Cirrhosis of the Liver

Description

A chronic disease with inflammation, necrosis, fibrosis, hepatocellular dysfunction, and vascular remodeling potentially leading to liver failure and/or cancer

Epidemiology

• Predominant age at diagnosis: 40 to 60 years old
• Predominant sex: male > female; more women with cirrhosis from alcohol abuse
• Liver disease and cirrhosis are the 9th leading cause of death among U.S. adult males; 12th overall leading cause of death in United States
• Nonalcoholic steatohepatitis (NASH) is an increasingly common cause of cirrhosis (projected to become the leading cause in the next decade).

Incidence
Roughly 30,000 cases of cirrhosis diagnosed each year and very likely an underestimate as many patients are unaware that they have cirrhosis.

Prevalence

• 0.3% of Americans are diagnosed with cirrhosis (~630,000) and 2% with chronic liver disease.
• Highest prevalence of cirrhosis in non-Hispanic blacks, Mexican Americans, and people living below the federal poverty level

Etiology and Pathophysiology

• Chronic hepatitis C virus (HCV) (26%)
• Alcohol abuse (21%), NASH/obesity (~10%)
• Hepatitis B virus (HBV) plus hepatitis D infection (15%)
• Other: hemochromatosis, autoimmune hepatitis, primary biliary cirrhosis, secondary biliary cirrhosis, biliary atresia, idiopathic biliary fibrosis, primary sclerosing cholangitis, Wilson disease, α₁-antitrypsin deficiency, granulomatous disease (e.g., sarcoidosis); drug-induced liver disease (e.g., methotrexate, α-methyldopa, amiodarone); venous outflow obstruction (e.g., Budd-Chiari syndrome, veno-occlusive disease); chronic right-sided heart failure; tricuspid regurgitation; and rare genetic, metabolic, and infectious causes
• Hepatocellular injury results in cellular hyperplasia (regenerating nodules), fibrous changes, and angiogenesis. Distortions in blood flow result in portal hypertension.

Genetics
Hemochromatosis, Wilson disease, and α₁-antitrypsin deficiency in adults are associated with cirrhosis.

Risk Factors

Alcohol abuse, intravenous drug abuse, obesity

General Prevention

• Mitigate risk factors (e.g., alcohol abuse; screen for hepatitis C); >80% of chronic liver disease is preventable.
• Limit alcohol consumption and advise weight loss in overweight or obese patients.

Commonly Associated Conditions

HCV, alcohol and drug abuse, diabetes, depression, obesity