Májcirrhosis

Májcirrhosis, or liver cirrhosis, is a chronic liver disease defined by progressive fibrosis and nodular regeneration that distorts hepatic architecture and impairs liver function.

Common causes include long-standing alcohol use, chronic infection with hepatitis B or C, metabolic conditions such as nonalcoholic fatty liver disease, autoimmune hepatitis, and hereditary or genetic disorders (hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency). Cholestatic diseases such as primary biliary cholangitis and primary sclerosing cholangitis also contribute.

Pathophysiology involves fibrotic scar tissue that increases portal venous pressure and reduces synthetic and detoxifying capacity. Progressive decompensation leads to complications such as ascites, peripheral edema, jaundice, coagulopathy, variceal bleeding, hepatic encephalopathy, and susceptibility to infections.

Diagnosis relies on clinical context and noninvasive tests; ultrasound or elastography can show a nodular, fibrotic liver. Blood tests show reduced albumin and elevated bilirubin, with prolonged INR and sometimes elevated alkaline phosphatase. Liver biopsy is not always required but may be used to determine cause. Staging systems such as Child-Pugh or MELD estimate prognosis.

Management focuses on treating the underlying cause and preventing complications. Abstaining from alcohol, antiviral therapy for hepatitis, weight loss with management of metabolic risks, and vaccinations are key. Complications are managed with diuretics and sodium restriction for ascites, beta-blockers for variceal bleeding risk, lactulose and rifaximin for encephalopathy, and infection monitoring. Regular screening for hepatocellular carcinoma and consideration of liver transplantation in advanced disease are part of care.

Epidemiology varies by region and underlying causes; cirrhosis carries substantial morbidity and mortality once decompensation occurs. Prognosis depends on stage and response to treatment, with higher Child-Pugh and MELD scores indicating greater risk.