Cirrhosis Stages: Symptoms, Treatment, and FAQ.

Cirrhosis is severe scarring of your liver that can lead to serious complications, like kidney failure or even death. Cirrhosis is divided into two stages: compensated and decompensated cirrhosis.

People in the compensated stage either don’t have symptoms or only have general symptoms of liver disease, like fatigue and nausea. They may not feel sick, but signs of advanced liver scarring can appear on imaging and blood tests.

The decompensated stage is characterized by complications of end stage liver disease, such as:

• yellowing of your eye whites and skin (jaundice)
• abdominal swelling (ascites)
• cognitive changes due to liver damage (hepatic encephalopathy)
• variceal bleeding

Read on to learn more about these two stages of cirrhosis, including the treatments for each stage.

Compensated cirrhosis

Compensated cirrhosis is the first stage of cirrhosis. People in this stage either don’t have symptoms or have minor symptoms. They might not feel or appear sick despite having severe liver scarring.

Compensated cirrhosis symptoms

Compensated cirrhosis often doesn’t cause symptoms. If symptoms are present, they might include:

• fatigue
• weakness
• weight loss
• muscle loss
• nausea

Decompensated cirrhosis

Decompensated cirrhosis is a more advanced form of cirrhosis that can cause symptoms of end stage liver disease. The survival rate for decompensated is much lower than that for compensated cirrhosis.

Decompensated cirrhosis symptoms

Decompensated cirrhosis symptoms can include:

• abdominal swelling (ascites)
• yellowing of your skin and eye whites (jaundice)
• esophageal varices, which are enlarged veins that can cause:
  • vomiting blood
  • pain near your stomach
  • lightheadedness
  • black, tarry, or bloody stools
• hepatic encephalopathy, which can cause:
  • confusion
  • personality changes
  • mood changes
  • poor concentration
• portal hypertension, which can cause:
  • spleen and liver enlargement
  • kidney failure
  • lung failure
• spider angioma, which causes characteristic red, spiderweb-shaped blood vessels

How do doctors diagnose the stages of cirrhosis?

Doctors can use a combination of tests to diagnose cirrhosis. These include:

• a physical exam to look for signs of liver disease, such as an enlarged liver or spleen
• a review of your symptoms
• a review of your personal and family medical history
• blood tests to look for:
  • atypical levels of liver enzymes
  • signs of internal bleeding
  • viral hepatitis
  • signs of autoimmune hepatitis
• imaging tests, like:
  • ultrasound
  • CT scan
  • transient elastography scan
• liver biopsy

Imaging findings that suggest cirrhosis include:

• spleen enlargement
• a bumpy surface on your liver
• presence of esophageal varices
• an enlarged left lobe of the liver
• a shrunken right lobe
• fluid buildup in your abdomen

Treating cirrhosis

Treatment for cirrhosis primarily focuses on managing the underlying cause of your liver damage and treating any complications that develop.

Compensated cirrhosis treatment

Doctors generally don’t consider cirrhosis reversible, but you can prevent further liver damage by addressing the underlying cause of your liver disease. According to one 2023 paper, about half of people with compensated cirrhosis live at least 12 years after their diagnosis. Survival is usually best in people who take steps to prevent further liver damage.

The primary treatment for cirrhosis due to consuming high amounts of alcohol is quitting drinking completely. For metabolic dysfunction-associated steatotic liver disease, which was previously known as non-alcoholic fatty liver disease, your doctor may recommend:

• losing weight
• eating a balanced diet
• taking medications to help control:
  • blood pressure
  • diabetes
  • cholesterol and triglyceride levels

You may receive antiviral drugs if you have chronic viral hepatitis or immunosuppressant medications if you have autoimmune hepatitis.

Other general ways to prevent liver damage include:

• avoiding or stopping illegal drug use
• getting vaccinated for:
  • hepatitis A
  • hepatitis B
  • influenza
  • pneumonia
  • shingles
• avoiding undercooked meat or seafood

Decompensated cirrhosis treatment

Managing the underlying cause of liver damage is also an important part of treatment for decompensated cirrhosis.

Your doctor may also recommend treatments to prevent or manage complications, such as:

• eating a low salt diet
• taking diuretics to reduce fluid retention and abdominal swelling
• getting endoscopic band ligation to treat esophageal varices
• taking lactulose (Generlac) to prevent hepatic encephalopathy
• taking rifaximin (Xifaxan), an antibiotic
• getting a type of surgery called transjugular intrahepatic portosystemic shunt to treat portal hypertension

Only about half of people with decompensated cirrhosis live longer than 2 years after their diagnosis, according to the same 2023 paper above. Some people with decompensated cirrhosis are candidates for liver transplants.

A liver transplant involves replacing your liver with a liver from a deceased donor or part of a liver from a live donor. Many studies have reported 1-year survival rates of 70% to 87%.

Frequently asked questions about cirrhosis stages

Here are some frequently asked questions that people have about cirrhosis stages.

What are the stages of liver disease?

The stages of liver disease are:

1. inflammation of your liver (hepatitis)
2. scarring of your liver (fibrosis)
3. severe scarring of your liver (cirrhosis)

How quickly does cirrhosis progress?

Approximately 20% of people with compensated cirrhosis progress to decompensated cirrhosis over 2 years.

Can your liver recover from cirrhosis?

Cirrhosis is characterized by severe scarring, and doctors generally don’t consider it reversible. In the past decade or so, researchers have found that your liver may be somewhat able to recover if you manage the underlying cause.

How long can you live with cirrhosis?

People with compensated cirrhosis usually have a much better survival rate than people with decompensated cirrhosis. An estimated 47% of people with compensated cirrhosis are alive 10 years after their diagnosis, compared with only 16% of people with decompensated cirrhosis.

Takeaway

Cirrhosis is characterized as compensated or decompensated. People with compensated cirrhosis usually don’t have noticeable symptoms. People with decompensated cirrhosis have complications such as jaundice or abdominal swelling.

The outlook for people with compensated cirrhosis is generally much better than for people with decompensated cirrhosis. Managing the underlying cause can help keep your liver disease from progressing.