What Are the 4 Stages of Cirrhosis of the Liver?

Medically Reviewed on 4/7/2022

4 stages of cirrhosis

4 Stages of Cirrhosis
Learn the four stages of cirrhosis of the liver below.

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.
  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 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.

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:

  • Bleeding of varices:
    • Varices are dilated blood vessels in the stomach or esophagus caused by 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.


Long-term heavy alcohol consumption can cause: See Answer

What are the signs of liver failure?

The following are some of the signs of liver failure:

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.

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.
    • Acute liver failure usually affects people who do not already have liver disease.
    • 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 have liver cirrhosis, see a doctor as soon as possible—the sooner it is detected and treated, the less likely it is to worsen.

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:

Other causes include:

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 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.

Medically Reviewed on 4/7/2022
Image Source: iStock Images

Cirrhosis of the Liver: https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

Stages of Cirrhosis: https://www.hepatitis.va.gov/cirrhosis/background/stages.asp

The Progression of Liver Disease: https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/

Liver Cirrhosis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271178/

Cirrhosis of the liver: https://www.healthdirect.gov.au/cirrhosis-of-the-liver