Cirrhosis

Many people think cirrhosis only comes from alcohol use disorder. But other things — like infections or genetic (inherited) conditions — can also damage and scar your liver. Getting the right diagnosis and finding out what’s causing your liver problems are important to successful treatment.

What to expect at your appointment

At your first appointment, we’ll ask about your overall health, symptoms, medical history and your family’s medical history. We’ll want to know if you take any medications or supplements regularly. And if you drink alcohol, we’ll want to know how much and how often you drink. We’ll also ask if you have any autoimmune diseases or other health issues, like hepatitis B or hepatitis C.

Next, we’ll do a physical exam to look for signs of cirrhosis, like:

• Abdominal (belly) pain or tenderness
• Belly abnormally swollen outward (distended abdomen)
• Bruises on your skin
• Reddened palms of your hands
• Red, spider-like blood vessels on your skin
• Tender or enlarged liver
• Yellowed skin or whites of your eyes (adult jaundice)

Testing for cirrhosis

If we think you might have cirrhosis, we’ll do some tests to make sure. These tests could include:

• Blood tests: A liver function test and complete blood count (CBC) will show if you have elevated liver enzymes, low or high white blood cell counts, clotting issues, low sodium and high creatinine levels, internal bleeding (hemorrhage) or infections.
• Imaging tests: A CT scan, abdominal ultrasound, MRI or elastography will let us take a closer look at your liver’s shape, size, stiffness and texture.
• Upper endoscopy: We’ll use a lighted, flexible tube (endoscope) with a camera on the end to look for changes in your esophagus and stomach while you’re under sedation.
• Endoscopic retrograde cholangiopancreatography (ERCP): This test combines endoscopy and X-rays to look at your bile ducts (the tubes that take digestive fluid from your liver to your small bowel).
• Liver biopsy: We’ll insert a small needle through your abdomen, in the spaces between your lower ribs on your right side, or through a blood vessel in your neck to get a small sample of your liver. Sometimes a liver biopsy can be taken when we do an upper endoscopy (using an upper endoscopic ultrasound – EUS). After we get the sample, we’ll send it to a lab where our pathologists (tissue experts) will look at it under a microscope to see if you have liver damage.

Meet Our Cirrhosis Team

At Cleveland Clinic, we’ll bring together a team of specialists to care for you. Together, they’ll create your personalized treatment plan. Your team could include:

• Gastroenterologists (digestive system specialists)
• Hepatologists (liver specialists)
• Surgeons
• Dietitians
• Endocrinologists (hormone specialists)
• Weight management specialists
• Social workers
• Psychologist
• Nurse practitioners
• Physician assistants

Cirrhosis is a chronic (lifelong) condition, but with the right treatment, we can help you manage it, relieve symptoms and slow down the condition’s progression. Your treatment depends on what’s causing the cirrhosis and how damaged your liver is.

Alcohol use disorder

If using alcohol has become a problem, our providers can recommend programs to help you stop drinking.

Diet and weight loss

If you have non-alcohol-associated fatty liver disease, a dietitian can help you change your eating habits and lose weight. And an endocrinologist or weight management specialist may prescribe medications to support your weight loss progress. You might also need to follow a low-sodium diet to keep fluid from building up in your abdomen.

Medications

We may recommend medications to treat underlying conditions that can cause cirrhosis. These medications can include:

• Antivirals to treat hepatitis B and C.
• Heart failure medications to improve how your heart pumps blood, lessen fluid buildup, reduce high cholesterol or treat high blood pressure (hypertension).
• Immunosuppressants to treat autoimmune hepatitis.
• Medications that improve symptoms related to inherited liver diseases like hemochromatosis, alpha-1 antitrypsin deficiency, cystic fibrosis, glycogen storage disease or Wilson disease.
• Ursodiol to open blocked bile ducts.

Our providers can also suggest medications to help with symptoms like fatigue (being really tired), itchy skin and belly pain.

Liver transplant

If you have advanced cirrhosis — and your liver no longer works like it should — you may need a liver transplant. Before surgery, we’ll do many tests to find out if a transplant is right for you. If so, we’ll put you on a national liver transplant waiting list to find a good match. And we’ll be with you every step of the way on this journey.

Cirrhosis can lead to other health issues. Our providers will keep a close eye on your health and suggest treatments to help with any other symptoms or related health problems you may have.

You might need to take antibiotics for infections. If you have liver failure, we might need to check your blood sugar (glucose) levels regularly and give you IV fluids so you won’t get dehydrated. And if you have liver cancer, you might need surgery or other treatments.

We’ll also watch your blood pressure in the veins that bring blood to your liver so you don’t get portal hypertension. If your blood pressure spikes and stays high, there are medications and therapies we can do to lower your liver’s blood pressure, reduce fluid buildup in your abdomen and prevent bleeding from varicose veins.

Taking the Next Step

While we can’t repair the damage cirrhosis causes in your liver, we can help you manage the condition with lifestyle changes, medication and other treatments. Our expert, compassionate providers will craft a treatment plan that’s just right for you, so you can continue to enjoy life and feel good. We’re here with the support you need to make changes, feel better and thrive.