Cirrhosis is the pathologic end-stage of any chronic liver disease and most commonly results from chronic hepatitis B and C, alcohol-related liver disease, and nonalcoholic fatty liver disease.
The main complications of cirrhosis are related to the development of liver insufficiency and portal hypertension and include ascites, variceal hemorrhage, jaundice, portosystemic encephalopathy, acute kidney injury and hepatopulmonary syndromes, and the development of hepatocellular carcinoma.
Once a patient with cirrhosis develops signs of decompensation, survival is significantly impaired.
Management of cirrhosis includes treating underlying liver disease, avoiding superimposed injury, and managing complications. Timely referral for liver transplantation may be the only curative treatment option for patients with decompensated cirrhosis.
Chronic liver disease and cirrhosis are significant causes of premature mortality.
Cirrhosis is a diffuse pathologic process, characterized by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.
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.
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)
- chest pain
- alcohol misuse
- intravenous drug use
- unprotected intercourse
- country of birth
- blood transfusion
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 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
- antimitochondrial antibody
- serum immunoglobulins
- serum ceruloplasmin
- plasma alpha-1 antitrypsin
- abdominal ultrasound
- abdominal CT
- abdominal MRI
- upper gastrointestinal endoscopy
- liver biopsy
- noninvasive tests of liver elasticity
- Budd-Chiari syndrome
- Portal vein thrombosis
- Splenic vein thrombosis
- Clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis
- Clinical practice guidelines on the management of hepatic encephalopathy
Cirrhosis: what is it?
Cirrhosis: what treatments work?More Patient leaflets
Ascitic drainage: animated demonstrationMore videos
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