CirrhosisHepatitis CHepatitis B


What Causes Cirrhosis of the Liver?

Any chronic liver disease can eventually lead to cirrhosis. Hepatitis C, fatty liver disease and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., other causes include:

  • Fatty liver associated with obesity, over-weight or metabolic syndrome, and diabetes.
  • Chronic hepatitis B.
  • Autoimmune hepatitis which happens when the immune system of the individual, for unknown reason, attacks the liver and causes inflammation and scarring.
  • Primary biliary cirrhosis is another immune disorder where the immune system for unknown reason attacks the small bile ducts inside the liver and causes inflammation and scarring.
  • Wilson disease is a genetic disease where copper accumulates inside the liver and causes scarring.
  • Genetic hemochromatosis is a genetic disease where iron accumulates inside the liver and causes scarring.
  • Alpha-1 antitrypsin deficiency is a metabolic disease where abnormal protein accumulates inside the liver and causes scarring. This protein is normally produced inside the liver and helps in digestion and other functions inside the body. For unknown reasons the protein stays inside the liver and causes liver damage.
  • Primary Sclerosing Cholangitis (PSC) is a disease where the immune system attacks the bile ducts inside and outside the liver and causes severe inflammation, blockage inside and outside the liver, and eventually scarring.
Children and Infants:
  • Biliary atresia in children and infants. It is a blockage of the bile duct, which carries bile formed in the liver to the intestine where it helps in the digestion of fats; in babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.
  • Genetic hemochromatosis is a genetic disease where the iron accumulates inside the liver and causes scarring
  • Certain inherited diseases such as:
    • Cystic fibrosis.
    • Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body.
    • Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver.
    • Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson’s disease, caused by the abnormal storage of copper in the liver.

Although less likely, other causes of cirrhosis include prolonged exposure to environmental toxins, or parasitic infections.

Medication such as Tylenol, Pain Killer and Anti-inflammatory Drugs do NOT cause cirrhosis, BUT can lead to acute liver failure which is a serious liver damage that happens within a few days.

Does everyone who has chronic liver disease develop cirrhosis?

Not necessarily. It is unknown why some people get cirrhosis and others don’t, although they may have the same disease. This depends on the severity of the disease, duration of the disease, and the presence of other liver conditions. For example, hepatitis C patients who drink alcohol will get cirrhosis faster than other hepatitis C patients who do not drink alcohol. Overall, individuals who have two risk factors for liver such as obesity and hepatitis C, or hepatitis C and alcohol use, develop cirrhosis faster.

How long does it take to develop cirrhosis from the time of diagnosis of chronic liver disease?

It is unknown how long it requires to develop cirrhosis. It depends on many factors as well as the severity of the disease. A patient who has two liver conditions will get cirrhosis faster than a patient who has one liver condition.

Do People Who Drink A Lot of Alcohol Always Get Cirrhosis of the Liver?

Cirrhosis does NOT cause symptoms at the beginning and early stages. The symptoms of cirrhosis of the liver vary with the stage of the illness. The most common symptom is “Fatigue.” As the disease worsens, symptoms may include:

  • Loss of appetite
  • Muscle wasting
  • Muscle cramps
  • Weight loss or sudden weight gain
  • Bruises
  • Nose bleeding
  • Trouble sleeping (insomnia)
  • Yellowing of skin or the whites of eyes (jaundice)
  • Itchy skin
  • Fluid retention (edema) and swelling in the ankles, legs, and abdomen (often an early sign)
  • A brownish or orange tint to the urine
  • Light colored stools
  • Confusion, disorientation, personality changes
  • Blood in the stool

How Is Cirrhosis of the Liver Diagnosed?

Cirrhosis of the liver is diagnosed through several methods:

  • Physical exam. During a physical exam, your doctor can observe changes in how your liver feels or how large it is (a cirrhotic liver is bumpy and irregular instead of smooth).
  • Blood tests. Low platelet count, which is a certain blood cells that helps prevent bleeding, is low in patients with cirrhosis.
  • Other tests. In some cases, other tests that take pictures of the liver are performed, such as a computerized tomography (CT scan), ultrasound, or another specialized procedure called a radioisotope liver/spleen scan.
  • Biopsy. Your doctor may decide to confirm the diagnosis by taking a sample of tissue (biopsy) from the liver.
  • Fibroscan is a new machine similar to ultrasound that can estimate the amount of scarring.

What Complications Are Caused by Cirrhosis of the Liver?

