Overview
Definition
A late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, characterized by nodular regeneration.
Epidemiology
Accounts for millions of deaths globally. Common causes vary by region (HCV/HBV vs Alcohol/MASLD).
Etiology & Risk Factors
- Alcoholic liver disease
- Chronic Hepatitis C or B
- Metabolic dysfunction-associated steatotic liver disease (MASLD/NASH)
- Autoimmune hepatitis
- Hemochromatosis
Clinical Symptoms
- Fatigue
- Jaundice
- Ascites
- Spider angiomata
- Palmar erythema
- Hepatic encephalopathy (confusion)
Clinical Approach
Diagnosis
- Liver biopsy (gold standard, but often diagnosed clinically/radiologically)
- Ultrasound/CT/MRI (nodular liver, portal hypertension signs)
- Labs: Thrombocytopenia, elevated PT/INR, low albumin, elevated bilirubin
Management
- Treat underlying cause (antivirals for Hep C/B, alcohol cessation)
- Ascites: Diuretics (Spironolactone + Furosemide), Paracentesis
- Encephalopathy: Lactulose, Rifaximin
- Varices: Non-selective beta-blockers (Nadolol), Band ligation
Complications
- Portal hypertension
- Esophageal varices bleeding
- Hepatocellular carcinoma
- Hepatorenal syndrome