20/08/2025
🔥 Liver Cirrhosis - High-Yield Points
End-stage liver disease characterized by fibrosis, regenerative nodules, and loss of liver architecture.
🔹 Etiology: (Viral, Alcoholic, Metabolic, Autoimmune)
* Alcoholic Cirrhosis (Most common in Western countries)
* Viral Hepatitis (HBV, HCV)
* Non-Alcoholic Fatty Liver Disease (NAFLD) - Commonly associated with obesity, diabetes.
* Hemochromatosis (Iron overload)
* Wilson’s Disease (Copper accumulation)
* Primary Biliary Cirrhosis (PBC) - Autoimmune, affects intrahepatic bile ducts.
* Primary Sclerosing Cholangitis (PSC) - Associated with IBD, especially UC.
* α1-antitrypsin deficiency (Inherited, PAS-positive globules in liver biopsy)
🔹 Pathophysiology:
Chronic liver injury → Inflammation → Fibrosis → Nodule formation (Regeneration attempt) → Portal hypertension & Liver failure.
🔹 Clinical Features:
* General: Fatigue, weight loss, weakness.
* Skin: Jaundice, spider angiomas, palmar erythema, pruritus.
* GI: Ascites, caput medusae, splenomegaly.
* Endocrine: Gynecomastia, testicular atrophy (due to hyperestrogenism).
* Hematologic: Coagulopathy (↓ clotting factors), thrombocytopenia.
* Neurologic: Hepatic encephalopathy (Asterixis, confusion, coma).
🔹 Complications:
* Portal Hypertension: Esophageal varices, splenomegaly, ascites.
* Hepatocellular Carcinoma (HCC): Increased risk.
* Hepatorenal Syndrome (HRS): Renal failure secondary to liver disease.
* Hepatopulmonary Syndrome (HPS): Hypoxia due to intrapulmonary vasodilation.
🔹 Diagnosis:
* Liver Biopsy: Gold standard (Confirms cirrhosis, identifies etiology).
* Non-Invasive: Ultrasound, Elastography (Fibroscan), CT/MRI.
Lab Findings:
* ↑ AST, ALT, ALP, GGT (Especially ALP, GGT in biliary causes).
* ↓ Albumin, ↑ PT/INR (Coagulopathy).
* ↑ Bilirubin.
🔹 Management:
* Lifestyle Modifications: Alcohol cessation, weight loss in NAFLD.
* Treatment of underlying cause: Antiviral therapy, phlebotomy (hemochromatosis), copper chelation (Wilson’s).
* Managing complications:
Ascites: Sodium restriction, diuretics (spironolactone, furosemide).
Esophageal varices: Non-selective beta-blockers (propranolol), endoscopic banding.
Encephalopathy: Lactulose, rifaximin.
* Liver Transplantation: Definitive treatment for end-stage cirrhosis.
🔹 Prognosis & Scoring Systems:
* Child-Pugh Score: Evaluates severity (Bilirubin, Albumin, INR, Ascites, Encephalopathy).
* MELD Score: Predicts mortality; important for transplant prioritization.