Cirrhosis of the Liver
Basics
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
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Citation
Domino, Frank J., et al., editors. "Cirrhosis of the Liver." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688407/all/Cirrhosis_of_the_Liver.
Cirrhosis of the Liver. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688407/all/Cirrhosis_of_the_Liver. Accessed December 3, 2024.
Cirrhosis of the Liver. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688407/all/Cirrhosis_of_the_Liver
Cirrhosis of the Liver [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688407/all/Cirrhosis_of_the_Liver.
* Article titles in AMA citation format should be in sentence-case
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T1 - Cirrhosis of the Liver
ID - 1688407
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688407/all/Cirrhosis_of_the_Liver
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