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Encyclopedia > Cirrhosis
Cirrhosis
Classification and external resources
Cirrhosis leading to hepatocellular carcinoma (autopsy specimen).
ICD-10 K70.3, K71.7, K74.
ICD-9 571
DiseasesDB 2729
eMedicine med/3183  radio/175
MeSH D008103
Liver cirrhosis as seen on an axial CT of the abdomen.
Liver cirrhosis as seen on an axial CT of the abdomen.

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated),[1][2][3] leading to progressive loss of liver function. Cirrhosis is most commonly caused by alcoholism and hepatitis C, but has many other possible causes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... negron305 Cat scan redirects here. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ... This article is about the medical term. ... Biological tissue is a group of cells that perform a similar function. ... This article does not cite any references or sources. ... In medicine, a nodule refers to a small aggregation of cells. ... Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinkers normal personal, family, social, or work life, and may lead to physical or mental harm. ... This page is for the disease. ...


Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible once it occurs, and treatment generally focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant. Hepatic encephalopathy is a potentially reversible neuropsychiatic abnormality in the setting of liver failure, whether chronic (as in cirrhosis), or acutely. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Liver transplantation is the replacement of a diseased liver with a healthy liver allograft. ...


The word "cirrhosis" derives from Greek kirrhos, meaning "tawny" (the orange-yellow colour of the diseased liver). While the clinical entity was known before, it was René Laennec who gave it the name "cirrhosis" in his 1819 work in which he also describes the stethoscope.[4] The Greek language (Greek Ελληνικά, IPA // – Hellenic) is an Indo-European language with a documented history of some 3,000 years. ... René Théophile Hyacinthe Laënnec René-Théophile-Hyacinthe Laennec (February 17, 1781- August 13, 1826) was a French physician and inventor of the stethoscope. ... Look up stethoscope in Wiktionary, the free dictionary. ...

Contents

Signs and symptoms

Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis.

  • Spider angiomata or spider nevi. Vascular lesions consisting of a central arteriole surrounded by many smaller vessels due to an increase in estradiol. These occur in about 1/3 of cases.[5]
  • Palmar erythema. Exaggerations of normal speckled mottling of the palm, due to altered sex hormone metabolism.
  • Nail changes.
    • Muehrcke's nails - paired horizontal bands separated by normal color due to hypoalbuminemia (low production of albumin).
    • Terry's nails - proximal two thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia
    • Clubbing - angle between the nail plate and proximal nail fold > 180 degrees
  • Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.
  • Dupuytren's contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be due to fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).
  • Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is due to increased estradiol and can occur in up to 66% of patients.
  • Hypogonadism. Manifested as impotence, infertility, loss of sexual drive, and testicular atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function.
  • Liver size. Can be enlarged, normal, or shrunken.
  • Splenomegaly (increase in size of the spleen). Due to congestion of the red pulp as a result of portal hypertension.
  • Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness). It may be associated with hydrocele and penile flomation (swelling of the penile shaft) in men.
  • Caput medusa. In portal hypertension, the umbilical vein may open. Blood from the portal venous system may be shunted through the periumbilical veins into the umbilical vein and ultimately to the abdominal wall veins, manifesting as caput medusa.
  • Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region (on examination by stethoscope) due to collateral connections between portal system and the remnant of the umbilical vein in portal hypertension.
  • Fetor hepaticus. Musty odor in breath due to increased dimethyl sulfide.
  • Jaundice. Yellow discoloring of the skin, eye, and mucus membranes due to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also appear dark.
  • Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy.
  • Other. Weakness, fatigue, anorexia, weight loss.

A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. ... This article is in need of attention. ... It has been suggested that this article or section be merged into serum albumin. ... Terrys nails is a physical finding in which fingernails and/or toenails appear white with a characteristic ground glass appearance, with no lunula. ... For other uses, see Clubbing (disambiguation). ... Hypertrophic osteopathy is a bone disease secondary to disease in the lungs. ... Shin splints are a condition where there is pain in the anterior tibia caused by overuse of the legs. ... Dupuytrens contracture (also known as Morbus Dupuytren) is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). ... Gynecomastia, or gynaecomastia, pronounced is the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk. ... -1... Hepatomegaly is the condition of having an enlarged liver. ... Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. ... A hydrocele denotes a pathological accumulation of serous fluid in a bodily cavity. ... Caput medusae is the appearance of distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdomen to join systemic veins. ... Fetor hepaticus, also known as breath of the dead, is a condition of gastrointestinal mercaptan formation frequently associated with liver failure. ... Dimethyl sulfide causes that distinctive smell from your St. ... Look up jaundice in Wiktionary, the free dictionary. ... Asterixis (Greek a, not + stērixis, fixed position) is a flapping tremor of the wrist upon extension (dorsiflexion), sometimes said to resemble a bird flapping its wings. Also called liver flap, it can be a sign of hepatic encephalopathy (damage to brain cells due to inability of the liver to...

