As the liver cells die they are replaced by fibrous tissue. Other liver cells regenerate in an abnormal manner, forming nodules surrounded by the fibrous tissue. Eventually the entire liver architecture can become abnormal, leading to decreased blood flow.
Early symptoms include red palms, spider angiomata (red spots on the upper body), hypertrophy of the parotid glands, and fibrosis of tendons in the hands.
As liver throughput decreases blood will concentrate in the spleen causing it to enlarge. From this the platelet count falls because of splenic sequestration leading to abnormal bleeding. Blood can also flow backwards causing gastric and esophageal varices and haemorrhoids.
If the damage is unchecked decreased bilirubin secretion produces to jaundice, there is immune system dysfunction, spontaneous bacterial peritonitis and kidney dysfunction and failure (hepatorenal syndrome). In advanced cases there can also be hepatic encephalopathy as toxic metabolites, normally removed from the blood, reach the brain.
Common causes of cirrhosis include alcoholic liver disease, chronic viral hepatitis (B, C and D), chronic bile duct diseases (such as primary biliary cirrhosis), inherited metabolic diseases (such as haemochromatosis or Wilson disease) and parasitic infections (like schistosomiasis).
Cirrhosis is irreversible but treatment of the causative disease will slow or even halt the damage.