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Cirrhosis

Cirrhosis
Other namesCirrhosis of the liver, hepatic cirrhosis
Cross-section of human liver with cirrhosis
Pronunciation
SpecialtyGastroenterology, Hepatology
SymptomsTiredness, itchiness, swelling in the lower legs, jaundice, easily bruising, fluid build-up in the abdomen[1]
ComplicationsSpontaneous bacterial peritonitis, hepatic encephalopathy, dilated veins in the esophagus, liver cancer[1]
Usual onsetOver months, years or decades[1]
DurationLong term[1]
CausesAlcoholic liver disease, hepatitis B, hepatitis C, non-alcoholic steatohepatitis
Diagnostic methodBlood tests, medical imaging, liver biopsy[2][1]
PreventionVaccination (such as hepatitis B), avoiding alcohol,[1] losing weight, exercising, low-carbohydrate diet, controlling hypertension and diabetes may help in those with NAFLD or NASH
TreatmentDepends on underlying cause[3]
Frequency2.8 million (2015)[4]
Deaths1.3 million (2015)[5]

Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease.[6] Damage to the liver leads to repair of liver tissue and subsequent formation of scar tissue. Over time, scar tissue can replace normal functioning tissue, leading to the impaired liver function of cirrhosis.[6][7] The disease typically develops slowly over months or years.[1] Early symptoms may include tiredness, weakness, loss of appetite, unexplained weight loss, nausea and vomiting, and discomfort in the right upper quadrant of the abdomen.[8] As the disease worsens, symptoms may include itchiness, swelling in the lower legs, fluid build-up in the abdomen, jaundice, bruising easily, and the development of spider-like blood vessels in the skin.[8] The fluid build-up in the abdomen may develop into spontaneous infections.[1] More serious complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus, stomach, or intestines, and liver cancer.[9] Stages of cirrhosis include compensated cirrhosis and decompensated cirrhosis.[10]

Cirrhosis is most commonly caused by alcoholic liver disease, non-alcoholic steatohepatitis (NASH – the progressive form of non-alcoholic fatty liver disease),[11] heroin abuse,[12] chronic hepatitis B, and chronic hepatitis C.[8][13] Heavy drinking over a number of years can cause alcoholic liver disease.[14] Liver damage has also been attributed to heroin usage over an extended period of time as well.[15] NASH has a number of causes, including obesity, high blood pressure, abnormal levels of cholesterol, type 2 diabetes, and metabolic syndrome.[16] Less common causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis that disrupts bile duct function, genetic disorders such as Wilson's disease and hereditary hemochromatosis, and chronic heart failure with liver congestion.[8]

Diagnosis is based on blood tests, medical imaging, and liver biopsy.[2][1]

Hepatitis B vaccine can prevent hepatitis B and the development of cirrhosis, but no vaccination against hepatitis C is available.[1] No specific treatment for cirrhosis is known, but many of the underlying causes may be treated by a number of medications that may slow or prevent worsening of the condition.[3] Hepatitis B and C may be treatable with antiviral medications.[1] Avoiding alcohol is recommended in all cases.[1] Autoimmune hepatitis may be treated with steroid medications.[1] Ursodiol may be useful if the disease is due to blockage of the bile duct.[1] Other medications may be useful for complications such as abdominal or leg swelling, hepatic encephalopathy, and dilated esophageal veins.[1] If cirrhosis leads to liver failure, a liver transplant may be an option.[16]

Cirrhosis affected about 2.8 million people and resulted in 1.3 million deaths in 2015.[4][5] Of these deaths, alcohol caused 348,000 (27%), hepatitis C caused 326,000 (25%), and hepatitis B caused 371,000 (28%).[5] In the United States, more men die of cirrhosis than women.[1] The first known description of the condition is by Hippocrates in the fifth century BCE.[17] The term "cirrhosis" was derived in 1819 from the Greek word "kirrhos", which describes the yellowish color of a diseased liver.[18]

  1. ^ a b c d e f g h i j k l m n o p "Cirrhosis". National Institute of Diabetes and Digestive and Kidney Diseases. April 23, 2014. Archived from the original on 9 June 2015. Retrieved 19 May 2015.
  2. ^ a b Ferri FF (2019). Ferri's clinical advisor 2019 : 5 books in 1. Philadelphia, PA. pp. 337–339. ISBN 978-0-323-53042-2.{{cite book}}: CS1 maint: location missing publisher (link)
  3. ^ a b "Treatment for Cirrhosis | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 20 March 2021. Retrieved 6 March 2021.
  4. ^ a b Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  5. ^ a b c Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  6. ^ a b "Cirrhosis". nhs.uk. 29 June 2020. Archived from the original on 5 October 2017. Retrieved 8 February 2021.
  7. ^ Dooley JS, Lok AS, Garcia-Tsao G, Pinzani M (8 June 2018). Sherlock's diseases of the liver and biliary system (13th ed.). Hoboken, NJ. p. 82. ISBN 978-1-119-23756-3. OCLC 1019837000.{{cite book}}: CS1 maint: location missing publisher (link)
  8. ^ a b c d "Symptoms & Causes of Cirrhosis | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 8 February 2021. Retrieved 8 February 2021.
  9. ^ "Definition & Facts for Cirrhosis | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 2021-03-11. Retrieved 2021-03-10.
  10. ^ Cite error: The named reference :2 was invoked but never defined (see the help page).
  11. ^ Castera L, Friedrich-Rust M, Loomba R (April 2019). "Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease". Gastroenterology. 156 (5): 1264–1281.e4. doi:10.1053/j.gastro.2018.12.036. PMC 7505052. PMID 30660725.
  12. ^ Ilić G, Karadžić R, Kostić-Banović L, Stojanović J, Antović A (February 2010). "Ultrastructural Changes In The Liver Of Intravenous Heroin Addiction". Bosnian Journal of Basic Medical Sciences. Vol. 10, no. 1. Journal of the Association of Basic Medical Sciences. pp. 36–43. PMC 5596609.
  13. ^ Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. (GBD 2013 Mortality Causes of Death Collaborators) (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  14. ^ "Alcoholic liver disease". MedlinePlus Medical Encyclopedia. Archived from the original on 2019-05-27. Retrieved 2021-03-10.
  15. ^ "Heroin and Liver Damage". Banyan Medical Centers. Retrieved August 7, 2022.
  16. ^ a b "Definition & Facts of NAFLD & NASH | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 12 March 2021. Retrieved 9 March 2021.
  17. ^ Brower ST (2012). Elective general surgery : an evidence-based approach. New York: McGraw-Hill Medical. p. 36. ISBN 978-1-60795-109-4. Archived from the original on 2017-09-08.
  18. ^ Roguin A (September 2006). "Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope". Clinical Medicine & Research. 4 (3): 230–235. doi:10.3121/cmr.4.3.230. PMC 1570491. PMID 17048358.

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