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What Are the 5 Stages of Liver Disease?

hurt liver cartoon

The liver is the largest organ in the human body. It is about the size of a football and sits in the upper right abdomen, just under the rib cage. The liver plays a critical role in digesting food, storing energy, and ridding the body of toxic chemicals. 

Millions of Americans are affected by liver disease. Liver problems can be genetic (inherited). They can also be caused by factors such as obesity, alcohol use, and viral infections. More than a hundred different liver diseases have been identified, including alcohol-related liver disease, non-alcoholic fatty liver, autoimmune hepatitis, primary biliary cirrhosis, glycogen storage diseases, portal hypertension, chronic hepatitis B, and dozens of others. 

Damage to the liver can happen quickly — this is called acute liver failure. On the other hand, chronic liver failure occurs gradually over time, during which healthy liver tissue goes through several stages of damage. Each stage of liver disease has an increasing effect on the liver’s ability to function properly. Over time, the damage can lead to liver cirrhosis (scarring). The scar tissue blocks normal function, which can ultimately progress to liver failure, a potentially life-threatening condition. However, early diagnosis and treatment of liver diseases can allow affected people to live normal lives. 

Please continue reading to learn more about the different stages of liver disease.

What are the first signs of a bad liver?

Liver disease does not always cause symptoms. When present, early symptoms and signs of liver disease include: 

  • Jaundice (yellowish skin and eyes)
  • Itchy skin
  • Pain and swelling in the abdomen
  • Swelling in the legs and ankles
  • Pale stool
  • Dark urine
  • Loss of appetite
  • Nausea and vomiting
  • Chronic fatigue
  • Easy bruising

What are the symptoms of liver cancer?

Many of the symptoms of liver cancer are similar to the symptoms of liver disease mentioned above. Other symptoms of liver cancer can include feeling full after small meals and unexplained weight loss.

What are the different stages of liver disease?

As mentioned above, chronic liver failure occurs in several stages. It progressively affects healthy liver cells, leading to a decline in liver functioning over time. The main stages of chronic liver disease are described below.

Stage 1: Inflammation

This is the early stage of liver disease in which the liver becomes inflamed or enlarged. A number of diseases can lead to liver inflammation, such as chronic hepatitis or nonalcoholic fatty liver disease. Many people with inflammation of the liver are unaware they have a problem because they don’t have any symptoms. However, if the inflammation continues, it can lead to permanent liver damage. 

Liver function tests are blood tests that check the levels of liver enzymes called AST and ALT. The levels of these enzymes can be elevated in people with damaged liver cells. In other words, if blood tests show elevated AST and ALT liver enzymes, it indicates inflammation and liver damage. If a doctor finds raised AST or ALT levels, they will likely order further testing to determine the cause, such as imaging studies or liver biopsy.

Stage 2: Fibrosis

This is a stage of liver disease in which scar tissue begins forming in an inflamed liver. Scarred tissue forms after repetitive or long-lasting inflammation. The scars replace healthy tissue in the liver. As a result, the liver cannot perform its normal functions, such as rid the body of toxic substances. 

Fibrosis in a diseased liver can be hard to detect because it frequently does not cause any symptoms. There is no specific treatment for liver fibrosis. It is a symptom of another problem in the liver tissue. The most effective way of treating fibrosis is to treat the underlying cause. Treating the cause of the liver damage can stop the fibrosis and allow the liver to heal. Early-stage fibrosis is usually reversible.

Stage 3: Cirrhosis

This is an advanced stage of liver disease in which there is severe scarring or cirrhosis. The scarred tissue overtakes healthy liver tissue, making it very difficult for the liver to function properly. As a result, symptoms of liver disease usually begin to appear at this stage, such as abdominal pain, loss of appetite, and jaundice. This is known as decompensated cirrhosis. 

It can take decades for liver disease to progress to this stage. However, there is no cure for liver cirrhosis. The liver damage is permanent. Depending on the cause of the cirrhosis, it may be possible to prevent the condition from worsening.

Stage 4: End-Stage Liver Disease (ESLD)

This is the last stage of liver disease. It is associated with a dramatic deterioration in liver function. Complications like ascites and hepatic encephalopathy are common in patients with a failing liver. This stage of liver disease is irreversible and the only treatment is liver transplantation.

Stage 5: Liver Cancer

Cancer is an uncontrolled growth of cells. A cancer that develops in the liver is called a primary liver cancer. Cancer can also develop in other parts of the body and metastasize to the liver (secondary liver cancer). Cancer in the liver can develop at any stage. However, people with cirrhosis are at an increased risk of developing liver cancer. 

How fast does liver disease progress?

Acute liver failure is a rapid loss of liver function. It can occur within days to weeks. Possible causes include viral hepatitis or large doses of drugs like acetaminophen which can cause liver damage. Acute liver failure is a medical emergency for which a person should seek medical attention immediately. Depending on the cause, treatment can sometimes reverse the liver damage. However, in some patients liver transplantation is the only cure.

Chronic liver failure occurs gradually over a period of time and progresses through the various stages of liver disease, as described above. Early diagnosis and treatment can prevent the progression of liver disease to chronic liver failure. The liver can repair and regenerate itself and heal from the damage, provided the cause is identified and treatment is started. Unfortunately, because many people with liver disease do not look or feel sick, oftentimes it is discovered only after the damage has become irreversible.

How long can you live with chronic liver failure and end stage liver disease?

Life expectancy in people with chronic liver failure and ESLD depends on various factors. For example, in an individual with alcohol-related liver disease, it depends on the severity and duration of alcohol abuse. 

In general, complications of liver disease develop after 5 to 10 years, although it can even take as long as 20 to 30 years. It is impossible to predict how soon a person’s health will deteriorate. Many other factors, such as other health conditions, hepatitis C virus infection, exposure to toxins, and the individual’s biology, play a role. 

Doctors use various methods to determine life expectancy in patients living with chronic liver failure. Two of the most popular methods are the CTP score (Child-Turcotte-Pugh score) and the Model for End-Stage Liver Disease (MELD) score. A person with CTP class A has mild cirrhosis and the longest life expectancy. CTP class B is moderate cirrhosis, and CTP class C is severe cirrhosis with the shortest life expectancy. 

The MELD score determines the risk of death in people with end-stage liver disease based on laboratory tests. It provides an estimate of the person’s likelihood of dying within the next three months. It helps doctors prioritize patients awaiting a liver transplant. A higher MELD score indicates a greater chance of dying within three months. This can help doctors decide to move a person up on the list of those waiting for a liver transplant. Liver transplants can add years of life to people living with cirrhosis, chronic liver failure, and end-stage liver disease. 


  1. https://surgery.ucsf.edu/conditions--procedures/end-stage-liver-disease-(esld).aspx
  2. https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver
  3. https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
  4. https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863