What is hepatic cirrhosis (liver scarring)?

From the Guidelines

Hepatic cirrhosis is a chronic liver disease characterized by the replacement of healthy liver tissue with scar tissue, leading to impaired liver function, and it is crucial to address the underlying cause, prevent further damage, and manage complications to improve morbidity, mortality, and quality of life. It develops gradually as a result of long-term damage to the liver, commonly caused by chronic alcohol abuse, viral hepatitis (particularly hepatitis B and C), nonalcoholic fatty liver disease, or certain genetic disorders 1. As cirrhosis progresses, the liver becomes increasingly unable to perform its vital functions, which include filtering toxins from the blood, producing proteins for blood clotting, and metabolizing drugs and nutrients. Symptoms may include fatigue, weakness, easy bruising, jaundice (yellowing of skin and eyes), fluid accumulation in the abdomen (ascites), swelling in the legs, confusion, and bleeding from enlarged veins in the esophagus.

The management of hepatic cirrhosis involves lifestyle changes, medications, and in some cases, liver transplantation. According to the most recent guidelines, patients with cirrhosis should be screened for hepatocellular carcinoma (HCC) regularly, as the risk of developing HCC is high in these patients 1. The British Society of Gastroenterology recommends surveillance for HCC in patients with cirrhosis who would benefit from early detection of HCC.

Some key points to consider in the management of hepatic cirrhosis include:

• The importance of early diagnosis and treatment to improve outcomes
• The need for regular screening for HCC in patients with cirrhosis
• The role of lifestyle changes, such as abstaining from alcohol, in managing the disease
• The use of medications, such as diuretics, to manage complications
• The potential need for liver transplantation in advanced cases

It is essential to prioritize the management of hepatic cirrhosis to improve morbidity, mortality, and quality of life, and to slow the progression of the disease. As stated in the EASL clinical practice guidelines, the management of decompensated cirrhosis should focus on addressing the underlying cause, preventing further damage, and managing complications 1.

In terms of specific management strategies, the EASL guidelines recommend the use of non-invasive methods, such as imaging and biomarkers, to diagnose and monitor liver fibrosis and cirrhosis 1. The guidelines also emphasize the importance of managing complications, such as ascites, variceal bleeding, and hepatic encephalopathy, to improve outcomes.

Overall, the management of hepatic cirrhosis requires a comprehensive approach that addresses the underlying cause, prevents further damage, and manages complications to improve morbidity, mortality, and quality of life.

From the Research

Definition and Characteristics of Hepatic Cirrhosis

• Hepatic cirrhosis is defined as the pathologic scarring of liver tissue that leads to impaired liver function 2.
• It can result from any etiology of chronic liver inflammation and causes significant disease burden.
• Cirrhosis is characterized by inflammation, necrosis, advanced fibrosis, and regenerative nodule formation 3.

Diagnosis and Management of Hepatic Cirrhosis

• Cirrhosis is typically diagnosed with a history, physical examination, and noninvasive testing, which includes laboratory tests, combination scoring indices, and imaging 2.
• Liver biopsy remains the reference standard for diagnosis and should be used when results of noninvasive evaluation are indeterminate 2.
• Management of cirrhosis includes counseling patients about alcohol use, obesity management, and prevention of infection, as well as avoiding drugs with potential hepatotoxicity 2.

Complications and Treatment of Hepatic Cirrhosis

• Cirrhosis can lead to complications such as hepatocellular carcinoma, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and esophageal varices 2.
• Non-selective beta-blockers (NSBBs) are the mainstay of treatment for portal hypertension in the setting of liver cirrhosis 4, 5.
• NSBBs can lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects 6.
• Carvedilol, a NSBB with intrinsic anti-α(1)-adrenergic activity, may be more effective than propranolol in lowering portal hypertension 4.