Cirrhosis

Cirrhosis is a "liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules."

Cause / etiology

The two most common causes, at least in women, may be alcoholism which causes alcoholic hepatitis and obesity with causes steatohepatitis. These two risks may have a "supra-additive interaction."

Diagnosis

Clinical prediction rules exist to help diagnosis cirrhosis. If the AST/ALT ratio ≥1 and platelet count ≤ 150,000/mm³ (Pohl's Index) then cirrhosis is very likely.

Complications

Clinical practice guidelines are available for the treatment of cirrhosis and its complications.

Esophageal varices

A clinical prediction rule is available to help detect patients at risk. For predicting clinically significant portal hypertension(hepatic venous pressure gradient ≥ 10 mmHg):

$Risk\ score\ =\ -0.193+(-0.359\times albumin)+(16.456\times INR)+(-0.0016\times ALT)+(-0.131\times albumin)$

At a cutoff value >0.06 the accuracy is:

• Sensitivity 93%
• Specificity 61%

For predicting esophagel varices:

$Risk\ score\ =\ -5.418+(-0.131\times albumin)+(1.949\times spider\ angiomas)+(-0.008\times ALT)$

(spider angiomas = 1 if present and 0 if absent)

At a cutoff value >-1.02 the accuracy is:

• Sensitivity 93%
• Specificity 37%

Patients with a thrombocytopenia and a palpable spleen are more likely to have large esophageal varices. The cutoff for thrombocytopenia ranges from 40,000 to 150,000.

Emergency portacaval shunt may be a better treatment than endoscopic sclerotherapy.

Spontaneous bacteremia

Spontaneous bacteremia may occur. Mong patients with Child-Pugh Score indicating class C, half of bacteremias may not have a definite focus.

Prognosis

MELD Score

The MELD Score can help predict mortality. An online calculator is available.

Child-Pugh score

The Child-Pugh Score can help predict mortality. An online calculator is available.