, and treat hepatic encephalopathy
Large volume paracentesis (LVP)is a procedure to drain ascites (fluid in the abdominal cavity) and improve discomfort, but without making the liver better
A transjugular intrahepatic portosystemic shunt (TIPS) is a stent inserted into the liver through a minimally invasive procedure performed by an interventional radiologist. This stent creates communication between veins inside the liver. By helping the blood flow easier through the liver, it is an effective treatment for ascites or bleeding from varices. Not all patients can benefit from TIPS, as it can cause complications such as worsening confusion, heart failure or liver failure.
Liver transplant may be considered for veterans with end-stage cirrhosis or liver failure. Transplant evaluation is typically recommended once cirrhosis progresses to decompensated stages, and the liver can no longer function adequately.

Ascites

Ascites, the buildup of fluid in the abdominal cavity, is one of the common complications of portal hypertension. It can cause significant discomfort, swelling, and pain. Managing ascites often involves dietary changes (low-salt diet), medications to remove excess fluid, and sometimes procedures to drain the fluid (paracentesis) or insertion of a TIPS. Regular monitoring is essential to prevent complications.

Hepatic Encephalopathy

Hepatic encephalopathy occurs when the liver can no longer filter out toxins from the blood, leading to an accumulation of ammonia that affects brain function. This can cause confusion, disorientation, and in severe cases, coma. Hepatic encephalopathy can be manageable with medications that help remove ammonia from the body, but it requires regular treatment and monitoring to keep symptoms under control.

Varices

Varices are enlarged veins in the esophagus or stomach that occur when blood cannot flow properly into the liver. These veins can rupture and cause life-threatening bleeding. Veterans with cirrhosis should consult with their medical team to see if they are at risk for varices. If necessary, doctors can treat varices by medication or during an upper endoscopy procedure with variceal banding or tying them off to prevent them from rupturing.

Cirrhosis can affect other organs, in particular kidneys, lungs, or heart. One of the most feared complications of cirrhosis is hepatorenal syndrome, which is kidney failure caused by the sick liver, that is why patients with cirrhosis also need periodic testing to monitor their kidney function.

What is Cirrhosis?