Liver cirrhosis: symptoms, causes, tests and treatment
What cirrhosis is, the causes most common in India, how scarring is measured, how complications are prevented, and when a liver transplant is considered.
Also known as: Hepatic fibrosis; Liver Cirrhosis
What cirrhosis is
Cirrhosis is severe, long-standing scarring of the liver. When the liver is injured repeatedly over years — by alcohol, a virus or fat — it repairs itself with scar tissue. Gradually the scar replaces healthy tissue, the liver becomes hard and lumpy, and blood can no longer flow through it easily.
The liver has a large reserve, so many people with cirrhosis feel well for years; this is called compensated cirrhosis. When the liver can no longer keep up, complications appear — fluid in the abdomen, bleeding, jaundice or confusion — and it becomes decompensated. Established scarring is usually permanent, but treating the cause can stop it getting worse, and in some people early scarring improves.
Symptoms
Early cirrhosis often causes no symptoms, or only tiredness and loss of appetite. As it progresses, symptoms may include:
- Tiredness, weakness and loss of muscle
- Jaundice — yellow eyes and skin, dark urine
- Swelling of the abdomen from fluid (ascites)
- Swollen legs and ankles
- Easy bruising and nosebleeds
- Itching, red palms and small spider-like blood vessels on the skin
- Confusion, drowsiness, poor concentration or day–night reversal of sleep, caused by toxins the liver can no longer clear
Causes and who is at risk in India
The commonest causes in India are:
- Alcohol — long-term heavy drinking, including country liquor and spirits
- Chronic hepatitis B and hepatitis C — viral infections that can damage the liver silently for decades
- Fatty liver disease (MASLD) — linked to obesity, diabetes and high cholesterol, and increasingly common
Less common causes include autoimmune hepatitis, diseases of the bile ducts, inherited conditions such as Wilson's disease (an important cause in children and young adults) and haemochromatosis, some medicines and herbal products, and heart failure. Often more than one cause is present — for example, fatty liver and alcohol together.
How it is diagnosed
- Liver function tests, blood count and clotting tests — show how well the liver is working; a low platelet count is an early clue.
- Ultrasound — shows a shrunken, irregular liver, an enlarged spleen and fluid, and screens for liver cancer.
- Transient elastography — a painless scan that measures liver stiffness, a guide to the degree of scarring.
- Upper GI endoscopy — looks for swollen veins (varices) in the food pipe and stomach that can bleed.
- Liver biopsy — needed only when the cause or the degree of scarring is unclear.
Blood tests for hepatitis B and C, and others for autoimmune and inherited liver disease, look for the cause. Doctors also use scoring systems based on blood results to judge severity and decide when to consider a transplant.
Which doctor to see
Cirrhosis should be managed by a liver specialist. The directory lists hepatologists under gastroenterology. People with advanced cirrhosis may be referred to a liver transplant team for assessment, ideally before they become very unwell.
You can find gastroenterologists in Bengaluru or transplant specialists in Bengaluru on The Doctor Index, each with a registration you can check.
Treatment
Treating the cause
Treating the cause is the most important step. Stopping alcohol completely, and for good, can lead to dramatic improvement and longer survival; support and medicines for alcohol dependence are available, so ask. Antiviral treatment controls hepatitis B and clears hepatitis C in most people. Weight loss and control of diabetes help fatty liver. Autoimmune and inherited conditions have their own treatments.
Preventing and treating complications
- Fluid in the abdomen is treated with a low-salt diet and diuretics (water tablets); large amounts may be drained with a needle.
- Beta blockers or banding of varices through an endoscope reduce the risk of bleeding from swollen veins.
- Confusion from liver toxins is treated with laxative-type medicines and sometimes an antibiotic that reduce toxins from the gut.
- Regular ultrasound, usually with a blood test, every few months screens for liver cancer, which is more treatable when found early.
- Vaccination against hepatitis A and B, influenza and pneumococcus is usually advised.
Liver transplant
A liver transplant is an option for people with advanced cirrhosis or early liver cancer who are otherwise fit. It can come from a deceased donor or, commonly in India, from a living related donor who gives part of their liver. A transplant team will assess whether it is suitable and when.
Many medicines, including some painkillers and sedatives, are risky in cirrhosis. Do not take over-the-counter painkillers, herbal or 'liver tonic' products without asking your liver doctor, and do not stop prescribed medicines on your own.
Living with cirrhosis
- Avoid alcohol completely
- Eat enough protein and calories; a late-evening snack helps prevent muscle loss. A dietitian can help
- Limit salt if you have fluid build-up, including pickles, papads and packaged foods
- Keep every ultrasound and endoscopy appointment
- Weigh yourself regularly if you have fluid problems, and report rapid gain
- Ask family members to watch for confusion or unusual sleepiness
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, for:
- Vomiting blood, or black, tarry stools — bleeding varices can be life-threatening
- New confusion, extreme drowsiness or unusual behaviour
- Fever or abdominal pain with a swollen abdomen — this can be an infection of the fluid
- Rapidly deepening jaundice, or passing very little urine
Questions to ask at your appointment
- What caused my cirrhosis, and can it be treated?
- Is my cirrhosis compensated or decompensated?
- Do I have varices, and how are we preventing bleeding?
- How often should I be screened for liver cancer?
- Which medicines and painkillers must I avoid?
- Should I be assessed for a liver transplant?
Common questions
Questions people ask
- Can cirrhosis be reversed?
- Established cirrhosis is usually permanent, but it does not always get worse. Treating the cause — stopping alcohol, treating hepatitis B or C, or losing weight in fatty liver — can halt progression, and some people see partial improvement in scarring over time.
- How long can someone live with cirrhosis?
- It varies widely. People with compensated cirrhosis whose cause is treated can live for many years. Once complications develop, the outlook is more serious, and transplant assessment may be advised. Your doctor can explain your own outlook using blood-test-based severity scores.
- Is a small amount of alcohol safe with cirrhosis?
- No. With cirrhosis, the advice is to avoid alcohol completely, whatever the original cause. Even small amounts add to liver damage and increase the risk of complications. If stopping is difficult, ask your doctor about support and treatment.
- Who can be a living liver donor?
- Usually a healthy adult family member with a compatible blood group, who is assessed carefully for their own safety. In India, living donation is governed by the Transplantation of Human Organs and Tissues Act, and each donation must be approved before it goes ahead. The transplant team will explain the process, risks and recovery for both donor and recipient.
This condition is usually assessed by a gastroenterologist. Every profile shows the doctor’s registration and what has been checked.
Gastroenterologists in Bangalore
A few gastroenterologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Cirrhosis; ask the clinic whether the doctor sees it.
Related conditions
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Cirrhosis
- American College of Gastroenterology — Liver Cirrhosis
- India Code — The Transplantation of Human Organs and Tissues Act, 1994
- MedlinePlus, National Library of Medicine — Cirrhosis — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Liver cirrhosis: symptoms, causes, tests and treatment is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-0522.