From the Guidelines
Cirrhosis is a serious liver disease characterized by extensive scarring (fibrosis) that develops when the liver is damaged repeatedly over time, and it is generally irreversible, but treating the underlying cause can slow progression.
Definition and Causes
Cirrhosis is an end-stage form of chronic liver disease, with a prevalence estimated at between 2000 and 3300 people per million inhabitants 1. The most common causes of cirrhosis include chronic alcohol abuse, viral hepatitis (particularly hepatitis B and C), nonalcoholic fatty liver disease, and certain genetic disorders.
Pathophysiology and Complications
The pathophysiology of cirrhosis involves the gradual replacement of healthy liver tissue by annular fibrosis, leading to the destruction of the liver architecture and blocking of intrahepatic portal blood flow 1. This can result in life-threatening complications related to portal hypertension and/or hepatic dysfunction, such as ascites, spontaneous bacterial peritonitis, variceal hemorrhage, hepatic encephalopathy, and hepatorenal syndrome.
Management and Treatment
Management of cirrhosis focuses on preventing further damage through lifestyle changes, such as avoiding alcohol and maintaining a healthy weight, medications to treat complications, and in severe cases, liver transplantation may be considered 1. Early detection through regular medical check-ups is crucial for those at risk.
Prognosis and Mortality
Cirrhosis is associated with a high rate of in-hospital mortality, ranging from 30% to 50% 1. The severity of cirrhosis can be established using the Child–Turcotte score or the CLIF SOFA score, which can help predict outcomes and guide management decisions.
Recent Guidelines and Recommendations
Recent guidelines and recommendations, such as those from the American Gastroenterological Association (AGA), provide guidance on the use of vasoactive drugs and intravenous albumin in the management of cirrhosis and its complications 1. These guidelines aim to improve outcomes and reduce mortality in patients with cirrhosis.
From the Research
Definition of Cirrhosis
- 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 2.
- Cirrhosis is a histologic term that requires liver biopsy for definitive diagnosis 3.
Causes and Risk Factors
- The most common causes of cirrhosis include alcohol use disorder, nonalcoholic fatty liver disease, and hepatitis C 4.
- Other risk factors include viral hepatitis, metabolic syndrome, and lifestyle diseases 5.
Symptoms and Complications
- Patients with cirrhosis may experience symptoms such as muscle cramps, pruritus, poor-quality sleep, and sexual dysfunction 4.
- Complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome 4, 6, 5.
- The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively 4.
Diagnosis and Treatment
- Cirrhosis can be diagnosed by liver biopsy, but may also be diagnosed noninvasively using elastography, laboratory tests, and imaging studies 2, 4.
- Treatment of cirrhosis includes management of the underlying cause, such as nonalcoholic fatty liver disease, viral hepatitis, or alcohol use 2.
- Medications such as lactulose, propranolol, and terlipressin may be used to manage complications of cirrhosis 4, 6.
- Liver transplantation may be considered in patients with advanced cirrhosis and complications such as hepatocellular carcinoma or hepatorenal syndrome 2, 6, 5.