Cirrhosis is an advanced form of liver disease that has many causes, not just chronic hepatitis B infection. Alcoholism, autoimmune diseases, hepatitis C, and other conditions can result in cirrhosis. In the case of hepatitis B, the virus attacks the liver and may gradually lead to the formation of scar tissue. Early damage is called fibrosis; severe damage is cirrhosis. About 25 percent of people who become chronically infected during childhood and 15 percent of those who become chronically infected after childhood die prematurely from cirrhosis or liver cancer; the majority have no symptoms until onset of cirrhosis or end-stage liver disease. Liver transplantation is the only treatment for cirrhosis.
Cirrhosis has two phases, compensated and decompensated. Compensated cirrhosis means that the liver is still functioning relatively well. At this stage, the early symptoms may still be vague and some people may be unaware that they have cirrhosis. The symptoms of compensated cirrhosis include:
- Appetite loss
- Confusion or difficulty thinking
- Dark, cola-colored urine
- Easy bruising and abnormal bleeding
- Edema in the feet and legs (swelling from fluid build-up)
- Fatigue (feeling tired)
- Impotence, shrinking of the testicles, and breast swelling in men
- Itchy skin (pruritus)
- Jaundice (yellowing in the skin, mucous membranes, or eyes)
- Muscle cramping
- Pale or clay-colored stools
- Redness on the palms of the hands
- Spider veins (small red spidery veins on the skin)
- Weight loss
Decompensated cirrhosis means that the liver is not functioning well. Some serious complications that occur with decompensated cirrhosis are:
- Ascites, which is bloating from fluid build-up in the abdomen.
- Hepatic encephalopathy (HE) is a brain disorder that develops when the liver is unable to remove ammonia and other toxins from the body. HE may cause impaired concentration, sleep disturbances, confusion, or coma.
- Spontaneous bacterial peritonitis (SBP) is associated with ascites, an infection of the membrane that covers the abdominal organs.
- Variceal hemorrhage is severe bleeding from enlarged veins in the esophagus and upper stomach.
The level of cirrhosis is sometimes measured with a tool known as the Child-Pugh or Child-Turcotte-Pugh (CTP) score. CTP Class A is the least amount of damage from cirrhosis and is considered compensated. CTP Class B and C are decompensated cirrhosis, with Class C being the most severe. People with decompensated cirrhosis should be referred to a medical provider with expertise in treating this advanced liver disease, ideally in a liver transplant center.
Last Reviewed: March 4, 2019