Cirrhosis

Chronic liver disease and cirrhosis are listed among the 10 leading causes of death in the US.

Cirrhosis is the pathologic end-stage of any chronic liver disease and most commonly results from chronic hepatitis C and B, alcohol misuse, and nonalcoholic fatty liver disease.

The main complications of cirrhosis are related to the development of liver insufficiency and portal HTN and include ascites, variceal hemorrhage, jaundice, portosystemic encephalopathy, hepatorenal and hepatopulmonary syndromes, and the development of hepatocellular carcinoma.

Once a patient with cirrhosis develops signs of decompensation, survival is significantly impaired.

The management of cirrhosis is aimed at treating underlying liver disease, avoiding superimposed injury, and managing complications. Timely referral for liver transplantation is the only curative treatment option for patients with decompensated cirrhosis.

Cirrhosis is a diffuse pathologic process, characterized by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.[1]Anthony PP, Ishak KG, Nayak NC, et al. The morphology of cirrhosis: definition, nomenclature, and classification. Bull World Health Organ. 1977;55:521-540. http://www.ncbi.nlm.nih.gov/pubmed/304393?tool=bestpractice.com [2]Ratib S, Fleming KM, Crooks CJ, et al. Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study. Am J Gastroenterol. 2015;110:1149-1158. http://www.ncbi.nlm.nih.gov/pubmed/26169512?tool=bestpractice.com It can arise from a variety of causes and is the final stage of any chronic liver disease. It leads to portal hypertension, liver insufficiency, and hepatic failure. In general, it is considered to be irreversible in its advanced stages.[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].