Liver cirrhosis

What is Liver Cirrhosis? Liver Cirrhosis is the fibrotic scarring of the liver parenchyma, causing damage and dysfunction of the organ. It affects about .20% of the US population, with a mortality burden of approximately 44,000 people annually. There has been an increase in the incidence of cirrhosis, especially in younger individuals, likely because of an increase in obesity, metabolic disease, and excessive alcohol use.

What causes Liver Cirrhosis?

The pathomechanism of liver cirrhosis usually involves chronic hepatic inflammation or cholestasis. Damage to the parenchyma precipitates the normal wound healing process with fibrin scarring. Chronic injury can cause increased, irreversible fibrosis in the perisinusoidal space, which causes further damage to hepatocytes and portal vein hypertension through the narrowing of the sinusoids. 

Common causes of liver cirrhosis:

  • Viral hepatitis
  • Alcohol-related liver disease
  • Non-alcoholic fatty liver disease

Other, less common causes:

  • Autoimmune hepatitis
  • Primary biliary cholangitis
  • Hemochromatosis
  • Wilson disease
  • Drug-induced liver cirrhosis

Signs and Symptoms of Liver Cirrhosis 

As liver cirrhosis results from chronic processes and the liver remains functional until there is extensive damage, the early stages of the disease, when it is clinically compensated, are asymptomatic. Diagnosis may occur incidentally through labs and imaging.

Decompensated liver cirrhosis can present with a variety of signs and symptoms because of the effect the resultant portal hypertension and decrease in liver function have on other organ systems, such as:

  • Ascites
  • Jaundice
  • Fatigue
  • Anorexia
  • Muscle wasting
  • Hepatic encephalopathy
  • Caput medusa
  • Coagulopathies
  • Spider nevi
  • Palmar erythema
  • Hypogonadism and gynecomastia
  • Asterixis
  • Foeter hepaticus

Complications of liver cirrhosis can include hepatocellular carcinoma, spontaneous bacterial peritonitis, and hepatorenal disease.

Source: Moon, A. M., Singal, A. G., & Tapper, E. B. (2020). Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clinical Gastroenterology and Hepatology, 18(12), 2650–2666.