Cirrhosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Cirrhosis is a consequence of chronic liver disease characterized by the replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. Cirrhosis is most commonly caused by alcoholism and hepatitis C, but has many other possible causes.
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible once it occurs, and treatment generally focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant.
Pathophysiology
Cirrhosis occurs due to long term liver injury which causes an imbalance between matrix production and degradation. Early disruption of the normal hepatic matrix results in its replacement by scar tissue, which in turn has deleterious effects on cell function.
Causes
There are a wide range of causes for cirrhosis, including alcohol abuse, genetic diseases, cardiac causes, toxins, viruses, and malnutrition. The consequence to the liver is the same in all cases however, with the functioning liver tissue being replaced by non-functioning scar tissue.
Differentiating Cirrhosis from other Diseases
Epidemiology and Demographics
The most common cause of cirrhosis in the United States is chronic and heavy alcohol use, while the most common cause of cirrhosis worldwide is the hepatitis virus. Cirrhosis and liver disease is the 10th leading cause of death in men, and the 12th leading cause of death in women.
Risk Factors
Certain aspects of genetics and lifestyle can put someone at risk for cirrhosis. Chronic alcohol use, or the development of a fatty liver can put one at risk for cirrhosis. Genetic diseases such as cystic fibrosis, and hemochromatosis, and not genetic diseases such as hepatitis B and hepatitis C, are also significant risk factors for the development of cirrhosis.
Natural History, Complications and Prognosis
Cirrhosis is irreversible, and will worsen if it is caused by an offending agent such as alcohol and the alcohol use continues. The natural history progresses so that there is a lengthy stage of compensation, followed by a fast development of complications and sequelae as a result of the cirrhosis. The most dire complications are complete liver failure and death, or the development of hepatocellular carcinoma. Other complications include portal hypertension, ascites, jaundice, itching, esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and cardiomyopathy. Prognosis depends on the causes, and the complications, and mortality is high. There are scores by which to classify severity and to determine suitability for liver transplant.
Diagnosis
History and Symptoms
The diagnosis of liver cirrhosis requires accurate knowledge of abuse of alcohol by the patient. Other causes of cirrhosis (eg: Hepatitis B and C, metabolic or autoimmune cause) also need to be determined to better understand the prognosis and treatment of the cirrhosis.
Physical Examination
Many signs and symptoms may occur in the presence of cirrhosis or as a result of the complications or causes of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any sign or symptom does not rule out the possibility of cirrhosis.