Complications

As the disease progresses, complications may develop. In some people, these may be the first signs of the disease.

  • Bruising and bleeding due to decreased production of coagulation factors.
  • Jaundice due to decreased processing of bilirubin.
  • Itching (pruritus) due to bile products deposited in the skin.
  • Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning: neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.
  • Sensitivity to medication due to decreased metabolism of the active compounds.
  • Hepatocellular carcinoma is primary liver cancer, a frequent complication of cirrhosis. It has a high mortality rate.
  • Portal hypertension - blood normally carried from the intestines and spleen through the hepatic portal vein flows more slowly and the pressure increases; this leads to the following complications:
    • Ascites - fluid leaks through the vasculature into the abdominal cavity.
    • Esophageal varices - collateral portal blood flow through vessels in the stomach and esophagus. These blood vessels may become enlarged and are more likely to burst.
  • Problems in other organs.
    • Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be aspecific are more difficult to recognize (e.g. worsening encephalopathy but no fever).
    • Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines (spontaneous bacterial peritonitis).
    • Hepatorenal syndrome - insufficient blood supply to the kidneys, causing acute renal failure. This complication has a very high mortality (over 50%).
    • Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting), leading to cyanosis and dyspnea (shortness of breath), characteristically worse on sitting up.[6]
    • Portopulmonary hypertension - increased blood pressure over the lungs as a consequence of portal hypertension.[6]

A bruise or contusion or ecchymoses is a kind of injury, usually caused by blunt impact, in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... This article is about the clotting of blood. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... For other uses, see Itch (disambiguation). ... An itch (Latin: pruritus) is a sensation felt on an area of skin that makes a person or animal want to scratch it. ... Hepatic encephalopathy is a potentially reversible neuropsychiatic abnormality in the setting of liver failure, whether chronic (as in cirrhosis), or acutely. ... For other uses, see Ammonia (disambiguation). ... Hepatocellular carcinoma (HCC, also called hepatoma or hepatocarcinogenesis) is a primary malignancy (cancer) of the liver. ... In medicine, portal hypertension is hypertension (high blood pressure) in the portal vein and its branches. ... The portal vein is a major vein in the human body draining blood from the digestive system and its associated glands. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Spontaneous bacterial peritonitis is a form of peritonitis that occurs in patients with cirrhosis. ... Hepatorenal syndrome (HRS), also called hepatorenal failure, refers to acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure associated with portal hypertension, usually in the absence of other disease of the kidney. ... Hepatopulmonary syndrome is a syndrome characterized by chronic liver disease with pulmonary vascular dilatations and reduced arterial oxygenation. ... Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ... Dyspnea (R06. ... There are very few or no other articles that link to this one. ...

Causes

Cirrhosis has many possible causes; sometimes more than one cause is present in the same patient. In the Western World, chronic alcoholism and hepatitis C are the most common causes.

