Signs and Symptoms of Cirrhosis
Medically reviewed by Jay N. Yepuri, MD
Cirrhosis is a condition characterized by scarring of the liver that results in permanent damage. Replacement of healthy liver tissues by scar tissues prevents the liver from functioning properly, causing symptoms of cirrhosis such as nausea, fatigue, itchiness, pain, and weakness. Scar tissue also blocks the flow of blood throughout the liver. One in 400 people in the United States are estimated to have cirrhosis.
You might not experience any symptoms during the early stages of cirrhosis. Symptoms of cirrhosis occur when the liver has been damaged significantly. Several factors can cause cirrhosis, including excessive consumption of alcohol, infection with viral hepatitis, untreated metabolic disorders, bile duct diseases, and others.
In some cases, cirrhosis can progress rapidly, leading to severe symptoms such as internal bleeding, swelling of legs or ankles, fluid build-up in the abdomen, as well as yellow discoloration of skin and whites of eyes.
Common Symptoms
Cirrhosis symptoms are most often non-specific or absent at early stages. You might start experiencing symptoms when excessive scar tissue replaces healthy liver tissue.
A few common symptoms include:
Itchy skin
Weight loss
Mild pain in the upper side of the abdomen
Muscle weakness and cramps
Advanced Symptoms
You might experience other severe symptoms as cirrhosis progresses, leading to continued worsening of liver function. These symptoms include:
Jaundice: This is a condition characterized by yellow discoloration of the skin and whites of the eyes. Persistently dark urine and pale stool generally occur before jaundice begins.
Ascites: Ascites is a build-up of fluid excessive fluid in the abdominal cavity that causes swelling of the abdomen.
Internal bleeding: Internal bleeding can occur due to the bursting of enlarged vessels termed varices that occur in the esophagus, intestines, or stomach.
Edema: Edema is the retention of excessive fluid in the body that causes swelling mostly in the legs, feet, or ankles.
Hepatic encephalopathy: This is the build-up of toxins in the brain due to improper filtering of the blood by the liver.
Symptoms by Stage
The symptoms of cirrhosis fall under two clinical stages: compensated and decompensated cirrhosis. Early diagnosis can help in the reversal from the decompensated to the compensated stage.
Compensated Stage
This is the asymptomatic stage where you do not have any observable symptoms. There might still be scarring of the liver but it has not become severe enough to cause symptoms. The outlook for the compensated stage is good; the median survival time is 12 years post-onset.
Decompensated Stage
This stage is characterized by the presence of at least any one of the complications including bleeding, ascites, jaundice, or hepatic encephalopathy. This stage can progress rapidly to liver failure and can become fatal. The median survival of decompensated stage is about 2-4 years. You can reverse it to the compensated stage in case of early diagnosis and treatment.
Symptoms in Children
Chronic liver conditions can lead to cirrhosis in children and adolescents. Cirrhosis can occur in infants mostly due to genetic-metabolic diseases and biliary atresia (a condition that occurs in infants where the bile ducts are scarred and consequently blocked, keeping them from sending bile to the infant's small intestine).
For older children, it can occur due to:
Alpha-1-antitrypsin deficiency: This is characterized by low levels of alpha-1 antitrypsin, or ATT, which is a protein the liver makes to protect your lungs.
Wilson’s disease: A genetic disorder that inhibits your body from naturally removing copper, causing it to build up in your organs.
Primary sclerosing cholangitis: A liver disease where the small bile ducts in the liver become inflamed and scarred, eventually narrowing or becoming blocked.
Autoimmune hepatitis: This is characterized by your immune system mistakenly attacking your liver.
Children experience similar cirrhosis symptoms just as adults. However, in most cases, the first symptom is reduced weight gain. Other symptoms include:
Fatigue
Nausea
Muscle weakness
Vomiting
Children also experience similar severe symptoms to adults including:
Ascites
Internal bleeding
Inflammation of the lining of the abdomen
When to See a Healthcare Provider
Symptoms of cirrhosis develop at a time when significant liver damage has taken place which cannot be reversed. You want to see a healthcare provider if you notice:
Black or bloody stools
Persistent or severe abdominal pain
Swollen legs or ankles
Unusual fluid build-up in the abdomen
Confusion
Recurring fever
Signs of jaundice
Healthcare providers can recommend blood tests, imaging tests, and liver biopsy to confirm the diagnosis of cirrhosis or another liver disease. They may refer you to a hepatologist, or a doctor who specializes in the liver.
A Quick Review
Cirrhosis is a liver condition that occurs due to the significant replacement of healthy liver tissue with scar tissue. It can occur due to excessive consumption of alcohol, untreated metabolic disorders, infection with viral hepatitis, or an untreated liver injury.
You may not experience the symptoms of cirrhosis until significant liver damage takes place. The initial symptoms include nausea, fatigue, abdominal pain, and muscle weakness. If left untreated it can progress to severe symptoms. You want to see your healthcare provider if you experience such symptoms in order to prevent disease progression and adverse outcomes.
Frequently Asked Questions
How long can you have cirrhosis without knowing?
You can have cirrhosis for years without knowing it. This is because cirrhosis does not cause any visible symptoms until the liver is damaged badly.
How quickly does cirrhosis progress?
Compensated cirrhosis might take a decade to progress but decompensated progresses quite rapidly and is associated with high mortality risk.
Can you live a normal life with cirrhosis?
You can live a normal life with cirrhosis but your healthcare provider might recommend treatments and lifestyle changes depending on the severity and cause of cirrhosis.
What are the 5 stages of cirrhosis?
Cirrhosis has two clinical stages that comprise five sub-stages. These include:
Stage 1a, characterized by no varices and blockage of blood flow through the portal vein
Stage 1b, characterized by blockage of blood flow through the portal vein resulting in portal hypertension but no varices
Stage 2, characterized by portal hypertension and varices
Stage 3, characterized by internal bleeding from the varices
Stage 4, characterized by the onset of ascites or hepatic encephalopathy
Stage 5, characterized by recurrent internal bleeding from varices, jaundice, recurrent ascites, or recurrent hepatic encephalopathy
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