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What Are the 4 Stages of Cirrhosis of

the Liver?
Medical Author: Karthik Kumar, MBBS
Medical Reviewer: Pallavi Suyog Uttekar, MD
Medically Reviewed on 4/7/2022

Disease and Condition: Liver Disease

4 Stages | Compensated vs. Decompensated | 18 Symptoms |

Acute vs. Chronic Liver Failure | Causes | Treatment Options

4 stages of cirrhosis
Cirrhosis of the liver is a disorder in which healthy liver cells are gradually replaced
by scar tissue. It is a progressive illness that might take several years to develop.

Cirrhosis is classified into four stages that include:

1. Stage I: Steatosis

The first stage of liver disease is characterized by inflammation of the bile

duct or liver.

As the body strives to fight against the disease or infection, abdominal

discomfort is frequently the first symptom of inflammation.

If this inflammation is not managed, it might cause damage to the liver,

exacerbating the illness.

Symptoms and inflammation are generally curable during stage I and can

prevent liver disease from escalating to stage II.

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2. Stage II: Scarring (fibrosis) of the liver due to inflammation

Many people with liver illness don't realize they have it until they are at stage II
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or III because the first symptoms generally go unreported.

 In stage II, scarring or inflammation (damage) begins to obstruct the natural

flow of blood in the liver.

This causes the liver to be unable to function properly, but with treatment, the
liver may still be capable of recovering, avoiding more damage, and slowing

the progression of the liver disease.

3. Stage III: Cirrhosis

Cirrhosis develops due to the advancement of liver disease, mainly due to lack

of therapy, in which scar tissue replaces good tissue in the liver.

This process occurs when healthy liver cells have been destroyed over time

(often several years) by a progressive illness or infection.

This causes permanent scarring of the liver, causing it to become hard and

lumpy.

The liver will eventually be unable to function because the growing scar tissue
will make blood flow through the portal vein and into the liver impossible.

When this blood is prevented from accessing the portal vein, it can flow into

the spleen, causing additional problems.

4. Stage IV: Liver failure or advanced liver disease or hepatic failure

Failure of the liver during the disease's ultimate stage will signify the end of
the liver's functioning. This will necessitate quick medical intervention to avoid

fatalities.
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Learn the four stages of cirrhosis of the liver below.

Compensated vs. decompensated cirrhosis

Compensated cirrhosis

This phase is asymptomatic because the healthy liver cells are still capable of

meeting the body’s needs and compensating for the scarred tissue and

damaged cells.

Treatment is necessary at this stage to prevent the illness from escalating to

liver failure because the body will be unable to efficiently rid itself of toxins.

Decompensated cirrhosis

This type of cirrhosis causes various symptoms and can lead to various problems,
including:
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Bleeding of varices:
Varices are dilated blood vessels in the stomach or esophagus  caused by
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obstruction of the portal vein to the liver. It is a medical emergency and needs
 immediate treatment due to the risk of blood loss.

Hepatic encephalopathy:

It is a loss of brain function caused by the liver's inability to eliminate poisons

from the person’s blood.

Confusion and forgetfulness are common symptoms.

Ascites:

The condition refers to the accumulation of fluids, mainly the protein-

containing fluid known as ascites, in the peritoneum (abdominal cavity).

Jaundice  :

This disorder is characterized by yellowing of the eyes and skin due to a high

amount of yellow pigment bilirubin in the body.

The liver is responsible for producing and processing this bile pigment; if the

liver and bile ducts are not functioning properly due to scarring and injury, this
pigment accumulates.

Gallstones:

Cirrhosis can cause an increase in the bilirubin chemical, which can contribute

to the production of gallstones.

What are the signs of liver failure?

The following are some of the signs of liver failure:

Altered consciousness

Bleeding through the rectum or vomiting blood

Severe abdominal distension

Diarrhea

Vomiting
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Fatigue

Jaundice ADVERTISEMENT

Weakness
 Itching

Loss of appetite

Bruising easily due to the injured liver's decreased production of blood clotting
components

Cirrhosis can proceed to liver failure over several years; nevertheless, the damage
done at this stage is irreversible and fatal. The goal is to diagnose and treat liver
illness as early as possible to enhance the prognosis and prevent liver failure.