  • Alcoholic liver disease (ALD). Alcoholic cirrhosis develops in 15% of individuals who drink heavily for more than a decade[citation needed]. There is great variability in the amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3 in some women[citation needed]). Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates. Patients may also have concurrent alcoholic hepatitis with fever, hepatomegaly, jaundice, and anorexia. AST and ALT are both elevated but less than 300 IU/L with a AST:ALT ratio > 2.0, a value rarely seen in other liver diseases. Liver biopsy may show hepatocyte necrosis, Mallory bodies, neutrophilic infiltration with perivenular inflammation.
  • Chronic hepatitis C. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis. Can be diagnosed with serologic assays that detect hepatitis C antibody or viral RNA. The enzyme immunoassay, EIA-2, is the most commonly used screening test in the US.
  • Chronic hepatitis B. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, especially South-East Asia, but it is less common in the United States and the Western world. Hepatitis B causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is dependent on the presence of hepatitis B, but accelerates cirrhosis in co-infection. Chronic hepatitis B can be diagnosed with detection of HBsAG > 6 months after initial infection. HBeAG and HBV DNA are determined to assess whether patient will need antiviral therapy.
  • Non-alcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications. This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol history. Biopsy is needed for diagnosis.
  • Primary biliary cirrhosis. May be asymptomatic or complain of fatigue, pruritus, and non-jaundice skin hyperpigmentation with hepatomegaly. There is prominent alkaline phosphatase elevation as well as elevations in cholesterol and bilirubin. Gold standard diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid bile duct lesions. It is more common in women.
  • Primary sclerosing cholangitis. PSC is a progressive cholestatic disorder presenting with pruritus, steatorrhea, fat soluble vitamin deficiencies, and metabolic bone disease. There is a strong association with inflammatory bowel disease (IBD), especially ulcerative colitis. Diagnosis is best with contrast cholangiography showing diffuse, multifocal strictures and focal dilation of bile ducts, leading to a beaded appearance. Non-specific serum immunoglobulins may also be elevated.
  • Autoimmune hepatitis. This disease is caused by the immunologic damage to the liver causing inflammation and eventually scarring and cirrhosis. Findings include elevations in serum globulins, especially gamma globulins. Therapy with prednisone +/- azathioprine is beneficial. Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90%+. There is no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of corticosteroids.
  • Hereditary hemochromatosis. Usually presents with family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, and/or cardiomyopathy, all due to signs of iron overload. Labs will show fasting transferrin saturation of > 60% and ferritin > 300 ng/mL. Genetic testing may be used to identify HFE mutations. If these are present, biopsy may not need to be performed. Treatment is with phlebotomy to lower total body iron levels.
  • Wilson's disease. Autosomal recessive disorder characterized by low serum ceruloplasmin and increased hepatic copper content on liver biopsy. May also have Kayser-Fleischer rings in the cornea and altered mental status.
  • Alpha 1-antitrypsin deficiency (AAT). Autosomal recessive disorder. Patients may also have COPD, especially if they have a history of tobacco smoking. Serum AAT levels are low. Recombinant AAT is used to prevent lung disease due to AAT deficiency.
  • Cardiac cirrhosis. Due to chronic right sided heart failure which leads to liver congestion.
  • Galactosemia
  • Glycogen storage disease type IV
  • Cystic fibrosis
  • Drugs or toxins
  • Certain parasitic infections (such as schistosomiasis)

The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ... Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... This page is for the disease. ... “HBV” redirects here. ... HBV redirects here. ... As its name signifies, Non-alcoholic steatohepatitis (NASH) or Nonalcoholic Fatty Liver Disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ... This article or section does not cite its references or sources. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... A bile duct is any of a number of long tube-like structures that carry bile. ... In medicine (gastroenterology), hepatitis is any disease featuring inflammation of the liver. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... In medicine, iron overload disorders are diseases caused by the accumulation of iron in the body. ... Venipuncture using a vacutainer. ... Wilsons disease or hepatolenticular degeneration is an autosomal recessive hereditary disease, with an incidence of about 1 in 30,000 in most parts of the world and a male preponderance. ... Kayser-Fleisher rings are pigmented rings in the cornea, resulting from copper deposition in Descemets membrane. ... Alpha 1-antitrypsin deficiency (A1AD or Alpha-1) is a genetic disorder caused by defective production of alpha 1-antitrypsin, deficient activity in the blood and lungs, and deposition of excessive amounts of abnormal A1AT protein in liver cells. ... The cigarette is the most common method of smoking tobacco. ... Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... Galactosemia is a rare genetic metabolic disorder which affects an individuals ability to properly digest the sugar galactose. ... Glycogen storage disease type IV is a very rare hereditary metabolic disorder. ... Hard and soft drugs are loose categories of psychoactive drugs. ... For other uses, see Toxin (disambiguation). ... Schistosomiasis or bilharzia is a parasitic disease caused by several species of flatworm. ...

