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For further information, see CMDT Part 16-11: Cirrhosis
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Essentials of Diagnosis
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Result of injury with inflammation that leads to both fibrosis and regenerating nodules
May be reversible if cause is removed
The clinical features result from hepatic cell dysfunction, portosystemic shunting, and portal hypertension
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General Considerations
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The most common histologic classification of cirrhosis is micronodular, macronodular, and mixed forms
Each form may be seen at different stages of the disease
Risk factors
Gluten enteropathy appears to be associated with an increased risk of cirrhosis
Many patients have more than one risk factor (eg, chronic hepatitis and alcohol use)
The risk of hospitalization or death due to cirrhosis has been reported to correlate with protein and cholesterol consumption and with hyperuricemia and inversely with carbohydrate consumption
Three clinical stages
Acute-on-chronic liver failure
Should be diagnosed in a patient with chronic cirrhosis and acute decompensation, which is defined as
New or worsening ascites
Thought to involve intense systemic inflammation and oxidative stress
Gastrointestinal hemorrhage, including variceal hemorrhage
Overt hepatic encephalopathy
Worsening nonobstructive jaundice
Bacterial infection associated with other organ failure
Precipitating factors include
Infections
Hemodynamic instability
Heavy alcohol use
Drug hepatotoxicity
Histologic classification divides cirrhosis into micronodular, macronodular, and mixed forms
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MICRONODULAR CIRRHOSIS
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MACRONODULAR CIRRHOSIS
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Characterized by larger nodules, up to several centimeters in diameter, which may contain central veins
Corresponds to postnecrotic (posthepatitic) cirrhosis; but may not always follow identifiable episodes of massive necrosis and stromal collapse
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The eleventh leading cause of death globally and eighth leading cause of death in the United States
The prevalence rate is 0.27%, with an estimated 1.5 billion persons having chronic liver disease and 2.14 million liver-related deaths worldwide
Mexican Americans and Blacks have a higher frequency of cirrhosis than Whites because of a higher rate of risk factors
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Can be asymptomatic for long periods
Symptoms may be insidious or, less often, abrupt
Fatigue, disturbed sleep, muscle cramps, anorexia, and weight loss are common
Nausea and occasional vomiting
Reduced muscle strength and exercise capacity
Jaundice—usually not an initial sign—is mild at first, increasing in severity
Abdominal pain from hepatic enlargement and stretching of Glisson capsule or from ascites
Hematemesis is the presenting symptom in 15–25%
Abdominal wall hernias occur in 20% ...