Complications associated with cirrhosis of the liver include:

  • Esophageal or Gastric Variceal bleeding. These are abnormal large veins in the esophagous (food pipe) or the stomach. It is caused by portal hypertension, which is an increase in the pressure within the portal vein (the large vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by a blockage of blood flow through the liver as a result of cirrhosis. Increased pressure in the portal vein causes other veins in the body to enlarge (varices). These varices become fragile and can bleed easily, causing severe hemorrhaging and fluid in the abdomen.
  • Confused thinking and other mental changes (hepatic encephalopathy). Hepatic encephalopathy most often occurs when cirrhosis has been present for a long time. Toxins produced in our intestines are normally detoxified by the liver, but once cirrhosis occurs, the liver cannot detoxify as well. Toxins get into the bloodstream and can cause confusion, changes in behavior, and even coma.
  • Ascites. This means abnormal fluid collection inside the abdomen caused by the intake of salty food.
  • Legs swelling. This could be the first sign of cirrhosis or worsening liver function in somebody who has liver disease. It is also caused by eating or drinking food that contains more than 2 gram of sodium every day.

Other serious complications of cirrhosis of the liver include:

  • Kidney failure
  • Reduced oxygen in the blood
  • Diabetes
  • Changes in blood counts
  • Increased risk of infections
  • Excessive bleeding and bruising
  • Breast enlargement in men
  • Premature menopause
  • Loss of muscle mass

What Is the Treatment for Cirrhosis of the Liver?

Although there is no cure for cirrhosis of the liver, there are treatments available that can stop or delay its progress, minimize the damage to liver cells, and reduce complications.

The treatment used depends on the cause of cirrhosis of the liver:

  • For cirrhosis caused by alcohol abuse, the person must stop drinking alcohol to halt the progression of cirrhosis.
  • If a person has hepatitis, the doctor may prescribe steroids or antiviral drugs to reduce liver cell injury.
  • For people with cirrhosis caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the treatment varies.

Medications may be given to control the symptoms of cirrhosis. Edema (fluid retention) and ascites (fluid in the abdomen) are treated, in part, by reducing salt in the diet. Drugs called diuretics are used to remove excess fluid and to prevent edema from recurring. Diet and drug therapies can help improve the altered mental function that cirrhosis can cause. Laxatives such as lactulose may be given to help absorb toxins and speed their removal from the intestines.

Liver transplantation may be needed for some people with signs and symptoms of liver failure or worsening cirrhosis

How Can I Prevent Cirrhosis of the Liver?

There are several ways to reduce your risk of developing cirrhosis of the liver:

  • Don’t abuse alcohol. If you do drink alcohol, limit how much you drink and how often. Remember it’s not only the heavy drinker who gets cirrhosis. If you drink more than 2 drinks a day, you are increasing your risk. A drink is a 5 oz glass of wine, a 12-oz can of beer, or a 1 1/2 oz portion of hard liquor.
  • Avoid high-risk behavior such as multiple partners and intravenous drug use.
  • Weight loss for overweight people.
  • Diabetes control.
  • Seek early treatment for your liver disease such as hepatitis B and C.
  • Get vaccinated against hepatitis B.

Dietary Recommendations for Patients with Cirrhosis

Patients with cirrhosis need to follow a certain diet in order to prevent major complications that can lead to serious consequences. While we encourage patients to eat a general diet with high calorie content, the only restriction needed is “Salt.” Patients with cirrhosis needs to follow a “2g sodium diet.” There is NO reason to restrict eating meat or other poultry food. As a matter of fact, patients with cirrhosis tend to lose muscle mass quickly and therefore need a high protein intake every day to prevent excessive loss in their body muscle. This brochure addresses the 2-gram sodium diet and illustrates which food has high and low sodium content. Please read it and discuss it with your liver doctor or dietary specialist.

Please visit our FAQ page on the recommended Low Salt Diet.


What is Hepatitis C?

It is a virus that gets into the blood and causes inflammation and damage to the liver, and in some cases other organs.

How does a person get infected?

Hepatitis C mainly transmitted by blood and rarely by sexual contact.  You are at risk if you have one of the following:

  • History of intravenous drug use or cocaine snorting
  • History of unsafe or unclean tattooing or piercing
  • History of blood products transfusion before 1992
  • History of multiple sexual partners of male-male sexual contact
  • Baby boomers or born before 1965
  • Live with somebody who has hepatitis C
  • Receiving hemodialysis
  • HIV infection
  • Children born to mother infected with hepatitis C
  • Healthcare worker injured by needle sticks

Can Hepatitis C be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low (<3%). The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. If your sexual partner has hepatitis C, you should be tested and if you are negative then your chance of getting the virus is almost zero, and there is no clinical reason to use protection if you are in a monogamous relationship.

Can Hepatitis C be spread within a household?

Yes, but this does not occur very often. If the Hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member. Sharing a razor or toothbrush is NOT recommended if you live with a hepatitis C person.

How soon after exposure to Hepatitis C do symptoms appear?