Diagnosis

The gold standard for diagnosis of cirrhosis is a liver biopsy, through a percutaneous, transjugular, laparoscopic, or fine-needle approach. Histologically cirrhosis can be classified as micronodular, macronodular, or mixed, but this classification has been abandoned since it is nonspecific to the etiology, it may change as the disease progresses, and serological markers are much more specific. However, a biopsy is not necessary if the clinical, laboratory, and radiologic data suggests cirrhosis. Furthermore, there is a small but significant risk to liver biopsy, and cirrhosis itself predisposes for complications due to liver biopsy.[7] In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ...


Lab findings

The following findings are typical in cirrhosis:

  • Aminotransferases - AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferases do not preclude cirrhosis.
  • Alkaline phosphatase - usually slightly elevated.
  • GGT – correlates with AP levels. Typically much higher in chronic liver disease from alcohol.
  • Bilirubin - may elevate as cirrhosis progresses.
  • Albumin - levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver
  • Prothrombin time - increases since the liver synthesizes clotting factors.
  • Globulins - increased due to shunting of bacterial antigens away from the liver to lymphoid tissue.
  • Serum sodium - hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.
  • Thrombocytopenia - due to both congestive splenomegaly as well as decreased thrombopoietin from the liver. However, this rarely results in platelet count < 50,000/mL.
  • Leukopenia and neutropenia - due to splenomegaly with splenic margination.
  • Coagulation defects - the liver produces most of the coagulation factors and thus coagulopathy correlates with worsening liver disease.

Other laboratory studies performed in newly diagnosed cirrhosis may include: In biochemistry, a transaminase or an aminotransferase is an enzyme that catalyzes a type of reaction between an amino acid and an α-keto acid. ... Ball and stick model of alkaline phosphatase Alkaline phosphatase (ALP) (EC 3. ... Gamma glutamyl transpeptidase (GGT) (EC 2. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... Albumin can refer to ovalbumin, the principal protein in egg white albumins, a group of proteins including serum albumin and together constituting roughly 60% of the protein in blood plasma. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... Globulin is one of the two types of serum proteins, the other being albumin. ... For sodium in the diet, see Salt. ... The electrolyte disturbance hyponatremia or hyponatraemia exists in humans when the sodium level in the plasma falls below 135 mmol/l. ... RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search Arginine vasopressin (AVP), also known as vasopressin, argipressin or antidiuretic hormone (ADH), is a hormone found in most mammals, including humans. ... Aldosterone, is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the kidney nephron to conserve sodium, secrete potassium,increase water retention, and increase blood pressure. ... Thrombopoietin is the recently discovered (1994) glycoprotein hormone that regulates the production of platelets. ... Leukopenia or leukocytopenia refers to a decrease in the number of circulating white blood cells (leukocytes) in the blood. ... Neutropenia (or neutropaenia, adjective neutrop(a)enic) is a hematological disorder characterized by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ... This article is about the clotting of blood. ...

Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ... An autoantibody is an antibody (a type of protein) manufactured by the immune system that is directed against one or more of the individuals own proteins. ... Anti-nuclear antibodies (ANAs, also known as anti-nuclear factor or ANF) are detected in a large group of autoimmune disorders. ... Anti-mitochondrial antibodies (AMA) are antibodies (immunoglobulins) formed against mitochondria,[1] primarily mitochondria in cells of the liver. ... Ferritin is a globular protein found mainly in the liver, which can store about 4500 iron (Fe3+)ions in a hollow protein shell made of 24 subunits. ... Percent transferrin saturation is a medical laboratory value. ... For other uses, see Copper (disambiguation). ... Ceruloplasmin Ceruloplasmin (or caeruloplasmin), officially known as ferroxidase or iron(II):oxygen oxidoreductase, is a copper transport protein found in the blood. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... Cholesterol is a sterol (a combination steroid and alcohol). ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search alpha 1-Antitrypsin or α1-antitrypsin (A1AT) is a glycoprotein and generally known as serum trypsin inhibitor. ...

Imaging

Ultrasound is routinely used in the evaluation of cirrhosis, where it may show a small and nodular liver in advanced cirrhosis along with increased echogenicity with irregular appearing areas. Ultrasound may also screen for hepatocellular carcinoma, portal hypertension and Budd-Chiari syndrome (by assessing flow in the hepatic vein). Sonography redirects here. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ...


