What causes cirrhosis?

There are many different types of liver disease. Cirrhosis is a late stage in most of them.

People often think of cirrhosis as part of alcohol related liver disease. This can be a cause of cirrhosis, but there are many other causes of liver disease that can also lead to cirrhosis.

Cirrhosis is sometimes called “advanced chronic liver disease”. You might also hear it called “end stage liver disease”. This does not mean you are going to die soon. It is called “end stage” because cirrhosis comes after the other stages of liver disease.

Your liver is very good at carrying on with all its jobs, even when it has a lot of damage. Many people live with cirrhosis for years and do not feel very unwell. But cirrhosis is a very serious condition. If your liver continues to get damaged, the cirrhosis will continue to get worse.

Find out more about the stages of liver disease.

On this page:

What causes cirrhosis?
Compensated and decompensated cirrhosis
Acute on chronic liver failure (ACLF)
Useful words

What causes cirrhosis?

Cirrhosis happens when the scarring from fibrosis becomes very severe, causing permanent liver damage.

Scar tissue can:

Build up and join to form bands of scar tissue called septa
Cause your liver to shrink and change shape
Replace normal liver cells, making it harder and harder for your liver to do all its normal jobs
Stop blood flowing through your liver normally

Cirrhosis is often divided into compensated and decompensated cirrhosis.

Cirrhosis is sometimes also given a score to say how severe it is. You can find out more about the scoring systems here.

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Compensated and decompensated cirrhosis

Compensated cirrhosis

Someone with compensated cirrhosis might seem well. Even with this level of damage your liver can still keep going and your body can continue to cope. So you might not have any symptoms, or they might only be very mild.

For many people it is possible to stop compensated cirrhosis getting worse. Usually by taking away or treating whatever was causing the damage.

Decompensated cirrhosis

Someone with decompensated cirrhosis will be very unwell. Their body is no longer coping with the liver scarring.

The change from compensated to decompensated will be different for different people. Cirrhosis is considered decompensated when any serious complications develop. These complications can affect other parts of your body. This includes your blood, other organs, and immune system.

These complications can include:

Portal hypertension (a build up of pressure in the blood vessels around your liver and bowel)
Ascites (swelling of your belly caused by a build-up of fluid)
Varices (swollen veins in your digestive system that can cause bleeding)
Hepatic encephalopathy (confusion or memory problems)
Thrombocytopenia (a low platelet count that can cause problems with bleeding)
Jaundice – yellowing of the eyes and skin.
Infections – as the immune system is less able to fight these
Liver cancer

You can find out more about complications and how they are treated here.

Your doctors might also use a cirrhosis scoring system, such as the Child-Pugh classification to decide if your cirrhosis is decompensated. You can find out more about this here.

Decompensated cirrhosis needs urgent treatment. People with the condition often have to spend time in hospital. They might need to come back to hospital regularly. This could be for planned treatment, or because one of their complications has suddenly got worse.

Decompensated cirrhosis can sometimes improve. Recompensation is when your liver cirrhosis goes from decompensated back to compensated. This does not mean your liver has got better. Just that your body has started to be able to cope with some of the damage. And some of the liver function has improved.

Some people move between periods of compensated and decompensated cirrhosis. This can be unpredictable, so it is also helpful to know what to look out for.

Acute on chronic liver failure

Sometimes called ACLF

Acute on chronic liver failure is a very serious condition. It happens when someone with serious long term (chronic) liver disease suddenly becomes very unwell. In acute on chronic liver failure, the liver and one or more other organs stop working. This is different to the usual way that cirrhosis progresses.

Unfortunately there are very few treatment options for acute on chronic liver failure. Someone with the condition will need immediate medical care to try and keep their body going. And to manage high levels of inflammation. They will probably need to be in an intensive or critical care unit.

In some cases it is possible to cure acute on chronic liver failure with a liver transplant. But not everyone with the condition will be able to have a transplant. It may not be possible to find a donor in time and a transplant is a very big operation. The chance of it working must be looked at alongside the risks of having the surgery.

Download our simple factsheet about acute on chronic liver failure.

You can find out more about liver transplants here.