Cirrhosis risk factors: alcohol, fatty liver and hepatitis

What cirrhosis is

In cirrhosis, scar tissue replaces healthy liver tissue, keeps the liver from working normally and partly blocks the flow of blood through it (NIDDK). Scar tissue forms because of injury or long-term disease, and it cannot make protein, help fight infections, clean the blood, help digest food or store energy the way healthy liver tissue does (MedlinePlus).

Many people do not know they have cirrhosis, because there may be no signs or symptoms until the liver is badly damaged (NIDDK). Researchers estimate that about 1 in 400 adults in the United States have cirrhosis, and the real number may be higher because many people are not diagnosed (NIDDK).

The most common causes

Cirrhosis has different causes, some people have more than one, and for some people the cause is not known (NIDDK). NIDDK names these as the most common causes (NIDDK):

• Alcohol-associated liver disease, damage to the liver from drinking too much alcohol.
• Fat buildup in the liver (nonalcoholic fatty liver disease), which is more common in people with overweight, obesity, metabolic syndrome or type 2 diabetes.
• Long-term (chronic) infection with hepatitis C or hepatitis B.

These conditions do not affect everyone the same way. Some people get more liver damage than others, and research suggests that certain inherited genes affect how much damage they do (NIDDK). MedlinePlus says the most common causes in the United States are chronic alcoholism and hepatitis (MedlinePlus).

To look at your drinking, try the AUDIT-C alcohol check. The hepatitis C screening check and hepatitis B screening check show who is advised to get tested, the hepatitis B and hepatitis C risk factors guides explain how those viruses spread, and the fatty liver disease guide covers fat in the liver.

Who is more likely to get cirrhosis

Beyond the conditions that cause it, NIDDK says cirrhosis is more common in people who (NIDDK):

• have a history of heavy alcohol use
• have overweight or obesity
• have type 2 diabetes
• are men
• are age 40 or older

Less common causes

NIDDK lists these less common causes (NIDDK):

• autoimmune hepatitis, in which the immune system attacks the liver
• diseases that damage, destroy or block the bile ducts, such as primary biliary cholangitis and primary sclerosing cholangitis
• inherited liver diseases, such as Wilson disease, hemochromatosis and alpha-1 antitrypsin deficiency
• long-term use of certain medicines, and high daily doses of vitamin A
• chronic heart failure with liver congestion, where blood flow out of the liver is slowed

Symptoms

The earliest stage may cause no symptoms (NIDDK). Early symptoms can include losing weight without trying and mild pain or discomfort over the liver in the upper right side of the abdomen (NIDDK). As liver function gets worse, people may have easy bruising and bleeding; confusion, memory loss, personality changes or sleep problems; swelling in the lower legs, ankles or feet; swelling of the abdomen from fluid (ascites); and a yellowish tint to the eyes and skin (jaundice) (NIDDK). A doctor diagnoses cirrhosis with blood tests, imaging tests or a biopsy (MedlinePlus).

What cirrhosis can lead to

In some people a complication is the first sign of cirrhosis (NIDDK). NIDDK describes (NIDDK):

• Portal hypertension, high blood pressure in the portal vein when scar tissue slows blood flow through the liver. It can lead to fluid in the abdomen, swelling in the legs, enlarged veins (varices) that can bleed, and confusion from toxins building up in the brain.
• Bacterial infections, such as urinary tract infections and pneumonia.
• Liver cancer. Most people who develop liver cancer already have cirrhosis. See liver cancer risk factors.
• Liver failure (end-stage liver disease), which may need a liver transplant.

Common questions

Can cirrhosis be reversed?

MedlinePlus says nothing will make the scar tissue disappear, but treating the cause can keep it from getting worse (MedlinePlus).

Which risk factors can I change?

Age, sex and inherited genes cannot be changed. Heavy alcohol use, overweight or obesity, type 2 diabetes and chronic hepatitis B or C are on the NIDDK lists (NIDDK) (NIDDK), and those are things to talk over with your clinician. Long-term use of certain medicines is also listed, but do not stop a medicine without talking to your clinician.

Is there a test for liver scarring?

A doctor diagnoses cirrhosis with blood tests, imaging tests or a biopsy (MedlinePlus). Our FIB-4 calculator page explains one blood-test score for liver scarring, with its own sources and limits.