Summary
Definition
Cirrhosis is a diffuse pathologic process, characterized by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.[1]
It can arise from a variety of causes and is the final stage of any chronic liver disease. It can lead to portal hypertension, liver failure, and hepatocellular carcinoma. In general, it is considered to be irreversible in its advanced stages, although there can be significant recovery if the underlying cause is treated.[Figure caption and citation for the preceding image starts]: Laparoscopic view of a cirrhotic liverCourtesy of Dr Eugene Schiff and Dr Lennox Jeffers; used with permission [Citation ends].
History and exam
Key diagnostic factors
- abdominal distension
- jaundice and pruritus
- blood in vomit (hematemesis) and black stool (melena)
- hand and nail features (e.g., leukonychia, palmar erythema, spider nevi)
- facial features, e.g., telangiectasia, spider nevi, jaundiced sclera
- abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension)
- altered mental status
Other diagnostic factors
- constitutional symptoms
- lower extremity swelling
- hepatic fetor
- muscle wasting
- peripheral edema
- recurrent infections
- decreased libido
- chest wall features (e.g., gynecomastia)
- dyspnea
- chest pain
- syncope
Risk factors
- alcohol misuse
- intravenous drug use
- unprotected intercourse
- obesity
- country of birth
- blood transfusion
- tattooing
- use of methotrexate or amiodarone
Diagnostic investigations
1st investigations to order
- liver function tests
- gamma-glutamyl transferase (GGT)
- serum albumin
- serum sodium
- serum potassium
- prothrombin time
- platelet count
- antibodies to hepatitis C virus ± hepatitis C virus RNA
- hepatitis B surface antigen ± hepatitis B DNA assay
Investigations to consider
- total iron, total iron binding capacity (TIBC), transferrin saturation, and serum ferritin
- antinuclear antibody
- antismooth muscle antibody
- liver kidney microsomal antibody
- antimitochondrial antibody
- serum immunoglobulins
- serum ceruloplasmin
- plasma alpha-1 antitrypsin
- alpha-fetoprotein
- abdominal ultrasound
- abdominal CT
- abdominal MRI
- upper gastrointestinal endoscopy
- liver biopsy
- imaging-based noninvasive tests
- blood-based noninvasive tests
- portal pressure assessment
Treatment algorithm
all patients
Составители
Авторы
Apostolos Koffas, MD (AUTH), MRCP (UK), FESBGH
Consultant Hepatologist
Barts Health NHS Trust
London
UK
Раскрытие информации
AK has served as a member of the UK & Ireland Gilead Sciences GB virtual chronic hepatitis delta virus (HDV) advisory board.
Patrick T. F. Kennedy, MB, BCh, BAO, BMedSci, FRCP, MD
Professor and Consultant Hepatologist
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
Раскрытие информации
PTFK declares educational grant funding from Gilead Sciences and Vir Biotechnology; being on a speaker bureau for Gilead Sciences and GSK; and being on consultancy/advisory boards for Aligos, Bluejay Therapeutics, Gilead Sciences and GSK.
Выражение благодарностей
Dr Apostolos Koffas and Professor Patrick T. F. Kennedy would like to gratefully acknowledge Dr Grace E. Dolman, Dr Keith D. Lindor, and Dr Flavia Mendes, previous contributors to this topic.
Раскрытие информации
GED declares that she has no competing interests. KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.
Рецензенты
Phillipp Hartmann, MD, MAS, DABOM
Assistant Professor - Pediatric Gastroenterology
Hepatology & Nutrition - University of California San Diego
Rady Children’s Hospital San Diego
San Diego
CA
Раскрытие информации
PH declares that he has no competing interests.
James Neuberger, DM, FRCP, Hon
Consultant Physician
Hon Professor in Medicine
Associate Medical Director NHSBT
Queen Elizabeth Hospital
Birmingham
UK
Раскрытие информации
JN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.Полный текст Аннотация
Orman ES, Fortune BE, John BV, et al. AGA clinical practice update on the management of ascites, volume overload, and hyponatremia in cirrhosis: expert review. Gastroenterology. 2025 Dec;169(7):1547-57.Полный текст Аннотация
de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII: renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.Полный текст Аннотация
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Полный текст Аннотация
Rogal SS, Hansen L, Patel A, et al. AASLD practice guidance: palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022 Sep;76(3):819-53.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Budd-Chiari syndrome
- Portal vein thrombosis
- Splenic vein thrombosis
Больше ОтличияРекомендации
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NAFLD Fibrosis Score
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Abdominal paracentesis animated demonstration
Больше Видео
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