Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- Cirrhosis is caused by long-term liver injury, most often from hepatitis B, hepatitis C, fatty liver or alcohol.
- Portal hypertension means raised pressure in the vein system that carries blood from the gut to the liver. It causes swollen veins in the food pipe (varices), fluid in the abdomen (ascites) and an enlarged spleen.
- Treating the cause, avoiding alcohol and regular follow-up are the foundations of care. Vomiting blood, black stools, new confusion or fever with abdominal pain are emergencies.
- People with cirrhosis need regular ultrasound checks, usually every six months, to look for liver cancer early.
Overview
In cirrhosis, healthy liver tissue is replaced by scar tissue and the liver becomes firm and lumpy. In the early stage (compensated cirrhosis) the liver still copes and people may feel well. When complications appear, it is called decompensated cirrhosis.
Scarring blocks the flow of blood through the liver. Pressure rises in the portal vein (portal hypertension), and blood is forced through fragile side channels, such as veins in the lower food pipe and stomach (varices), which can bleed. Portal hypertension and a failing liver together cause ascites, kidney problems and hepatic encephalopathy (confusion caused by toxins the liver cannot clear).
Cirrhosis is not always relentless progression. If the cause is controlled, for example by curing hepatitis C, suppressing hepatitis B or stopping alcohol, liver function can stabilise or improve, and complications become less likely.
Causes and risk factors
- Chronic hepatitis B and C
- Fatty liver disease (MASLD) and diabetes
- Alcohol-related liver disease
- Autoimmune liver diseases (autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis)
- Genetic and metabolic diseases such as Wilson disease and haemochromatosis, and long-standing bile duct blockage
Symptoms
- Tiredness, loss of appetite, weight or muscle loss
- Yellow eyes or skin, itching
- Swelling of the abdomen or legs (fluid)
- Easy bruising or bleeding, spider-like marks on the skin, red palms
- Confusion, poor concentration, sleep reversal (awake at night, sleepy by day)
- Vomiting blood or black stools if varices bleed
When to seek urgent medical care
- Vomiting blood or coffee-ground vomit, or black stools
- New confusion, severe drowsiness or unusual behaviour
- Fever with abdominal pain or rapidly swelling abdomen (possible infection of the ascitic fluid)
- Passing very little urine, or fainting
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- Blood tests: liver function, blood count (platelets), kidney function, clotting, and tests for the cause
- Ultrasound and elastography to stage scarring, and to look for a liver lump
- Endoscopy to look for varices, unless non-invasive tests show the risk is very low. Your doctor will decide
- Ultrasound (with or without an AFP blood test) about every 6 months to screen for liver cancer
- Testing a sample of ascitic fluid when fluid is new or the patient is unwell
Treatment
Treat the cause
- Antivirals for hepatitis B or C, complete alcohol avoidance, weight and diabetes control for fatty liver, and specific treatment for autoimmune or metabolic causes
Prevent and treat complications
- Varices: medicines such as non-selective beta-blockers (for example carvedilol) or endoscopic band ligation reduce the risk of first bleeding. Bleeding is treated urgently in hospital with endoscopy
- Ascites: reduced salt, water tablets (diuretics) and sometimes fluid drainage. Avoid anti-inflammatory painkillers
- Confusion: treated with lactulose and, in some cases, rifaximin, and by treating triggers such as infection, constipation, dehydration or bleeding
- Infections are common and can be serious, so fever or new abdominal pain needs prompt review
Referral
- When cirrhosis is advanced or complications recur, early referral to a liver transplant centre is part of good care
What you can do
- Do not restrict protein. People with cirrhosis usually need more protein, often around 1.2 to 1.5 g per kg of body weight a day unless advised otherwise, in small frequent meals plus a late-evening snack to protect muscle
- With ascites, limit salt as advised (commonly under 2 g of sodium, about 5 g salt, a day); do not restrict fluids unless told to
- Avoid alcohol completely
- Avoid anti-inflammatory painkillers (ibuprofen, diclofenac, aspirin) and unlabelled herbal remedies unless your doctor agrees. Keep paracetamol within the dose your doctor gives you
- Stay active within your limits; gentle strength and walking exercise help muscle mass
- Keep vaccinations up to date (hepatitis A and B, influenza, pneumococcus), and attend every follow-up and screening appointment
Common questions
Can cirrhosis be reversed?
Established advanced scarring usually does not disappear completely, but if the cause is treated the liver can stabilise and sometimes improve, and the risk of complications falls. The earlier the cause is treated, the better.
Why do I need an endoscopy?
Endoscopy looks for varices in the food pipe and stomach. If they are present, treatment can greatly reduce the chance of dangerous bleeding.
Should I eat less protein?
No. Protein restriction is outdated and can worsen muscle loss. Most people with cirrhosis need adequate protein. Your doctor or dietitian will guide you, and may adjust it in special situations.
How often do I need an ultrasound?
Usually every six months, to look for liver cancer at an early, treatable stage. Your doctor will confirm what is right for you.
اردو خلاصہ
سروسس میں جگر میں گہرے زخم (سکارنگ) بن جاتے ہیں۔ وجوہات میں ہیپاٹائٹس بی، سی، فیٹی لیور، الکحل اور خود مدافعتی بیماریاں شامل ہیں۔ پورٹل ہائپرٹینشن کا مطلب جگر کی طرف جانے والی رگ میں دباؤ کا بڑھ جانا ہے، جس سے خوراک کی نالی کی رگیں (ویریسز) پھول سکتی ہیں اور پیٹ میں پانی بھر سکتا ہے۔
بنیادی وجہ کا علاج، الکحل سے مکمل پرہیز، ڈاکٹر کی ہدایت کے مطابق ادویات، پروٹین بند نہ کرنا (تھوڑا تھوڑا کئی بار کھائیں) اور باقاعدہ فالو اپ ضروری ہے۔ جگر کے کینسر کی جانچ کے لیے عموماً ہر چھ ماہ بعد الٹراساؤنڈ ہوتا ہے۔
خون کی قے، کالا پاخانہ، نئی الجھن یا غنودگی، یا بخار کے ساتھ پیٹ کا درد ہو تو فوراً ہسپتال کی ایمرجنسی جائیں۔
Videos on this topic
Dr Usman Naeem’s own videos (mostly Urdu). They load only when you press play.
Liver Damage Warning: What Cirrhosis Does to Your Body & How to Stop It: Life-Saving Treatments
Watch on YouTube12 Signs of Liver Disease |What is Liver Cirrhosis and Its Warning Signs?|
Watch on YouTubeپیٹ میں پانی بھر گیا؟ (Ascites) 7 احتیاطیں جو ہر مریض کو معلوم ہونی چاہئیں
Watch on YouTubeSwollen Belly Due to Liver Disease? 4 Proven Ways to Manage Ascites
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.