Definition of Liver Cirrhosis
Liver cirrhosis is an end-stage form of chronic liver disease characterized by the progressive replacement of healthy liver tissue with fibrotic scar tissue and regenerative nodules, which destroys the normal liver architecture, blocks intrahepatic portal blood flow, and leads to portal hypertension and hepatic dysfunction. 1
Pathological Process
The disease develops through a specific sequence of structural changes:
- Fibrosis begins with deposition of a fine neomatrix within the space of Disse that progressively matures and enlarges over time. 1, 2
- The fibrotic process typically starts in the centrilobular region and extends toward the portal tract as the disease advances. 2, 3
- This architectural distortion increases intrahepatic resistance to portal blood flow, which is the primary mechanism driving portal hypertension. 1, 3
Major Etiologies
The most common causes worldwide include:
- Viral hepatitis (hepatitis B and C) accounts for approximately 54% and 31% of cirrhosis cases globally, respectively 1
- Chronic alcohol abuse represents a leading cause, accounting for 40-50% of cases in some European countries 1
- Metabolic-associated steatotic liver disease (MASLD/NAFLD) affects approximately 19% of US adults (28.8 million people) and is an increasingly recognized cause 1
- Autoimmune and genetic conditions including autoimmune hepatitis, primary biliary cholangitis, hereditary hemochromatosis, and alpha-1-antitrypsin deficiency 1
Clinical Stages
Cirrhosis progresses through two distinct prognostic phases:
- Compensated cirrhosis is asymptomatic with no clinically evident complications and a median survival exceeding 12 years 4
- Decompensated cirrhosis manifests with complications including ascites, variceal hemorrhage, hepatic encephalopathy, and jaundice, with median survival reduced to approximately 1.8-2 years 4
- Patients with compensated cirrhosis progress to decompensation at a rate of 5-7% per year, with about 50% developing ascites within 10 years of diagnosis. 4
Key Complications
Portal hypertension drives the major complications:
- Gastroesophageal varices develop in 30-40% of patients with compensated cirrhosis and up to 85% with decompensated cirrhosis 1, 3
- Hepatocellular carcinoma (HCC) occurs at an annual incidence of 1-8% in cirrhotic patients 1
- Ascites is often the first sign of decompensation, with 1-year and 2-year survival rates of 60% and 45%, respectively 4
Diagnostic Features
Morphologic features visible on imaging include:
- Liver surface nodularity (particularly anterior left lobe), atrophic right lobe with hypertrophied caudate lobe, narrow hepatic veins (<5 mm), and enlarged caudate-to-right lobe ratio (>0.90) 4, 1
- Noninvasive assessment includes serum markers, elastography techniques (transient elastography, ARFI), and conventional cross-sectional imaging 4, 1