If symptoms occur, the average time is 6–7 weeks after exposure, but this can range from 2 weeks to 6 months. These symptoms may include one of the following: 

  • Fatigue
  • Yellow colored skin (jaundice)
  • Itchiness
  • Flu type symptoms
  • Nausea
  • Joint pain

However, many people infected with the Hepatitis C virus do not develop symptoms. 

Can a person spread Hepatitis C without having symptoms??

Yes, the majority of patients with hepatitis C do not have any symptoms and find out about the disease only when it is far advanced and caused either cancer or scarred liver. Persons with no symptoms, he or she can still spread the virus to others.

Is it possible to have Hepatitis C and not know it?

Yes, many people who are infected with the Hepatitis C virus do not know they are infected because they do not look or feel sick.

What are the symptoms of chronic Hepatitis C?

Most people with chronic Hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.

How serious is chronic Hepatitis C?

Chronic Hepatitis C is a serious disease and in many cases is a DEADLY disease if left untreated. It can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 15,000 people die every year from Hepatitis C related liver disease.

What are the long-term effects of Hepatitis C?

These can range from chronic liver disease to liver cancer and death. Between 20%-30% of patients will live with hepatitis C and have no liver damage. Almost 70% of patients will develop either chronic hepatitis C, cirrhosis or liver cancer.

What is cirrhosis?

Cirrhosis is a stage 4 scarring in the liver. It is a very serious disease and will lead to liver cancer, death, or liver transplantation.

What blood tests are used to test for Hepatitis C?

Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) This is called Hepatitis C antibody test. Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, then the next test will be hepatitis C viral load or HCV RNA. It means measuring how much virus exists in the blood. If it is positive, or detected at any range, then the person has chronic hepatitis C and needs evaluation for treatment.

How many types of hepatitis C?

There are six types of hepatitis C called genotypes. The most common one in the United States is genotype 1.  It is very important to know the genotype because it helps determine what kind of treatment the person needs.

Can Hepatitis C be treated?

Yes, many treatments are available now that are very effective, cause less side effects, and can cure the virus in more than 90% of all cases.

What I should do to get treated?

First you need to have your primary doctor determine that you have hepatitis C, then have him/her refer you to a local gastroenterologist or liver specialist who is treating hepatitis C. You can also refer yourself if you don’t have primary care physician. If you live in Southern California or Nevada you can contact us and we will help get you referred to a hepatitis C specialist. A liver specialist or gastroenterologist may run certain blood test and ultrasound of the liver before considering the treatment. 

Is Liver Biopsy needed in order to get treatment?

A liver biopsy, obtaining small sample of the liver for testing by needle, is rarely needed these days to determine the eligibility for treatment. It helps estimate how much damage you have in the liver and / or if you have another liver disease that also damaging your liver. However, you need to discuss it further with your doctor. Another alternative to liver biopsy – but may not replace it – are Fibroscan and FibroSure blood tests. Discuss if you are eligible for one of these two tests with your doctor.

What is the treatment for hepatitis C?

Hepatitis C treatment in the past was very long, had a lot of side effects, and was not very effective. It used to consist mainly of pegylated interferon, ribavirin and boceprevir and telaprevir.  

Starting in 2014, multiple new hepatitis C treatments became available in the market. The new treatment is oral pills called Direct Acting Agents (DAAs) with or without pegylated interferon. It is expected that interferon will not be used as part of hepatitis C treatment starting November 2014. The treatment now, and in the future, consists of a combination of two or three pills that are taken every day for 8-12 weeks.

Sofosubuvir, simeprevir, ledipsevir and daclatasvir are all pills that are either already available in the market or it will be available by November 2014. Many other new medications will be available in 2015. These pills work by attacking the virus in different ways, which helps get rid of hepatitis and prevents it from occurring again after finishing the treatment. Your doctor will discuss with you the advantage of every combination, and which one is most suited for your case. Please contact us if you have any questions about any of the new hepatitis C treatments.

Can I be cured from hepatitis C if I use the new treatment?

Very likely yes, the new treatment offers a greater-than 90% chance of cure from hepatitis C.

Who should be treated with the new hepatitis C treatment?

Anybody who has hepatitis C should be evaluated and get treated using the new treatment. There is no reason for anybody to live with this virus since the new treatment became available and offers a high response rate and few side effects.

Can I drink alcohol if I have hepatitis C?

It is NOT recommended for you to drink alcohol f you have hepatitis C. Alcohol drinking can lead to more and severe liver damage in person with hepatitis C.  You can drink in moderation or socially if you received hepatitis C treatment and got cured from the virus.  It is NOT recommended for you to drink any alcohol while you are receiving hepatitis C treatment.


What is Hepatitis B?

