Decompensated Cirrhosis

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What Is Decompensated Cirrhosis?

Cirrhosis is permanent scarring that prevents the liver from working normally and blocks blood flow through it. It becomes decompensated cirrhosis when the liver can no longer compensate for the damage and serious complications develop, such as abdominal fluid buildup, confusion or internal bleeding.

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What Causes Decompensated Cirrhosis?

Decompensated cirrhosis is the advanced stage of liver damage caused by another condition. Common causes include alcohol-associated liver disease, metabolic dysfunction–associated steatotic liver disease, chronic hepatitis B or C, autoimmune liver diseases and conditions affecting the bile ducts. Inherited disorders, certain medicines and long-term heart problems can also cause cirrhosis.

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Living With Decompensated Cirrhosis

Regular monitoring is important even when symptoms appear stable. Keeping track of weight, abdominal swelling, confusion, bowel movements, medicines and recent test results can help identify changes earlier.

Family members or caregivers may notice confusion or behaviour changes before the person experiencing them. Having a written medication list and emergency plan can help everyone respond more quickly.

Stages of Cirrhosis

In compensated cirrhosis, the liver is scarred but continues to perform many essential functions, and symptoms may be mild or absent.

In decompensated cirrhosis, complications such as ascites, hepatic encephalopathy or bleeding from enlarged veins have developed. A person may experience more than one of these complications, and symptoms can change over time.

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How Is Decompensated Cirrhosis Treated?

Treatment focuses on managing the underlying cause, preventing further liver damage and controlling complications. This may include antiviral treatment, stopping alcohol, treating an autoimmune or metabolic condition and reviewing medicines that could affect the liver.

Additional treatments may be needed for ascites, infections, hepatic encephalopathy, varices or kidney problems. The treatment plan should be managed by a liver specialist and may change as the condition changes.

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Liver Transplantation

A liver transplant may be considered when cirrhosis has caused liver failure or complications that cannot be controlled adequately. Referral does not guarantee that a transplant will be needed or suitable, but it allows a specialist team to assess the available options.

People with decompensated cirrhosis should discuss whether and when a transplant evaluation may be appropriate.

Risks

Risk Factors

The risk of cirrhosis is higher in people with long-term liver conditions, heavy alcohol use, chronic viral hepatitis, obesity, type 2 diabetes or certain autoimmune and inherited diseases. Some people have more than one cause of liver damage.

Once cirrhosis is present, ongoing liver injury can increase the likelihood of decompensation. Cirrhosis and its complications are medical conditions and should not be viewed as a personal failure.

Decompensated cirrhosis can increase the risk of infections, kidney problems, malnutrition, muscle loss and liver failure. People with cirrhosis also have a higher risk of developing liver cancer and may need regular imaging and blood tests.

The complications experienced and their severity differ from person to person.

Symptoms

Symptoms may include severe tiredness, weakness, reduced appetite, nausea, weight or muscle loss, itching, easy bruising and yellowing of the skin or eyes.

People may also develop a swollen abdomen, swollen legs or ankles, dark urine, confusion, sleep changes or bleeding from the digestive tract.

Hepatic encephalopathy occurs when the liver cannot remove certain toxins effectively and they affect the brain. Symptoms may include difficulty concentrating, forgetfulness, changes in sleep, unusual behaviour, confusion, slurred speech or severe drowsiness.

Episodes may be triggered by infection, bleeding, dehydration, constipation or changes in medicines. Sudden confusion should always be assessed promptly rather than assumed to be a normal part of cirrhosis.

Diagnosis

Diagnosis may involve a review of symptoms and medical history, a physical examination, blood tests and imaging such as ultrasound, CT, MRI or elastography.

Doctors may use test results to assess liver and kidney function, blood clotting and the severity of the condition. Endoscopy may be used to check for varices, while a liver biopsy is sometimes needed when the diagnosis or cause remains unclear.