Cirrhosis

Liver cirrhosis is a pathologically defined entity that is associated with irreversible chronic injury and necrosis of the hepatic parenchyma, extensive fibrosis and formation of regenerative nodules. The hepatic parenchyma architecture is damaged and the vascular bed is remodelated.

Etiology, Pathology and Pathogenesis
Liver cirrhosis may result from various insults, however, the most frequent reasons are alcoholism, infectious diseases, posthepatic damage, biliary diseases, cardiac failure or metabolic reasons (including genetics consequences and drugs-related injuries). Sometimes the reasons remain unknown and we call it cryptogenic cirrhosis.

Cirrhosis is associated with necrosis of the hepatic cells, fibrotic tissue proliferation and formation of regenerative nodules. Everything is started by chronic injury of the hepatic tissue when hepatic stellate cells are activated. Under the influence of cytokines and transforming growth factor &beta; they assume a myofibroblast-like conformation and produce collagen.

Clinical Features
According to loss of functioning hepatic tissue we can see:
 * jaundice – because of hyperbilirubinaemia,
 * edema – due to protein loss,
 * coagulopathy – due to less produce of coagulation factors,
 * ascites – because of loss of plasma through the damaged hepatic tissue,
 * and other metabolic abnormalities.

Diagnosis
Diagnosis can be made through imaging methods:
 * ultrasonography

Laboratory findings include:
 * elevated enzymes: alanine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GMT)
 * elevated bilirubin levels
 * low levels of albumin
 * coagulation defects

Of course, liver biopsy can be performed from a percutaneous, transjugular, laparoscopic, or fine-needle approach. But this is not necessary when clinical, laboratory and imaging findings show certain liver cirrhosis.

Related articles

 * Alcoholic Cirrhosis
 * Cardiac Cirrhosis
 * Posthepatic Cirrhosis
 * Primary Biliary Cirrhosis
 * Secondary Biliary Cirrhosis
 * Hepatic Encephalopathy
 * Ascites
 * Esophageal Varices
 * Portal Hypertension