A new type of device, the FibroScan (transient elastography), uses elastic waves to determine liver stiffness which theoretically can be converted into a liver score based on the METAVIR scale. The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa.) The test is much faster than a biopsy (usually last 2.5-5 minutes) and is completely painless. It shows reasonable corellation with the severity of cirrhosis.[8]


Other tests performed in particular circumstances include abdominal CT and liver/bile duct MRI (MRCP). negron305 Cat scan redirects here. ... MRI redirects here. ... MRCP is an imaging technique which detects biliary and pancreatic ducts in a non-invasive manner, moreover, after secretin stimulation, dynamic MRCP images of the pancreatic duct can be acquired. ...


Endoscopy

Gastroscopy (endoscopic examination of the esophagus, stomach and duodenum) is performed in patients with established cirrhosis to exclude the possibility of esophageal varices. If these are found, prophylactic local therapy may be applied (sclerotherapy or banding) and beta blocker treatment may be commenced. In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ...


Rarely diseases of the bile ducts, such as primary sclerosing cholangitis, can be causes of cirrhosis. Imaging of the bile ducts, such as ERCP or MRCP (MRI of biliary tract and pancreas) can show abnormalities in these patients, and may aid in the diagnosis. Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... Duodenoscopic image of two pigment stones extracted from common bile duct after sphincterotomy Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct. ... MRCP is an imaging technique which detects biliary and pancreatic ducts in a non-invasive manner, moreover, after secretin stimulation, dynamic MRCP images of the pancreatic duct can be acquired. ...


Pathology

Macroscopically, the liver may be initially enlarged, but with progression of the disease, it becomes smaller. Its surface is irregular, the consistency is firm and the color is often yellow (if associates steatosis). Depending on the size of the nodules there are three macroscopic types: micronodular, macronodular and mixed cirrhosis. In micronodular form (Laennec's cirrhosis or portal cirrhosis) regenerating nodules are under 3 mm. In macronodular cirrhosis (post-necrotic cirrhosis), the nodules are larger than 3 mm. The mixed cirrhosis consists in a variety of nodules with different sizes. Histological section of a murine liver showing severe steatosis. ... René-Théophile-Hyacinthe Laennec (February 17, 1781- August 13, 1826), French physician; inventor of the stethoscope. ...


Microscopically, cirrhosis is characterized by regeneration nodules, surrounded by fibrous septa. In these nodules, regenerating hepatocytes are disorderly disposed. Portal tracts, central veins and the radial pattern of hepatocytes are absent. Fibrous septa are important and may present inflammatory infiltrate (lymphocytes, macrophages) If it is a secondary biliary cirrhosis, biliary ducts are damaged, proliferated or distended - bile stasis. These dilated ducts contain inspissated bile which appear as bile casts or bile thrombi (brown-green, amorphous). Bile retention may be found also in the parenchyma, as the so called "bile lakes."[9]


Grading

The severity of cirrhosis is commonly classified with the Child-Pugh score. This score uses bilirubin, albumin, INR, presence and severity of ascites and encephalopathy to classify patients in class A, B or C; class A has a favourable prognosis, while class C is at high risk of death. It was devised in 1964 by Child and Turcotte and modified in 1973 by Pugh et al.[10] In medicine (gastroenterology), the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... It has been suggested that this article or section be merged into serum albumin. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... Hepatic encephalopathy is a potentially reversible neuropsychiatic abnormality in the setting of liver failure, whether chronic (as in cirrhosis), or acutely. ...


More modern scores, used in the allocation of liver transplants but also in other contexts, are the Model for End-Stage Liver Disease (MELD) score and its pediatric counterpart, the Pediatric End-Stage Liver Disease (PELD) score. Liver transplantation is the replacement of a diseased liver with a healthy liver allograft. ... The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. ... Pediatric end-stage liver disease (PELD) is a disease severity scoring system for children under 18 years of age. ...


The hepatic venous pressure gradient, i.e. the difference in venous pressure between afferent and efferent blood to the liver, also determines severity of cirrhosis, although hard to measure. A value of 16 mm or more means a greatly increased risk of dying.[11]


Pathophysiology

The liver plays a vital role in synthesis of proteins (e.g. albumin, clotting factors and complement), detoxification and storage (e.g. vitamin A). In addition, it participates in the metabolism of lipids and carbohydrates. You may be looking for albumen, or egg white. ... This article is about the clotting of blood. ... A complement protein attacking an invader. ... The structure of retinol, the most common dietary form of vitamin A Vitamin A is an essential human nutrient. ... Some common lipids. ... Lactose is a disaccharide found in milk. ...


