Description

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

Epidemiology

• Diagnosis: typically at 40 to 60 years old; male > female
• Liver disease and cirrhosis are the 12th leading cause of death in the United States.
• Nonalcoholic steatohepatitis (NASH) is an increasingly common cause of cirrhosis.

Incidence
~≥30,000 new cases of cirrhosis per year

Prevalence

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

Etiology and Pathophysiology

• Chronic hepatitis C virus (HCV) (26%); alcohol abuse (21%); NASH(~10%) and increasing; hepatitis B virus (HBV) plus hepatitis D infection (15%); other (~25%): hemochromatosis, autoimmune hepatitis, primary biliary cirrhosis (PBC), 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)
• Hepatocellular injury results in cellular hyperplasia (regenerating nodules), fibrous changes, and angiogenesis. Distortions in blood flow result in portal hypertension.

Genetics
Hereditary 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., screen for and address hepatitis C and alcohol overuse); >80% of CLD is preventable.
• Advise weight loss in overweight or obese patients.

Commonly Associated Conditions

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