Cirrhosis of the liver is a condition in which the tissue of the liver slowly deteriorates. As a result of chronic damage, non-functional scar tissue replaces functional liver tissue. The progression of cirrhosis is described in four distinct stages based on the degree of damage. According to the Centers for Disease Control and Prevention, advanced-stage liver disease is the cause of more than 30,000 deaths in the U.S. each year.
The first stage of cirrhosis is characterized by the presence of inflammation, characterized by swelling, an influx of inflammatory-promoting immune cells and some destruction of liver tissue. Additionally, there may also be the growth of abnormal connective tissue. These two factors, inflammation and abnormal connective tissue, are confined to the portal area of the liver. The portal area is the region surrounding the large hepatic artery, vein and bile duct. This is the area where blood and fluid flow into and out of the liver.
The second stage of cirrhosis is also characterized by inflammation, but fibrosis is also beginning to occur. Fibrosis as the replacement of normal liver tissue with scar tissue. There are no symptoms at this stage of cirrhosis because the remaining normal liver tissue is able to compensate for the non-functional scar tissue that is starting to form. However, scar tissue will not become normal functioning liver tissue, meaning this transformation is permanent.
As cirrhosis progresses, the damage to the liver becomes increasingly more severe. In this stage of cirrhosis, the fibrosis forms “bridges,” and is called bridging fibrosis. These bridges develop abnormal connections between the hepatic artery, vein and other vessels that cause abnormal blood flow and increased blood pressure in the liver. This increases blood pressure, called hepatic hypertension -- a condition that can cause further liver damage.
Stage 4 is the most advanced stage and the growth of scar tissue has progressed to the point that it is not functioning normally. Whereas the previous stages are not normally associated with symptoms, advanced-stage cirrhosis has many symptoms, including bleeding in the digestive tract, jaundice -- yellow coloring of the eyes and skin, mental effects such as confusion, unusual sleepiness and slurring of speech, build-up of fluid in the body -- edema; and intense and unexplained skin itching.
- National Digestive Diseases Information Clearinghouse (NDDIC): Cirrhosis
- American College of Gastroenterology: Liver Cirrhosis
- Merck Manuals: Cirrhosis
- World Journal of Gastroenterology: Management of Liver Cirrhosis Between Primary Care and Specialists
- Centers for Disease Control and Prevention: Chronic Liver Disease and Cirrhosis