Cirrhosis is often preceded by hepatitis and fatty liver (steatosis), independent of the cause. If the cause is removed at this stage, the changes are still fully reversible.


The pathological hallmark of cirrhosis is the development of scar tissue that replaces normal parenchyma, blocking the portal flow of blood through the organ and disturbing normal function. Recent research shows the pivotal role of stellate cell, a cell type that normally stores vitamin A, in the development of cirrhosis. Damage to the hepatic parenchyma leads to activation of the stellate cell, which becomes contractile (called myofibroblast) and obstructs blood flow in the circulation. In addition, it secretes TGF-β1, which leads to a fibrotic response and proliferation of connective tissue. Furthermore, it disturbs the balance between matrix metalloproteinases and the naturally occurring inhibitors (TIMP 1 and 2), leading to matrix breakdown and replacement by connective tissue-secreted matrix.[12] Parenchyma is a term used to describe a bulk of a substance. ... Hepatic stellate cells, also known as Ito cells, are pericytes found in the perisinusoidal space (a small area between the sinusoids and hepatocytes) of the liver. ... The structure of retinol, the most common dietary form of vitamin A Vitamin A is an essential human nutrient. ... Histological section through testicular parenchyma of a boar. ... Transforming growth factor beta 1 or TGFβ1 is a polypeptide member of the Transforming growth factor beta superfamily of ligands. ... Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ... Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases; other family members are adamalysins, serralysins, and astacins. ... In biology, the word matrix is used for the material between animal or plant cells, or generally the material (or tissue) in which more specialized structures are embedded, and also specifically for one part of the mitochondrion. ...


The fibrous tissue bands (septa) separate hepatocyte nodules, which eventually replace the entire liver architecture, leading to decreased blood flow throughout. The spleen becomes congested, which leads to hypersplenism and increased sequestration of platelets. Portal hypertension is responsible for most severe complications of cirrhosis. The spleen is an organ located in the abdomen, where it functions in the destruction of old red blood cells and holding a reservoir of blood. ... Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. ... A 250 ml bag of newly collected platelets. ...


Treatment

Traditionally, liver damage from cirrhosis cannot be reversed, but treatment could stop or delay further progression and reduce complications. A healthy diet is encouraged, as cirrhosis may be an energy-consuming process. Close follow-up is often necessary. Antibiotics will be prescribed for infections, and various medications can help with itching. Laxatives, such as lactulose, decrease risk of constipation; their role in preventing encephalopathy is limited. Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. ...


Treating underlying causes

Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with chelation therapy (e.g. penicillamine) to remove the copper. Wilsons disease or hepatolenticular degeneration is an autosomal recessive hereditary disease, with an incidence of about 1 in 30,000 in most parts of the world and a male preponderance. ... Chelation therapy is the administration of chelating agents to remove heavy metals from the body. ... Penicillamine is a pharmaceutical of the chelator class. ...


Preventing further liver damage

Regardless of underlying cause of cirrhosis, alcohol and acetaminophen, as well as other potentially damaging substances, are discouraged. Vaccination of susceptible patients should be considered for Hepatitis A and Hepatitis B. Acetaminophen (USAN) or paracetamol (INN), is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. ... Species Hepatitis A virus Hepatitis A (formerly known as infectious hepatitis) is an acute infectious disease of the liver caused by the hepatovirus hepatitis A virus. ... “HBV” redirects here. ...


Preventing complications

Ascites

Main article: Ascites

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be necessary to suppress ascites. This illustration shows where some types of diuretics act, and what they do. ...


Esophageal variceal bleeding

Main article: Esophageal varices

For portal hypertension, propranolol is a commonly used agent to lower blood pressure over the portal system. In severe complications from portal hypertension, transjugular intrahepatic portosystemic shunting is occasionally indicated to relieve pressure on the portal vein. As this can worsen encephalopathy, it is reserved for those at low risk of encephalopathy, and is generally regarded only as a bridge to liver transplantation or as a palliative measure. In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Propranolol (INN) (IPA: ) is a non-selective beta blocker mainly used in the treatment of hypertension. ... A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the liver from the portal vein to a hepatic vein (for blood). ...


