Page 2 - 06- Cirrhosis of the Liver

CIRRHOSIS OF THE LIVER
Liam P. Burke, MD

BASICS

DESCRIPTION
A chronic disease with inflammation, necrosis, fibrosis, hepatocellular dysfunction, and vascular
remodeling potentially leading to liver failure and/or cancer

EPIDEMIOLOGY
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 causes of death among U.S. adult males; 12th
overall

ETIOLOGY AND PATHOPHYSIOLOGY
Chronic hepatitis C virus (HCV) (26%)
Alcohol abuse (21%)
Nonalcoholic steatohepatitis (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, α -antitrypsin deficiency, granulomatous disease (e.g., sarcoidosis); drug-induced
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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.
Genetics
Hemochromatosis, Wilson disease, and α -antitrypsin deficiency in adults are associated with
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cirrhosis.

RISK FACTORS
Alcohol abuse, intravenous drug abuse, obesity

GENERAL PREVENTION
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

DIAGNOSIS