Cirrhosis is a chronic liver disease characterized by the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury, leading to portal hypertension and end-stage liver disease
Pathophysiology
- Fibrosis and nodules: The disease involves the replacement of normal liver parenchyma with fibrotic tissue and regenerative nodules
- Portal hypertension: This structural change results in increased blood pressure in the portal vein, known as portal hypertension
- Immune dysfunction: Cirrhosis is associated with immune dysfunction, characterized by immunodeficiency and systemic inflammation, increasing susceptibility to bacterial infections
Etiology
Cirrhosis can result from various causes, including:
- Obesity and non-alcoholic fatty liver disease
- High alcohol consumption
- Hepatitis B or C infection
- Autoimmune diseases
- Cholestatic diseases
- Iron or copper overload
Clinical progression
- Compensated cirrhosis: The disease initially presents as asymptomatic (compensated cirrhosis).
- Decompensated cirrhosis: It progresses to a symptomatic phase (decompensated cirrhosis), often resulting in hospitalization, impaired quality of life, and high mortality
Management
- Treatment of causes and complications: Management focuses on treating the underlying causes and complications of cirrhosis
- Liver transplantation: In some cases, liver transplantation may be required
- Pharmacotherapy: Pharmacological treatments are being developed to halt progression to decompensated cirrhosis or even reverse cirrhosis
In summary, cirrhosis is a chronic liver disease characterized by fibrosis and regenerative nodule formation, leading to structural and functional impairment of the liver. It progresses from a compensated to a decompensated state, with significant clinical implications. Management involves addressing the underlying causes and complications, with liver transplantation as a potential option for advanced cases.