Many different causes of chronic liver disease can lead to fibrosis, typically from decades of inflammation. Common causes include: alcohol, hepatitis C, hepatitis B, NASH.
Sometimes multiple chronic diseases (e.g. hep c + ETOH + fatty liver) can co-contribute to cirrhosis.
Less common causes include: PBC, PSC, Wilson's disease, autoimmune hepatitis, hemochromatosis.
An acute insult (e.g. ETOH, med toxicity) can also be superimposed on chronic cirrhosis to precipitate decompensation (ascites, confusion, other manifestations of liver failure).
Risk Factors
Chronic alcohol use, obesity, chronic use of meds that are hepatotoxic, chronic hepatitis C, chronic hepatitis B.
Symptoms
Often asymptomatic for years
Decompensation associated with: fatigue, jaundice, loss of muscle mass, development of ascites, peripheral edema, confusion (with encephalopathy), vomiting blood (with varices), darkening of urine
Physical Exam Findings
Jaundice, icterus
Ascites, lower extremity edema
Gynecomastia, spider angiomata, small testes (men)
Asterixsis (with encephalopathy)
Tests
US w/flows to assess liver parenchyma, hepatic and portal vein, splenomegaly, ascites; or CT
Labs to assess for hepatic disease: LFTs, chronic hep b, hep c, CBC (low plt w/portal htn)
Occult chronic liver dz: ferritin, anti-sm muscle ab, cerruloplasmin, alpha-1 anti-trypsin, liver bx if cause of cirrhosis remains cryptic