Cirrhosis & Its Complications
Advanced scarring of the liver from any chronic liver disease. With careful management, most complications can be prevented or treated — and quality of life maintained.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Cirrhosis is the end-stage of chronic liver disease — scar tissue replaces healthy liver. Compensated cirrhosis = no symptoms; the liver still functions. Decompensated cirrhosis = complications appear: fluid in the abdomen (ascites), confusion (hepatic encephalopathy), bleeding from veins in the esophagus (varices). The goal of management is to prevent decompensation and screen for liver cancer.
How common is it?
Saudi prevalence rising due to MASLD and chronic hepatitis. Major causes here: chronic hepatitis B (declining), MASLD (rising), hepatitis C (decreasing post-DAAs), autoimmune diseases.
Why does it happen?
Years of liver inflammation from any cause: viral hepatitis, MASLD, alcohol, autoimmune liver disease, genetic conditions, drug-induced injury.
Symptoms
- Compensated: often none
- Fatigue
- Easy bruising or bleeding
- Ascites (swollen abdomen)
- Leg swelling
- Confusion or memory problems (hepatic encephalopathy)
- Vomiting blood (variceal bleeding)
- Jaundice
- Itching
Red flags — seek urgent medical care
Vomiting blood or large amounts of black stools
Variceal bleeding — emergency.
Confusion, drowsiness, change in personality
Hepatic encephalopathy — needs urgent care.
Sudden swelling of abdomen + fever
Possible spontaneous bacterial peritonitis — emergency.
Sudden severe abdominal pain
Multiple causes possible — need emergency assessment.
How is it diagnosed?
Combination of: blood tests (low platelets, low albumin, elevated bilirubin, INR), imaging (ultrasound, CT, MRI), FibroScan or MR elastography, sometimes liver biopsy. Endoscopy to screen for varices. AFP and ultrasound every 6 months for liver cancer surveillance.
Outlook — what to expect
Compensated cirrhosis: median survival >10 years with good care. Decompensated: depends on which complications and how well controlled. Liver transplant offers cure for end-stage cirrhosis. Always treat the underlying cause to prevent further damage.
Treatment
Habits & Lifestyle
Habits prevent decompensation.
- STOP ALCOHOL — completely.
- Treat the underlying cause: weight loss for MASLD, antiviral for hepatitis B/C.
- Get hepatitis A, B (if not immune), pneumococcal, flu, and shingles vaccinations.
- AVOID NSAIDs (ibuprofen, diclofenac) — can cause kidney failure in cirrhosis.
- AVOID herbal "liver" supplements — many cause severe liver injury.
- Don't eat raw shellfish — risk of severe Vibrio infection.
- Strict salt restriction (2 g/day) if you have ascites.
Diet
Adequate protein and salt restriction are key.
- Adequate protein (1.2-1.5 g/kg/day) — protein restriction is OUTDATED and harmful.
- Late-evening snack — prevents protein breakdown overnight.
- Salt restriction (<2 g/day) for ascites.
- Coffee 3-4 cups daily — protective.
- See a dietitian familiar with liver disease.
Medications
Multiple drugs prevent and treat complications.
- Treat underlying cause first.
- Ascites: spironolactone ± furosemide; salt restriction.
- Variceal bleeding prevention: non-selective beta-blockers (carvedilol, propranolol) OR endoscopic banding.
- Hepatic encephalopathy: lactulose (titrated to 2-3 soft stools/day), rifaximin.
- Spontaneous bacterial peritonitis prophylaxis: ciprofloxacin or norfloxacin in selected patients.
Procedures & Surgery
Procedures save lives in decompensated cirrhosis.
- Endoscopy every 1-3 years to screen for varices; band ligation if found.
- Paracentesis to drain large ascites.
- TIPS (transjugular intrahepatic portosystemic shunt) for refractory ascites or recurrent variceal bleeding.
- Liver ultrasound + AFP every 6 months — surveillance for liver cancer.
- Liver transplantation — cure for advanced disease.
In the Saudi context
Saudi tertiary centers (KFSH, KFMC, KAMC) have advanced hepatology programs including TIPS and liver transplantation. Living donor and deceased donor transplants are both available. The MOH covers most cirrhosis-related care.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Compensated or decompensated — what stage am I?
- Am I a candidate for liver transplant?
- When is my next variceal screening?
- Should I be on a beta-blocker?
Medically reviewed by: SGA Hepatology Panel · Last reviewed 24/04/2026