Cirrhosis

What is cirrhosis?

Cirrhosis means scarring of the liver. Over time, ongoing liver damage causes healthy liver cells to die and be replaced with stiff scar tissue. This process is usually slow and irreversible, and it interferes with the liver’s ability to function properly.

What causes cirrhosis?

Cirrhosis can result from many different liver conditions. The most common causes in Australia include:

Other less common causes include autoimmune liver disease, inherited liver disorders, and bile duct diseases.

What are the symptoms of cirrhosis?

Cirrhosis often develops silently over many years, and symptoms may not appear until liver function is significantly impaired. When present, symptoms may include:

  • Fatigue

  • Loss of appetite or unintentional weight loss

  • Nausea

  • Itchy skin

  • Yellowing of the skin or eyes (jaundice)

  • Dark urine and pale stools

  • Abdominal swelling (ascites)

  • Swelling in the legs or ankles (oedema)

  • Confusion, poor concentration or drowsiness (hepatic encephalopathy)

  • Easy bruising or bleeding

If you experience any of these symptoms, especially in the context of known liver disease or risk factors, it’s important to seek medical advice.

Why is cirrhosis a problem?

Scarring affects both the structure and function of the liver. This can lead to:

  • Backpressure in the portal vein (which supplies blood to the liver), causing:

    • An enlarged spleen

    • Fluid build-up in the abdomen (ascites)

    • Varices – large veins in the oesophagus or stomach that may bleed

  • Toxin build-up in the bloodstream, as the liver can no longer filter properly – leading to confusion or drowsiness (called hepatic encephalopathy)

  • Reduced liver function, resulting in:

    • Jaundice (yellowing of the skin and eyes)

    • Easy bruising or bleeding

    • Low levels of essential proteins

People with cirrhosis are also at increased risk of liver cancer, with an estimated 2–3% annual risk of developing hepatocellular carcinoma (HCC)

What are the stages of cirrhosis?

Cirrhosis is classified into two main stages: compensated and decompensated. These stages help determine how well the liver is functioning and guide treatment decisions.

Compensated Cirrhosis

In compensated cirrhosis, the liver is scarred but still able to perform most of its essential functions. Many people with compensated cirrhosis have no symptoms or only mild, non-specific ones. With appropriate monitoring and management of the underlying cause, compensated cirrhosis can remain stable for many years and patients can maintain a good quality of life. However, complications may still develop over time. Regular monitoring is essential to detect disease progression, especially the development of portal hypertension or early signs of decompensation.

Decompensated Cirrhosis

Decompensated cirrhosis occurs when the liver is no longer able to carry out its normal functions due to severe scarring and damage. This stage is associated with serious complications. Presentations of decompensated cirrhosis include:

  • Ascites (accumulation of fluid in the abdomen)

  • Jaundice (yellowing of the skin and eyes)

  • Hepatic encephalopathy (confusion caused by toxin build-up)

  • Variceal bleeding (from enlarged veins in the oesophagus or stomach)

Decompensated cirrhosis requires close monitoring, treatment and may lead to consideration for liver transplantation in eligible individuals. Decompensated cirrhosis carries a poorer prognosis, with reduced life expectancy without appropriate management. However, many of these complications can be controlled with medications and specialist care.

How is cirrhosis managed?

While cirrhosis cannot usually be reversed, careful monitoring and supportive treatment can reduce complications and improve quality of life. Management typically includes:

1. Treatment of underlying disease

Managing the root cause is a key part of slowing or halting disease progression:

  • Hepatitis B or C – antiviral therapy may help suppress or cure the infection

  • Alcohol-related liver disease – complete alcohol cessation is essential

  • MAFLD – weight loss, improved metabolic control, and management of diabetes and cholesterol

  • Autoimmune liver diseases – immunosuppressive medication

  • Iron overload or other inherited liver conditions – specific therapies may apply

2. Regular cancer screening

Cirrhosis increases the risk of liver cancer. You will need:

  • Liver ultrasound and blood test (AFP) every 6 months

3. Screening for varices

Patients may be advised to have a gastroscopy to check for varices. This decision is often based on clinical factors, blood and FibroScan results. The frequency of monitoring depends on the severity of liver disease and whether varices are found

4. Medical therapy

Non-selective beta blockers are indicated in patients with clinically significant portal hypertension

5. Nutrition support

Cirrhosis often leads to malnutrition and muscle wasting. A adequate diet is crucial to support your health. A dietitian should be involved to tailor your nutrition plan.

6. Routine blood tests

Blood tests help assess liver function and detect complications. These are typically needed before each clinic appointment, ideally within a few days of the visit.

7. Bone health

Cirrhosis increases the risk of osteopenia and osteoporosis (thinning of the bones), which can lead to fractures.

  • A healthy diet (with calcium containing foods) and vitamin supplements may be recommended

  • Monitoring of bone density using DEXA scans

8. Surgical precautions

Some surgeries can stress the liver or trigger liver failure. Always inform your healthcare team if surgery is planned, so that appropriate precautions can be taken.