20th April 2024

Chronic Liver Disease and Liver Cirrhosis

Background

Cirrhosis is the final common pathway of many diseases that affect the liver. It is a histological diagnosis characterised by hepatic nodule formation and diffuse fibrosis. The most common causes in the UK include alcoholic liver disease, viral hepatitis (hepatitis C and B) and non-alcoholic fatty liver disease (NAFLD). Other causes include autoimmune liver disease (autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cholangitis), haemochromatosis, Wilson’s disease and α-1 antitrypsin deficiency.

Presentation

Cirrhosis can be picked up incidentally in patients with deranged LFTs. It can also present non-specifically or with features of decompensation. Features of decompensation include development of jaundice, hepatic encephalopathy, or ascites.

Diagnosis

Cirrhosis is diagnosed via imaging, with USS showing a small shrunken nodular liver. A liver biopsy can be used to confirm the diagnosis and establish the cause if uncertain. Patients should also be investigated for the presence of oesophageal varices and other features of portal hypertension.

Management

Management of cirrhosis is mostly supportive, with treatment aimed at avoiding complications. Good nutrition and avoidance of alcohol is vital regardless of aetiology and all patients should be prescribed thiamine. Treating the underlying cause can also slow down or even sometimes partially reverse disease progression. Patients should be screened for HCC with regular USS and α-fetoprotein levels. The only curative treatment for cirrhosis is a liver transplant.

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