Hepatic encephalopathy

Main article: Hepatic encephalopathy

High-protein food increases the nitrogen balance, and would theoretically increase encephalopathy; in the past, this was therefore eliminated as much as possible from the diet. Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition. Hepatic encephalopathy is a potentially reversible neuropsychiatic abnormality in the setting of liver failure, whether chronic (as in cirrhosis), or acutely. ... The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood that comes from urea. ... Encephalopathy literally means disease of the brain. ...


Hepatorenal syndrome

Main article: Hepatorenal syndrome

The hepatorenal syndrome is defined as a urine sodium less than 10 mmol/L and a serum creatinine > 1.5 mg/dl (or 24 hour creatinine clearance less than 40 ml/min) after a trial of volume expansion without diuretics.[13] Hepatorenal syndrome (HRS), also called hepatorenal failure, refers to acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure associated with portal hypertension, usually in the absence of other disease of the kidney. ... Hepatorenal syndrome (HRS), also called hepatorenal failure, refers to acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure associated with portal hypertension, usually in the absence of other disease of the kidney. ... Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... Creatinine clearance is a method that estimates the glomerular filtration rate (GFR) of the kidneys. ...


Spontaneous bacterial peritonitis

Cirrhotic patients with ascites are at risk of spontaneous bacterial peritonitis. Spontaneous bacterial peritonitis is a form of peritonitis that occurs in patients with cirrhosis. ... Spontaneous bacterial peritonitis is a form of peritonitis that occurs in patients with cirrhosis. ...


Transplantation

Main article: Liver transplantation

If complications cannot be controlled or when the liver ceases functioning, liver transplantation is necessary. Survival from liver transplantation has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and other medical problems in the recipient.[14] In the United States, the MELD score (online calculator)[15] is used to prioritize patients for transplantation. Transplantation necessitates the use of immune suppressants (ciclosporin or tacrolimus). The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. ... Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ... Tacrolimus (also FK-506 or Fujimycin) is an immunosuppressive drug whose main use is after allogenic organ transplant to reduce the activity of the patients immune system and so the risk of organ rejection. ...


Decompensated cirrhosis

In patients with previously stable cirrhosis, decompensation may occur due to various causes, such as constipation, infection (of any source), increased alcohol intake, medication, bleeding from esophageal varices or dehydration. It may take the form of any of the complications of cirrhosis listed above. Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. ... An infection is the detrimental colonization of a host organism by a foreign species. ... This article does not cite any references or sources. ...


Patients with decompensated cirrhosis generally require admission to hospital, with close monitoring of the fluid balance, mental status, and emphasis on adequate nutrition and medical treatment - often with diuretics, antibiotics, laxatives and/or enemas, thiamine and occasionally steroids, acetylcysteine and pentoxifylline. Administration of saline is generally avoided as it would add to the already high total body sodium content that typically occurs in cirrhosis. For the town in the Republic of Ireland, see Hospital, County Limerick. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... This illustration shows where some types of diuretics act, and what they do. ... Staphylococcus aureus - Antibiotics test plate. ... Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... This 2qt (about 1. ... For the similarly spelled nucleic acid, see Thymine Thiamine or thiamin, also known as vitamin B1, is one of the B vitamins. ... Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Acetylcysteine (rINN) (IPA: ), also known as N-acetylcysteine (abbreviated NAC), is a pharmacological agent used mainly as a mucolytic and in the management of paracetamol overdose. ... Pentoxifylline is the International Nonproprietary Name(INN) of a drug sold by Aventis under the name Trental. ... In medicine, saline is a solution of sodium chloride (a substance also commonly known as table salt) in sterile water, used frequently for intravenous infusion, rinsing contact lenses, and nasal irrigation (or the yogic practice called jala neti). ...


Epidemiology

Cirrhosis and chronic liver disease were the 10th leading cause of death for men and the 12th for women in the United States in 2001, killing about 27,000 people each year.[16] Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.


