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
Diagnostic investigations
1st investigations to order
- liver function tests
- gamma-glutamyl transferase (GGT)
- serum albumin
- serum sodium
- prothrombin time
- platelet count
- antibodies to hepatitis C virus
- hepatitis B surface antigen
Investigations to consider
- total iron, total iron binding capacity (TIBC), transferrin saturation, and ferritin
- antinuclear antibody
- antismooth muscle antibody
- antimitochondrial antibody
- serum ceruloplasmin
- plasma alpha-1 antitrypsin
- serum protein electrophoresis
- abdominal ultrasound
- abdominal CT
- abdominal MRI
- upper gastrointestinal endoscopy
- liver biopsy
- noninvasive tests of liver elasticity
Treatment algorithm
Contributors
Authors
Grace E. Dolman, PhD MA (Cantab) MRCP
Clinical Research Fellow
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
Disclosures
GED declares that she has no competing interests.
Patrick T. F. Kennedy, MB BCh BAO BMedSci FRCP MD
Reader and Honorary Consultant in Hepatology
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
Disclosures
PTFK acts as an advisor for Gilead Sciences, Janssen, and Immunocore. PTFK has received grant funding from Gilead Sciences. These roles are unrelated to the current article.
Acknowledgements
Dr Grace E. Dolman and Dr Patrick T. F. Kennedy would like to gratefully acknowledge Dr Keith D. Lindor and Dr Flavia Mendes, previous contributors to this topic.
Disclosures
KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.
Peer reviewers
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Disclosures
NR declares that she has no competing interests.
Cynthia Levy, MD
Clinical Assistant Professor
Division of Gastroenterology Hepatology and Nutrition
University of Florida
Gainesville
FL
Disclosures
CL declares that she has no competing interests.
James Neuberger, DM, FRCP, Hon
Consultant Physician
Hon Professor in Medicine
Associate Medical Director NHSBT
Queen Elizabeth Hospital
Birmingham
UK
Disclosures
JN declares that he has no competing interests.
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