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; male > female; more women from alcohol abuse
- Liver disease and cirrhosis are the 12th leading cause of death in Unites States; 7th among adults aged 25 to 64 years in the Unites States
- Nonalcoholic steatohepatitis (NASH) is an increasingly common cause of cirrhosis.
~30,000 cases of cirrhosis/per year
- 0.3% of Americans are diagnosed with cirrhosis (~630,000) and 2% with chronic liver disease.
- Highest prevalence 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 (~25%): 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)
- 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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