Chronic hepatitis B (CHB) is an inflammation of the liver caused by certain virus that lives in blood. This virus is different type from other viruses that cause hepatitis. The disease can be easily prevented by vaccination or other measures that will be discussed below. Adult patients can effectively clear the virus without treatment. If the virus stay in the system more than 6 months then it will be called Chronic Hepatitis B and if it last less than six months then will be called acute hepatitis B. The disease is very common in certain areas in the world such as Southeast Asia, Africa and parts of the Middle East.

Who is at risk of acquiring hepatitis B?

  • Unprotected sexual contact with person who has the disease
  • Born to mother who has the disease (vertical transmission)
  • Live with somebody who has the disease
  • Sharing needle with infected person
  • HIV infected person
  • Hemodialysis patients
  • Person received blood products before 1990
  • Homosexual and person with multiple sexual partners
  • Tattooing or piercing in unclean condition
  • Person who lives in endemic areas such as China, Cambodia, Vietnam, Korea and The Philippines
  • Healthcare workers

How the disease can be prevented?

The most important step in prevention is getting vaccination as soon as possible. When all the vaccination shots are taken, the vaccine can offer 100% protection. If you did not receive hepatitis B vaccination during childhood then it is NOT too late to get the vaccination. Your doctor can help you obtain the vaccination. The second step is avoiding unprotected sex with, or sharing a needle with, an infected person.

What is the difference between acute and chronic hepatitis B?

Acute hepatitis B occurs right after exposure and person usually have many symptoms such as yellow color of the skin, nausea, and vomiting and abdominal pain. Some patients may not experience any symptoms. Liver function tests in this stage are usually elevated. 80% of adult patients will overcome this infection and will be cured and develop the immunity to it. Patients with acute hepatitis usually do not require treatment unless they have signs of liver failure such as altered level of consciousness.

Chronic hepatitis B usually means the person has the infection for more than six months and did not cure it. The majority of these patients have no symptoms. Treatment in this stage is required if the patient meets certain criteria or shows a sign of inflamed liver or elevated liver enzymes. Your liver specialist or doctor will explain the treatment criteria for you in details.

How do I know if I have hepatitis B?

You will most probably have NO symptoms and in some cases patients may experience one or all of the following symptoms:

  • Feeling very tired
  • Mild fever
  • Headache
  • Not wanting to eat
  • Feeling sick to your stomach or vomiting
  • Belly pain
  • Diarrhea or constipation
  • Muscle aches and joint pain
  • Skin rash
  • Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away

If you have any of the above risk factors you should ask your doctor to check you for hepatitis B.

What test I need to do to check for hepatitis B?

Your doctor will check hepatitis B surface antigen in blood. If it is positive then the next step is checking viral load. If both are positive then you will be diagnosed with chronic hepatitis B.

I What should I do if my partner, one of my parents or one of my siblings is diagnosed with hepatitis B?

You should see your doctor immediately and discuss the precautions that you need to follow.

If you received the vaccination and immunized to the disease, you are protected and you don’t need to do anything. If you did not receive vaccination then your doctor should immediately check you for the disease and give you vaccination.

If your sex partner diagnosed with hepatitis B and you are vaccinated and developed the immunity, you don’t need to worry about contracting the disease. If you are not vaccinated and your partner just diagnosed with hepatitis B, you should see your doctor immediately to be checked and use protection (condom) until your doctor tell you otherwise.

What hepatitis B carrier means?

It means person has hepatitis B surface antigen but no viral load. Usually the person in this condition doe not needs treatment.

What are the consequences of hepatitis B?

Hepatitis B can cause one or all of the following:

  • Cirrhosis (terminal scarring of the liver)
  • Liver cancer
  • Liver failure requiring immediate liver transplantation
  • Rarely can cause inflammation of the joints or kidney damage

How can I prevent hepatitis B consequences?

If you have hepatitis B, talk to your doctor about treatment as early as possible. You will need ultrasound of the liver EVERY SIX months to screen for liver cancer.

When is liver transplant indicated?

Your doctor will refer you for liver transplantation if you have cirrhosis with signs of liver failure such as ascites (fluid in the abdomen), confusion or bleeding from esophageal varices. Your doctor also will refer you for liver transplantation if you develop liver cancer.

What is the treatment for hepatitis B?

According to the guidelines from American Association for the Study of Liver Disease, one of these two medications can be used: Baraclude (entecavir) or Viread (tenofovir). Usually you will need one of these medications but in certain cases when the virus does not respond to one, your doctor may add the second one.

Can I be cured of hepatitis B?

No. The current treatment does not cure hepatitis B but it will keep it dormant and prevent further damage in your liver and decrease the chance of liver cancer. We are hoping the new treatment that is in development now will offer cure but this is not expected to happen before 2018.

Cirrhotic Liver