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Cirrhosis: Overview and Risk Factors

Cirrhosis is a chronic, irreversible liver disease that results from prolonged hepatocellular injury. Ultimately, the liver architecture is destroyed with regenerating hepatocytes and increased fibrosis, and the organ’s synthetic and metabolic functions are progressively decreased.

The majority of cases are due to chronic alcohol use or viral hepatitis, especially hepatitis C. However, any chronic liver disease (eg, hemochromatosis, Wilson’s disease, sclerosing cholangitis, autoimmune hepatitis) can result in cirrhosis.

The initial presentation is nonspecific, including weight loss, anorexia, fatigue, weakness, nausea, dull abdominal pain, and constipation or diarrhea. As the disease progresses, clinical features become progressively more prominent. These include jaundice, spider angiomata, palmar erythema, gynecomastia, testicular atrophy, bruising, and hypocoagulation. Portal hypertension occurs as the liver architecture is obliterated, resulting in ascites, edema, splenomegaly, and esophageal varices.

Complications of advanced disease can be fatal. Hepatic encephalopathy can result in lethargy, confusion, slurred speech, hallucinations, asterixis, obtundation, and coma. Hemorrhage from esophageal varices occurs in up to 40% of cirrhosis patients, resulting in massive hematemesis and high mortality. Other complications include spontaneous bacterial peritonitis, acute renal failure (hepatorenal syndrome), and hepatocellular carcinoma.

Risk Factors

Chronic alcohol abuse. Alcoholic liver disease results in 12,000 deaths per year in the United States. Unfortunately, many patients become symptomatic only after severe liver disease is present. Daily alcohol intake as low as 20 grams (two drinks) per day for women and 40 grams (4 drinks) per day for men can result in liver disease over the course of 10 years. However, a somewhat higher amount, perhaps 80 grams daily or more, may be necessary to significantly predispose an individual to cirrhosis.

Unprotected intercourse. Hepatitis B and C infections are easily transmitted through unprotected sexual intercourse.

Intravenous drug use. Hepatitis B and C transmission is also common through intravenous drug use.

Inherited or acquired chronic liver disease. Hemochromatosis, Wilson’s disease, and autoimmune hepatitis can lead to cirrhosis.

Toxins. Chronic toxic exposures can lead to chronic hepatic injury, although it is not yet clear if toxin exposures other than alcohol lead to cirrhosis.

 

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Cirrhosis: Diagnosis and Treatment >>