Cirrhosis

Last updated: Wednesday, 24, November, 2010
Causes + Complications Appropriate Tests

The diagnosis is suspected on the basis of clinical assessment and supported by pathology tests.

Although liver biopsy provides the definitive pathological diagnosis, it is not always indicated or feasible.

Liver function can be assessed by albumin, bilirubin, PT.

Ongoing inflammation, necrosis and cholestasis are assessed by AST, ALT (AST/ALT ratio), GGT, ALP, LD, immunoglobulins G, A, M.

Liver function tests may be normal in quiescent cirrhosis.

The findings may be complicated by the coexistence of acute hepatitis and/or hepatic failure.
Causes

Chronic Alcoholism

 See Alcoholism

Hepatitis B virus infection

Hepatitis D virus infection

See Hepatitis C virus infection

Autoimmune hepatitis

 Smooth muscle antibodies, liver/kidney microsomal antibodies. See Hepatitis chronic

Metabolic, including
  • Alpha-1-antitrypsin deficiency
 Alpha-1-antitrypsin, with phenotyping, genotyping.
  • Type IV glycogen storage disease
 See under Glycogen storage diseases.
  • Tyrosinaemia type I
 Amino acids - urine, organic acids (succinylacetone).

Cholestasis (prolonged), especially 

 See Cholestasis
  • Primary biliary cirrhosis
 Mitochondrial antibodies.
  • Prolonged large duct obstruction
  • Biliary atresia

Drugs and toxins, including
  • Methotrexate
  • Aflatoxin
 In some geographic areas eg, Southeast Asia.

Cryptogenic

Anaemia

FBC. Anaemia is often multifactorial: likely cause(s) are indicated by the red cell indices and blood film findings.

Complications

Ascites

Bleeding, due to:

 See Bleeding disorders
  • Failure of synthesis of coagulation factors, related to
 PT, APTT, fibrinogen. The APTT is less sensitive than the PT to the coagulation factor deficiency of liver disease.
    • Hepatocellular failure
 See Hepatic failure
FBC.
    • Alcohol marrow toxicity
 See Alcoholism
    • DIC (usually low grade)
  • Primary Fibrinolysis
 Usually low grade: thrombin time, fibrinogen, euglobulin clot lysis time. See Fibrinolysis
  • Dysfibrinogenaemia
 Thrombin time, reptilase time.

Hepatic encephalopathy

Hepatic failure

Hepatocellular carcinoma

Hepato-renal syndrome

 See Renal failure.

Peritonitis

 See under Alcoholism.

Portal hypertension, causing
May be associated Hypersplenism.
  • Variceal bleeding
 See Alcoholism.