Cirrhosis

Description

Histologically, cirrhosis is defined by the presence of fibrosis with regenerative nodules. Clinically. cirrhosis presents with evidence of portal hypertension, i.e. ascites, variceal bleeding, hepatic encephalopathy.

Causes

Although most often associated with alcohol abuse, cirrhosis of the liver can result from many causes. Almost any chronic liver disease can lead to cirrhosis. This list gives some of the many causes:

Alcoholic liver disease - most common cause in the U. S. A.

Chronic viral hepatitis B, C and D

Chronic autoimmune hepatitis

Inherited metabolic diseases (e. g. hemochromatosis, Wilson disease)

Chronic bile duct diseases (e. g. primary or secondary biliary cirrhosis)

Chronic congestive heart failure. Cardiac cirrhosis

Parasitic infections (e. g. schistosomiasis)

Nonalcoholic steatohepatitis (liver inflammation that can be caused by fatty liver)

Long term exposure to toxins or drugs

Alpha 1-antitrypsin deficiency, Cystic fibrosis

Autoimmune chronic hepatitis with cirrhosis

Primary sclerosing cholangitis

Glycogen storage disease, Galactosemia, Fructose intolerance, Tyrosinemia

Acid cholesterol ester hydrolase deficiency

Conventional Labs

Recognition of liver injury - elevated AST, elevated ALT; elevated alkaline phosphatase. Note: All liver injury tests may be normal.

Functional impairment of the liver - elevated bilirubin, decreased albumin, elevated globulin, prolonged prothrombin time



Etiologic screen for liver disease:

Ceruloplasmin (Wilson's disease)

Iron, iron binding capacity, ferritin (hemochromatosis)

lpha fetoprotein (hepatocellular cancer)

HBsAg (hepatitis B)

Anti-HCV (hepatitis C)

ANA (autoimmune hepatitis)

Anti-smooth muscle antibody (autoimmune hepatitis)

Anti-mitochondrial antibody (AMA) (primary biliary cirrhosis)

Alpha 1-antitrypsin (deficiency)

Serum protein electrophoresis (SPEP) - increased IgG with any liver disease; increased IgM with primary biliary cirrhosis (PBC)

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