Cirrhosis is a chronic (ongoing, long-term) disease of the liver. It means damage to the normal liver tissue that keeps this important organ from working as it should. If the damage is not stopped, the liver gradually loses its ability to carry out its normal functions. This is called liver failure, sometimes referred to as end-stage liver disease.

Cirrhosis is a complication of many liver diseases that is characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmuneliver disease in which the body'simmune system attacks the liver.

Patients with cirrhosis may have few or no symptoms and signs of liver disease. Some of the symptoms may be nonspecific, that is, they don't suggest that the liver is their cause. Some of the more common symptoms and signs of cirrhosis include:

• Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood
• Fatigue
• Weakness
• Loss of appetite
• Itching
• Easy bruising from decreased production of blood clotting factors by the diseased liver.
Patients with cirrhosis also develop symptoms and signs from the complications of cirrhosis that are discussed next.

Cirrhosis can be caused by a number of conditions, including long-standing inflammation, poisons, infections, and heart disease, as well as chronic alcoholism and chronic hepatitis, the most common causes.
Chronic alcoholism: Alcohol can poisonall living cells, causing liver cells to become inflamed and die.

• The death of liver cells leads your body to form scar tissue around veins of your liver. Healing liver cells form nodules, which also press on the liver veins.
• This scarring process occurs in 10-20 percent of alcoholics and is the most common form of cirrhosis in the United States.
• The severity of the process depends on how much you drink and how long you have been abusing alcohol. The amount of alcohol needed to injure the liver varies widely from individual to individual.
• Some families are more susceptible to cirrhosis than others.

Hepatitis: Hepatitis means inflammation of the liver from any cause, but it usually refers to a viral infection of the liver.

• Over many years the inflammation damages liver cells and leads to scarring.
• Hepatitis B, hepatitis C, and hepatitis D all can cause cirrhosis.
• Worldwide, hepatitis B is the most common cause of cirrhosis, but in the United States hepatitis C is a more common cause.
Biliary cirrhosis: Bile is a substance produced by the liver to help the body digest fats. If the ducts carrying bile out of liver get blocked it can cause inflammation of liver cells leading to cirrhosis.
Autoimmune cirrhosis: Autoimmune diseases occur when the immune system instead begins to fight healthy body tissues and organs.In autoimmune hepatitis, the body's immune system attacks the liver, causing cell damage that leads to cirrhosis.
Nonalcoholic fatty liver: This is a condition in which fat builds up in the liver, eventually causing scar tissue to form It is associated with diabetes, obesity, coronary artery disease, protein malnutrition.It is sometimes called "steatohepatitis."
Inherited diseases: A variety of genetic diseases can damage the liver.They include Wilson's disease, cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, galactosemia, and glycogen storage disease.
Drugs, toxins, and infections: Various substances and germs can cause damage to the liver (for example, acetaminophen ), poisons, and environmental toxins can lead to cirrhosis.
Cardiac cirrhosis: Your heart is a pump that pushes blood throughout your body. When your heart doesn't pump well, blood "backs up" into the liver. This congestion causes damage to your liver.

• Edema and ascites
• Spontaneous bacterial peritonitis (SBP)
• Bleeding from esophageal varices
• Hepatic encephalopathy
• Hepatorenal syndrome
• Hepatopulmonary syndrome
• Hypersplenism
• Liver cancer (hepatocellular carcinoma)

The steps in making the diagnosis of cirrhosis may include the following:

• Blood tests - To check whether the liver is functioning normally. Lab findings can be normal in cirrhosis, however.
• Ultrasound, CT scan, or radioisotope scan - To look for signs of cirrhosis within or on the surface of the liver
• Laparoscope - A very tiny camera inserted through a small slit in the abdomen to view the liver directly
• Liver biopsy - It is required so as too remove tissue from the liver and studying it under a microscope to identify fibrosis and scarring. Biopsy is the only way diagnosis can be 100% certain