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 9th leading cause of death in the United States. Age-adjusted mortality is 22/100,000.
• Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common cause of cirrhosis.

Etiology and Pathophysiology

• Chronic hepatitis C virus (HCV) (24%); alcohol related (28%); MASLD (~26%); hepatitis B virus (HBV) (2%); other (~20%): 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 leads to chronic inflammatory changes, extracellular matrix deposition, cellular hyperplasia (regenerating nodules), fibrous infiltration, and angiogenesis. Distortions in blood flow result in portal hypertension.

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