Liver Cirrhosis: Definition, Stages, Clinical Features, Diagnosis, and Treatment

Definition and Pathophysiology

• Liver cirrhosis is a chronic liver disease characterized by the replacement of normal liver tissue with scar tissue, leading to loss of liver function.
• It is a result of chronic liver injury, which can be caused by various factors such as:
  • Viral hepatitis (B and C)
  • Alcoholic liver disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Autoimmune hepatitis
  • Bile duct obstruction

Stages of Liver Cirrhosis

• Compensated cirrhosis: The liver still functions adequately despite scarring, but may have symptoms such as fatigue and weakness.
• Decompensated cirrhosis: The liver function is impaired, leading to symptoms such as:
  • Ascites (fluid accumulation in the abdomen)
  • Variceal bleeding (bleeding from esophageal or gastric varices)
  • Encephalopathy (confusion, altered mental status)

Clinical Features

• Symptoms:
  • Fatigue
  • Weakness
  • Loss of appetite
  • Nausea and vomiting
  • Abdominal pain
  • Jaundice (yellowing of the skin and eyes)
• Signs:
  • Palmar erythema (redness of the palms)
  • Spider nevi (small, spider-like blood vessels on the skin)
  • Gynecomastia (breast enlargement in men)
  • Testicular atrophy (shrinkage of the testes)

Diagnosis

• Laboratory tests:
  • Liver function tests (LFTs)
  • Complete blood count (CBC)
  • Coagulation studies
• Imaging studies:
  • Ultrasound
  • CT or MRI scan
• Liver biopsy: The gold standard for diagnosing cirrhosis, but not always necessary

Treatment and Management

• Treatment of underlying causes (e.g. antiviral therapy for viral hepatitis)
• Management of complications:
  • Ascites: diuretics and paracentesis (fluid removal)
  • Variceal bleeding: endoscopic therapy and beta blockers
  • Encephalopathy: lactulose and rifaximin
• Liver transplantation: The only cure for end-stage liver cirrhosis