QUESTION

Long-term heavy alcohol consumption can cause:

SEE ANSWER

What is difference between acute and chronic liver

failure?
Acute liver failure is sudden onset, whereas chronic liver failure is gradual onset.

Other differences may include:

Acute (sudden) liver failure:

This type of uncommon liver failure proceeds quickly and occurs within a few

days or weeks.
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Acute liver failure usually affects people who do not already have liver

disease. ADVERTISEMENT

The illness frequently manifests itself suddenly, with no signs or warning.

 The most common causes are drug overdoses from taking too much Tylenol

(acetaminophen), poisoning, or severe hepatitis A infection.

Chronic (gradual) liver failure:

Chronic liver failure is a slower type of liver failure that can occur over months

or years (typically six months or more) before any symptoms appear.

Cirrhosis, a serious liver disease, is usually the cause of this disorder.

How will I know if I have liver cirrhosis?

Cirrhosis symptoms vary depending on the stage of the disease. In the early stages
of cirrhosis, some people experience no symptoms. Symptoms may not develop
until the liver has been severely damaged.

Twelve symptoms of cirrhosis include:

1. Fatigue  or weakness

2. Nausea and vomiting

3. Loss of appetite

4. Unintentional weight loss

5. Right upper quadrant abdominal pain or tenderness

6. Increased bruising and/or bleeding from any orifices in the body

7. Jaundice
8. Urticaria (severe skin itching)

9. Peripheral edema (swelling in the ankles, legs, and feet  )

10. Bloating from a buildup of fluid in the abdomen, known as ascites

11. Hepatic encephalopathy

12. Darkening of urine color (from excretion of certain liver-made proteins)

If you experience any of the following symptoms or are concerned that you may
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have liver cirrhosis, see a doctor as soon as possible—the sooner it is detected and
treated, the less likely it is to worsen.ADVERTISEMENT

If you have any of the below symptoms, go to a hospital or visit a doctor right away:
1. Blood-tinged sputum or blood in vomit

2. Symptoms of fever or chills

3. Swelling that’s red or feels hot to the touch

4. Difficulty breathing (shortness of breath)

5. Feel dizzy or fainting-like episodes

6. Black or tar-colored stools

What causes cirrhosis of the liver?

The majority of cases of liver cirrhosis are caused by:

Excessive alcohol consumption

Chronic viral hepatitis (both hepatitis B and C viruses  induce liver cirrhosis)

Other causes include:

Type II diabetes
Obesity

Nonalcoholic fatty liver disease

Rare causes include:

Autoimmune chronic active hepatitis: It is a condition that results from the

body's immune system attacking and destroying liver cells

Drugs and chemicals: Several drugs, herbs, and chemicals can lead to liver
cirrhosis.

Inherited metabolic disorders: Several rare disorders, most of which are caused

by a missing enzyme, can produce a metabolic imbalance in the liver, leading to

hepatic cirrhosis. The most frequent is hemochromatosis, which produces

excessive iron deposits in the liver, and Wilson's disease, which causes
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excessive copper accumulation.

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What are the treatment options for liver cirrhosis?

If possible, treatment focuses on curing the underlying cause of cirrhosis to
prevent further damage.

A doctor may prescribe the following:

Antiviral medicines can be used to treat viral hepatitis  infections.

Steroid medicines if the cause is an autoimmune disease.

Changes to your lifestyle and diet to control your symptoms and lower your risk of
problems, such as:

Drinking less alcohol (or not at all)

Losing weight if you’re overweight or obese

Smoking cessation
Doing regular exercise

Eating a healthy, balanced diet 

Cutting down on salt in your diet to help with fluid buildup

Practicing good hygiene to make sure you don’t get any infections

Getting vaccinations

If your liver is severely damaged, doctors may offer a liver transplant, but this is
only done in rare situations and only after all other treatment options have failed. A
liver transplant is a surgical procedure that includes replacing your diseased liver
with a healthy liver from someone else.

Cirrhosis of the liver caused by years of alcohol abuse or being overweight can be
avoided by making changes in the early stages of the disease. However, it is
difficult to prevent liver cirrhosis caused by a genetic ailment or an issue with your
immune system.

Once your liver is severely damaged and scarred, there is no way to repair the
damage.
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SLIDESHOW

Hepatitis C, Hep B, Hep A: Symptoms, Causes, Treatment

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