Established cirrhosis has a 10-year mortality of 34-66%, largely dependent on the cause of the cirrhosis; alcoholic cirrhosis has a worse prognosis than primary biliary cirrhosis and cirrhosis due to hepatitis. The risk of death due to all causes is increased twelvefold; if one excludes the direct consequences of the liver disease, there is still a fivefold increased risk of death in all disease categories.[17]


Little is known on modulators of cirrhosis risk, apart from other diseases that cause liver injury (such as the combination of alcoholic liver disease and chronic viral hepatitis, which may act synergistically in leading to cirrhosis). Studies have recently suggested that coffee consumption may protect against cirrhosis, especially alcoholic cirrhosis.[18]


References

  1. ^ Cirrhosis – MayoClinic.com.
  2. ^ Liver Cirrhosis. Review of Pathology of the Liver.
  3. ^ Pathology Education: Gastrointestinal.
  4. ^ Roguin A (2006). "Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope". Clinical medicine & research 4 (3): 230–5. PMID 17048358. 
  5. ^ Li CP, Lee FY, Hwang SJ, et al (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520-3. doi:10.1080/003655299750026272. PMID 10423070. 
  6. ^ a b Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004;24:861-80. PMID 15516683.
  7. ^ Grant, A; Neuberger J (1999). "Guidelines on the use of liver biopsy in clinical practice". Gut 45 (Suppl 4): 1-11. PMID 10485854. “The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.” 
  8. ^ Foucher J, Chanteloup E, Vergniol J, et al (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut 55 (3): 403-8. doi:10.1136/gut.2005.069153. PMID 16020491. 
  9. ^ Pathology atlas, "cirrhosis".
  10. ^ Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-9. PMID 4541913.
  11. ^ Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding D Patch, a A Armonis, a C Sabin, b K Christopoulou, a L Greenslade,a A McCormick, a R Dick, a A K Burroughsa
  12. ^ Iredale JP. Cirrhosis: new research provides a basis for rational and targeted treatments. BMJ 2003;327:143-7. Fulltext. PMID 12869458.
  13. ^ Ginés P, Arroyo V, Quintero E, et al (1987). "Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study". Gastroenterology 93 (2): 234-41. PMID 3297907. 
  14. ^ E-medicine liver transplant outlook and survival rates
  15. ^ Cosby RL, Yee B, Schrier RW (1989). "New classification with prognostic value in cirrhotic patients". Mineral and electrolyte metabolism 15 (5): 261-6. PMID 2682175. 
  16. ^ Anderson RN, Smith BL (2003). "Deaths: leading causes for 2001". National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 52 (9): 1–85. PMID 14626726. 
  17. ^ Sørensen HT, Thulstrup AM, Mellemkjar L, et al (2003). "Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark". Journal of clinical epidemiology 56 (1): 88–93. doi:10.1016/S0895-4356(02)00531-0. PMID 12589875. 
  18. ^ Klatsky AL, Morton C, Udaltsova N, Friedman GD (2006). "Coffee, cirrhosis, and transaminase enzymes". Arch. Intern. Med. 166 (11): 1190–5. doi:10.1001/archinte.166.11.1190. PMID 16772246. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

  • Cirrhosis of the Liver at the National Digestive Diseases Information Clearinghouse (NDDIC). NIH Publication No. 04-1134, December 2003.
  • [1] at the National Library of Medicine and the National Institutes of Health. Medline Plus: Cirrhosis – also called: Hepatic fibrosis
Hematemesis or haematemesis is the vomiting of fresh red blood. ... In medicine, melena or melaena refers to the black, tarry feces that are associated with gastrointestinal hemorrhage. ... Gastrointestinal bleeding describes every form of hemorrhage (blood loss) in the gastrointestinal tract, from the pharynx to the rectum. ... Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage. ... Lower gastrointestinal bleeding refers to any form of bleeding in the Lower gastrointestinal tract. ...

  Results from FactBites:
 
Cirrhosis (1677 words)
Cirrhosis is characterized anatomically by widespread nodules in the liver combined with fibrosis.
Cirrhosis of the liver is irreversible but treatment of the underlying liver disease may slow or stop the progression.
In patients with primary biliary cirrhosis, a rising bilirubin indicates a poor prognosis and such patients should be considered for transplantation as the serum bilirubin concentration begins to rise.
Cirrhosis of the Liver (1739 words)
In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should.
Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year.
Cirrhosis caused by Wilson disease, in which copper builds up in organs, is treated with medications to remove the copper.
  More results at FactBites »

 
 

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