Overview
Definition
A late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, resulting in architecturally distorted regenerative nodules.
Epidemiology
A leading cause of death. Often silent until decompensation occurs.
Etiology & Risk Factors
- Chronic Alcohol abuse
- Chronic Viral Hepatitis (Hepatitis C and B)
- Non-alcoholic fatty liver disease (NAFLD/NASH)
- Hemochromatosis (iron overload)
- Autoimmune hepatitis, Primary Biliary Cholangitis (PBC)
Clinical Symptoms
- Fatigue, weight loss
- Jaundice (yellowing of skin/sclera)
- Pruritus (itching)
- Ascites (abdominal swelling)
- Hepatic encephalopathy (confusion/asterixis due to ammonia buildup)
Clinical Approach
Diagnosis
- Labs: Thrombocytopenia (earliest sign due to splenic sequestration), elevated INR, low albumin, elevated bilirubin
- Ultrasound: Nodular, shrunken liver with splenomegaly
- Liver Biopsy (Gold Standard, but often diagnosed clinically/radiologically without it)
Management
- Ascites: Sodium restriction, Diuretics (Spironolactone + Furosemide), Paracentesis
- Encephalopathy: Lactulose (traps ammonia in gut), Rifaximin
- Varices: Non-selective beta-blockers (Nadolol/Propranolol) or endoscopic banding
- Definitive: Liver Transplantation
Complications
- Portal Hypertension (leading to bleeding esophageal varices)
- Hepatic Encephalopathy
- Hepatocellular Carcinoma (HCC) - requires surveillance ultrasound every 6 months
- Spontaneous Bacterial Peritonitis (SBP)
- Hepatorenal syndrome