Causes of cirroosi are diverse. The most common include chronic alcohol use, chronic hepatitis B or C infection, and nonalcoholic fatty liver disease with its inflammatory form (NASH). Other contributors are autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, as well as long-standing exposure to hepatotoxic drugs or toxins. Risk factors such as age, obesity, metabolic syndrome, and concomitant liver injuries increase the likelihood of progression to cirrhosis.
Pathophysiology involves bridging fibrosis that replaces healthy tissue and creates architectural nodularity. This increases resistance to portal blood flow, causing portal hypertension, and compromises liver functions such as protein synthesis, bilirubin clearance, and coagulation. The condition raises the risk of hepatocellular carcinoma and predisposes to complications from impaired liver function.
Clinical features may be absent in early stages and become evident with decompensation. Symptoms include fatigue, jaundice, abdominal swelling (ascites), peripheral edema, and signs of portal hypertension like varices. Complications include variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. Diagnosis relies on a combination of laboratory tests (elevated bilirubin, altered liver enzymes, low albumin, prolonged INR), imaging showing a nodular liver, elastography to assess stiffness, and sometimes liver biopsy to confirm the diagnosis and stage the disease.
Staging distinguishes compensated cirrhosis from decompensated disease, which carries a poorer prognosis. Prognostic scores such as Child-Pugh and MELD help guide treatment decisions.
Management focuses on treating the underlying cause, preventing further liver injury, and managing complications. This includes antiviral therapy for viral hepatitis, alcohol abstinence, weight reduction for NAFLD, vaccinations, and nutrition optimization. For ascites, diuretics and salt restriction may be used, with paracentesis as needed. Variceal bleeding prophylaxis and therapy, endoscopic treatment, and, in select cases, transjugular intrahepatic portosystemic shunt (TIPS) are considered. Liver transplantation remains the only curative option for eligible patients with advanced or decompensated cirrhosis.