Cirrhosis of the Liver

When something attacks and damages the liver, liver cells are killed and scar tissue forms (over the span of a number of years), which is known as fibrosis. When the entire liver becomes scarred, it shrinks and hardens, which is called cirrhosis. Usually this damage cannot be reversed unless the underlying cause can either be removed (for example, by stopping alcohol consumption or by eliminating hepatitis C virus) or controlled (for example, with antiviral treatment for hepatitis B). Any illness that affects the liver over a long period of time can lead to fibrosis, and eventually, cirrhosis.

At the Cirrhosis Program, part of the University of Michigan’s Hepatology Program, our multidisciplinary team provides chronic disease management support for people with cirrhosis. Our patients are provided structured education on disease self-management, and are enrolled in a specialty software program that tracks health maintenance, such as screening for hepatocellular carcinoma (liver cancer).

Who’s at Risk for Cirrhosis of the Liver?

There are a number of reasons that the liver can become damaged to the point of cirrhosis, including:

  • Chronic alcoholism
  • Autoimmune liver disease
  • Hepatitis B and C
  • Nonalcoholic fatty liver disease
  • Disorders of the bile ducts
  • Long-term exposure to certain drugs/medications
  • Inherited disorders, such hereditary hemochromatosis

Cirrhosis of the Liver Symptoms

It is possible to live for years without having any symptoms of cirrhosis. However, if nothing is done about the cause of cirrhosis, eventually the body will become overwhelmed from the damage and symptoms will become apparent, such as:

  • Low energy
  • Poor appetite
  • Weight loss
  • Loss of muscle mass
  • Fluid accumulation/swelling

You may also develop these more serious symptoms because of the progression of cirrhosis from compensated state to decompensated state, which can be life threatening:

  • Internal bleeding from large blood vessels in the esophagus, called bleeding varices
  • Buildup of fluid in the belly, called ascites
  • Confusion from the buildup of toxins in the blood, called encephalopathy
  • Yellowing of the eyes and skin, called jaundice
  • Kidney failure

How Is Liver Cirrhosis Diagnosed?

To diagnose cirrhosis, we begin with a thorough conversation to understand your symptoms, and a physical examination. Your doctor may determine that additional tests are necessary. They may include:

  • Blood test
  • Imaging tests: CT scan, MRI or ultrasound to look for signs of the disease on the liver.
  • Noninvasive modalities for the staging of fibrosis (see the next section)
  • Endoscopy: To look for abnormal veins particularly in the esophagus, stomach, and intestines.
  • Liver function test: A group of tests used to check for liver inflammation and liver damage.
  • Liver biopsy: Removing tissue for examination under a microscope by fine needle aspiration using endoscopic ultrasound (EUS), which involves using an endoscope,  a lighted, flexible tube about the thickness of a finger, to examine the liver and create detailed pictures using ultrasound imaging.

Noninvasive Modalities for the Staging of Fibrosis and Assessment of Fat Content in the Liver

Liver elastography is a noninvasive way to stage the degree of fibrosis (scarring). It provides more accurate assessments of advanced fibrosis than imaging tests do. Liver elastography involves the use of a surface ultrasound probe that delivers a low frequency pulse or shear wave to a small volume of liver tissue under the rib cage. The transmission of the sound wave is completely painless.
There are multiple approaches to the use of this technique: vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), acoustic radiation force–based elastography, and shear wave elastography. Of these approaches, vibration-controlled transient elastography is the most widely used worldwide. 
Both VCTE and MRE are available at University of Michigan. Doctors from the Hepatology Program at the University of Michigan use the FibroScan device, which was approved by the FDA for liver elastography measurements in patients with known chronic liver disease and particularly for patients with chronic hepatitis C and fatty liver disease. Same day appointments are available for this test.
For more information about this test, please visit the Liver Elastography page.

What Kind of Treatment Is There for Cirrhosis?

The liver is able to repair itself from mild damage. However, with cirrhosis, the damage is so severe that the liver is unable to repair itself or function properly. There are some options to help with the damage caused by cirrhosis:

Medications and diet:  Used to control the buildup of fluid and toxins. Nutritional counseling is available at the University of Michigan Liver Clinic.

Upper endoscopy: A sedated outpatient procedure, upper endoscopy can be used to place rubber bands on varices (dilated veins in the esophagus) to prevent bleeding.

In addition, we offer the following more advanced treatments:

Transjugular Intrahepatic Portosystemic Shunt (TIPS): A stent placed inside the liver to allow blood to flow through more easily. This is done for patients with uncontrolled or repeated bleeding from varices (dilated veins in the esophagus) or ascites (buildup of fluid in the belly) that cannot be controlled with medications.

Balloon-retrograde transvenous obliteration (BRTO): A minimally invasive procedure to treat bleeding from dilated veins in the stomach. This procedure is only available at a handful of medical centers nationwide.

Liver transplantation:  A surgery to remove the diseased liver and replace it with a liver from another person.

Other Cirrhosis Services at the University of Michigan Hepatology Program

  • Patients are provided with a cirrhosis management “toolkit” to take home. Liver Cirrhosis: A Toolkit for Patients.
  • Patients and caregivers are provided information on common symptoms and guidance on their management through a series of videos prepared with input and participation of providers, patients, and caregivers
  • Cognitive testing to screen for encephalopathy
  • Telephone management system to care for patients between visits
  • Seamless coordinated care with the Liver Transplant and Liver Tumor programs

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page.

Make an Appointment

To schedule an appointment with the University of Michigan Hepatology Program to discuss treatment for cirrhosis of the liver, call us toll-free at 844-233-0433.