Cirrhosis of the Liver

Cirrhosis of the Liver is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

A chronic hepatocellular disease with inflammation, necrosis, and fibrosis 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

Etiology and Pathophysiology

  • Chronic hepatitis C virus (HCV) (26%)
  • Alcohol abuse (21%)
  • Nonalcoholic steatohepatitis (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); >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

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