Cirrhosis of the Liver
A chronic disease with inflammation, necrosis, fibrosis, hepatocellular dysfunction, and vascular remodeling potentially leading to liver failure and/or cancer
- 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).
Roughly 30,000 cases of cirrhosis diagnosed each year and very likely an underestimate as many patients are unaware that they have cirrhosis.
- 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.
Hemochromatosis, Wilson disease, and α1-antitrypsin deficiency in adults are associated with cirrhosis.
Alcohol abuse, intravenous drug abuse, obesity
- 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
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