Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Cirrhosis occurs due to long term liver injury which causes an imbalance between matrix production and degradation. Notice the large nodules separated by wider scars are irregularly distributed throughout the liver, which occurs usually due to an infectious agent such as viral hepatitis C which does not diffuse uniformly throughout the liver. Chronic infection with hepatitis C (>6 months) is a risk factor for the development of cirrhosis and hepatocellular carcinoma, which primarily happens through chronic inflammation. Unlike hepatitis B (a DNA virus), hepatitis C cannot integrate into the host genome and instead causes a constant inflammtory reaction. The pathogenesis of cirrhosis involves inflammation, hepatic stellate cell activation, angiogenesis and fibrogenesis. Decompensated cirrhosis is the term used to describe the development of specific complications resulting from the changes brought on by cirrhosis. The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed. Cirrhosis often has no signs or symptoms until liver damage is extensive. The devastating complications include complete liver failure or the development of hepatocellular carcinoma. Other complications include portal hypertension, ascites, jaundice, itching, esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal and hepatopulmonary syndromes, and cardiomyopathy. Liver transplantation is necessary when complications develop and liver cease to function.