Cirrhosis: Clinical Patient Journey

Reviewed by: [Name, MD – Board-Certified Gastroenterologist or Hepatologist]
Affiliation: The Medical Group of New Jersey

Cirrhosis is a serious liver condition that develops when healthy liver tissue is gradually replaced by scar tissue (fibrosis) after years of ongoing injury. Common causes include chronic viral hepatitis, alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD), autoimmune liver disorders, and certain inherited conditions.

As scarring progresses, the liver becomes less able to perform its essential functions, including filtering toxins, processing nutrients, producing proteins, and regulating blood clotting. Cirrhosis can eventually lead to complications such as portal hypertension, fluid accumulation in the abdomen (ascites), internal bleeding, confusion from toxin buildup (hepatic encephalopathy), and liver cancer.

At The Medical Group of New Jersey, our specialists provide comprehensive evaluation, advanced diagnostic testing, and long-term management designed to preserve liver function, prevent complications, and maintain quality of life.

Symptom Onset & Initial Evaluation

Cirrhosis often develops slowly over many years and may cause few or no symptoms in its early stages. Many patients are diagnosed during routine blood work or imaging performed for another reason.
As liver damage progresses, symptoms may include:

Fatigue or generalized weakness
Loss of appetite
Unintentional weight loss
Swelling of the legs or ankles
Abdominal swelling caused by fluid accumulation (ascites)
Yellowing of the skin or eyes (jaundice)
Itching
Red palms or visible spider-like blood vessels on the skin
Confusion, forgetfulness, or difficulty concentrating (hepatic encephalopathy)

During your evaluation, your provider will review:

Prior liver disease or abnormal liver tests
Alcohol use history
Viral hepatitis risk factors
Medication and supplement use
Family history of liver disease
Diabetes, obesity, high cholesterol, and other metabolic conditions
Current symptoms and their progression

A comprehensive physical examination helps assess liver function and identify signs of advanced liver disease or complications.

Diagnosis & Risk Assessment

The goals of diagnostic testing are to confirm cirrhosis, determine its severity, identify the underlying cause, and screen for complications.

Blood Tests

Laboratory evaluation may include:

Liver enzyme testing (AST, ALT, alkaline phosphatase)
Bilirubin levels
Albumin levels
Blood clotting tests (INR/PT)
Complete blood count (CBC)
Viral hepatitis testing
Autoimmune and metabolic liver disease evaluation when indicated

These tests help assess how well the liver is functioning and identify potential causes of liver injury.

Imaging Studies

Ultrasound

Evaluates liver appearance and blood flow
Detects fluid accumulation and signs of portal hypertension

FibroScan® (Transient Elastography)

Noninvasive assessment of liver stiffness
Helps estimate the degree of fibrosis and cirrhosis

CT Scan or MRI

Provides a detailed evaluation of liver anatomy
Screens for liver cancer and other complications

Endoscopy

Upper endoscopy may be recommended to evaluate for:

Esophageal varices
Gastric varices
Other signs of portal hypertension

Liver Biopsy

Although not always necessary, a liver biopsy may occasionally be performed when the diagnosis is uncertain or when additional information is needed regarding the cause and severity of liver disease.
Early diagnosis provides the opportunity to treat underlying causes, slow progression, and prevent serious complications.

Treatment & Management

Treatment focuses on slowing disease progression, preserving remaining liver function, managing complications, and addressing the underlying cause of liver injury.

Treating the Underlying Cause

The most important step in managing cirrhosis is preventing additional liver damage.
Examples include:

Viral Hepatitis

Antiviral medications for hepatitis B or hepatitis C

Alcohol-Related Liver Disease

Complete abstinence from alcohol
Nutritional counseling and support

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD/NASH)

Weight management
Diabetes control
Cholesterol management
Dietary and lifestyle modifications

Autoimmune Liver Diseases

Immune-modulating medications when appropriate

Managing Cirrhosis Complications

Treatment may include:

Ascites and Swelling

Low-sodium die
Diuretic medications
Monitoring fluid balance

Portal Hypertension and Varices

Non-selective beta blockers to reduce bleeding risk
Endoscopic band ligation for enlarged veins when indicated

Hepatic Encephalopathy

Lactulose therapy
Additional medications, such as rifaximin, when appropriate
Monitoring for mental status changes

Nutrition Support

Individualized dietary recommendations
Protein optimization when appropriate
Management of vitamin and mineral deficiencies

Advanced Therapies

For patients with more advanced disease, additional procedures may be necessary.
TIPS (Transjugular Intrahepatic Portosystemic Shunt)

May be recommended for severe portal hypertension or recurrent ascites
Helps reduce pressure within the liver’s venous system

Liver Transplant Evaluation

Considered for patients with decompensated cirrhosis or progressive liver failure
Coordinated with regional transplant centers when appropriate

Ongoing Management & Long-Term Care

Cirrhosis requires lifelong monitoring, even when symptoms are well controlled. Your long-term management plan may include:

Blood tests every 3–6 months to monitor liver function
Ultrasound or other imaging every 6 months to screen for hepatocellular carcinoma (HCC)
Periodic endoscopy to monitor for varices
Hepatitis A and hepatitis B vaccination when indicated
Management of diabetes, obesity, and cardiovascular risk factors
Nutritional counseling and lifestyle support
Early referral for transplant evaluation when appropriate

Regular follow-up allows complications to be identified and treated before they become severe, helping reduce hospitalizations and improve long-term outcomes.

When to Seek Immediate Medical Attention

Contact your healthcare provider or seek medical care immediately if you experience:

Vomiting blood
Black, tarry stools
Sudden worsening of abdominal swelling
Severe shortness of breath
New or worsening confusion
Excessive drowsiness or difficulty staying awake
Rapid progression of jaundice
Fever or signs of infection

These symptoms may indicate a serious complication that requires prompt evaluation and treatment.