97. Cirrhosis of the liver

  1. C. J. Hawkey FMedSci3,
  2. Jaime Bosch MD, PhD4,5,
  3. Joel E. Richter MD, FACP, MACG6,7,
  4. Guadalupe Garcia-Tsao MD8,9 and
  5. Francis K. L. Chan MD10
  1. Gennaro D'Amico MD1 and
  2. Giuseppe Malizia MD2

Published Online: 16 APR 2012

DOI: 10.1002/9781118321386.ch97

Textbook of Clinical Gastroenterology and Hepatology, Second Edition

Textbook of Clinical Gastroenterology and Hepatology, Second Edition

How to Cite

D'Amico, G. and Malizia, G. (2012) Cirrhosis of the liver, in Textbook of Clinical Gastroenterology and Hepatology, Second Edition (eds C. J. Hawkey, J. Bosch, J. E. Richter, G. Garcia-Tsao and F. K. L. Chan), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118321386.ch97

Editor Information

  1. 3

    Nottingham Digestive Diseases Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK

  2. 4

    Hepatic Hemodynamic Laboratory, Liver Unit Hospital Clínic-IDIBAPS, University of Barcelona, Spain

  3. 5

    Biomedical Research Centre Network of Hepatic and Digestive Diseases (CIBERehd), National Institute of Health Carlos III Ministry of Science and Innovation Barcelona, Spain

  4. 6

    Division of Gastroenterology and Nutrition, University of South Florida Tampa, FL, USA

  5. 7

    Joy M. Culverhouse Center for Esophageal Diseases, University of South Florida Tampa, FL, USA

  6. 8

    Section of Digestive Diseases Yale University, School of Medicine New Haven, CT, USA

  7. 9

    Veterans Affairs Connecticut Healthcare System West Haven, CT, USA

  8. 10

    Department of Medicine & Therapeutics The Chinese University of Hong Kong, Hong Kong SAR, China

Author Information

  1. 1

    Department of Gastroenterology, Ospedale V Cervello, Palermo, Italy

  2. 2

    Consultant in Gastroenterology, Department of Gastroenterology, Ospedale V Cervello, Palermo, Italy

Publication History

  1. Published Online: 16 APR 2012
  2. Published Print: 20 APR 2012

ISBN Information

Print ISBN: 9781405191821

Online ISBN: 9781118321386

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Keywords:

  • Cirrhosis;
  • Portal hypertension;
  • Esophageal varices;
  • Variceal bleeding;
  • Ascites;
  • Compensated cirrhosis;
  • Decompensated cirrhosis;
  • Natural history;
  • Prognostic factors;
  • Child–Pugh score;
  • MELD

Summary

Cirrhosis is a diffuse alteration of the liver structure by fibrosis, regenerative nodules, and profound microcirculatory changes, resulting in portal hypertension. Chronic hepatitis C and B virus infection, alcohol, and non-alcoholic fatty liver disease are the most frequent causes. Liver biopsy is the gold standard for diagnosis; however a combination of clinical, biochemical, ultrasonography, and endoscopic findings is ∼90% accurate. Portal hypertension is a major determinant of the clinical course. In the early asymptomatic stage, termed compensated cirrhosis, esophageal varices may develop in approximately 5% of patients/year and median survival is more than 10 years. Progression of portal hypertension causes transition to the decompensated stage characterized by ascites, variceal hemorrhage, encephalopathy, and jaundice. with a median survival of approximately 2–3 years. Hepatocellular carcinoma may develop during the course of the disease at a rate of approximately 2–3%/year. Major causes of death are liver failure, bleeding, hepatocellular carcinoma, hepatorenal syndrome, and sepsis. The only curative therapy is liver transplantation.