Cirrhosis

What it is

Cirrhosis is divided by its complications. Patients with compensated cirrhosis and no complications may be asymptomatic or have nonspecific symptoms such as fatigue, poor sleep or itching. Patients with complications of cirrhosis, that is hepatic encephalopathy, variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, jaundice or HCC, have decompensated cirrhosis.

Portal hypertension is responsible for most of these complications. It also causes splenomegaly and hypersplenism, and so thrombocytopenia, and it goes with the loss of hepatic synthetic function, and so coagulopathy and hypoalbuminemia. Portal hypertension is divided into prehepatic, intrahepatic and posthepatic causes; cirrhosis itself is the most common cause and is an intrahepatic form, while portal vein thrombosis and Budd-Chiari syndrome are the pre- and posthepatic examples.

Causes and risk

Chronic HCV infection manifests as chronic liver disease because the acute infection is asymptomatic, and it can cause cirrhosis and is a risk factor for HCC.

How it is diagnosed

Ascites is read from the fluid itself. An ascitic fluid granulocyte count >250/uL confirms spontaneous bacterial peritonitis. The serum-ascites albumin gradient is then read against the ascitic fluid protein:

• SAAG >1.1 with protein <2.5 g/dL: cirrhosis.
• SAAG >1.1 with protein >2.5 g/dL: right-sided HF or Budd-Chiari syndrome.
• SAAG <1.1 with protein <2.5 g/dL: nephrotic syndrome.
• SAAG <1.1 with protein >2.5 g/dL: malignancy or TB.