Summary Cirrhosis is a condition caused by chronic damage to the liver, most commonly due to excessive alcohol consumption, nonalcoholic fatty liver disease, or hepatitis C. Other causes include inflammatory or metabolic diseases, such as primary biliary cirrhosis and hemochromatosis. Cirrhosis is characterized by hepatic parenchymal necrosis and an inflammatory response to the underlying cause. Subsequent hepatic repair mechanisms lead to fibrosis and abnormal tissue architecture, which impair liver function. Patients can present with a range of symptoms, including ascites; hepatosplenomegaly; and skin manifestations of cirrhosis, such as jaundice, spider angioma, and/or palmar erythema. Men may also display signs of feminization (e.g., gynecomastia, hypogonadism). In severe cases, the accumulation of toxic metabolites or involvement of additional organs can lead to complications such as hepatic encephalopathy and hepatorenal syndrome (HRS). Laboratory studies show signs of hepatocyte damage (e.g., elevated liver enzymes, hyperbilirubinemia) and/or impaired hepatic synthetic function (e.g., prolonged prothrombin time, low albumin). Abdominal ultrasound typically shows shrunken, heterogeneous liver parenchyma with a nodular surface. A biopsy is the method of choice for confirming the diagnosis; however, it is usually only performed if the results from other diagnostic modalities are inconclusive. Management consists of treatment of the underlying disease (e.g., avoidance of toxic substances, antiviral drugs), adequate calorie intake, and medication for treating complications (e.g., spironolactone for ascites). In cases of decompensated cirrhosis, interventional procedures may be used to alleviate symptoms (e.g., paracentesis to drain ascites) or as a bridge until liver transplantation is possible. Show
EpidemiologyEpidemiological data refers to the US, unless otherwise specified. Etiology
Cryptogenic cirrhosis is a diagnosis of exclusion and should only be considered after a complete patient evaluation has ruled out all other possible causes of cirrhosis. Hepatitis C, alcoholic liver disease, and NASH are the most common causes of cirrhosis in the US. Pathophysiology
Clinical featuresClinical manifestations of liver cirrhosis generally correlate with the severity of liver disease. [6]
DiagnosticsPatients with cirrhosis are usually either asymptomatic with incidental abnormal findings on laboratory studies or imaging, or present late with features of decompensated cirrhosis. Laboratory studiesRoutine laboratory studies [10][12][13]
Liver chemistries may be normal in early compensated cirrhosis. [10] Some CBC abnormalities are due to the combination of increased hepatic and splenic sequestration of thrombocytes (portal hypertension leads to splenomegaly with hypersplenism) and decreased production of hematopoietic factors by the liver. Hepatocyte injury: ↑ AST, ALT, ALP, GGT. Synthetic dysfunction: ↑ bilirubin and PT/INR; ↓ albumin and platelets Additional laboratory studies [10][13][14][15]These studies may help to identify the underlying etiology and further evaluate liver function. Modification may be required based on clinical features and the presence of risk factors.
Abdominal ultrasound with Doppler [10][18]CT abdomen [18][21]
Noninvasive liver fibrosis scoring systems [10][23]These biomarker-based tools can be used as an adjunct to confirm and stage cirrhosis of certain etiologies. Liver elastography [10][25][26]StagingModel for end-stage liver disease score (MELD score) [28]
Child-Pugh score [22]
CHILD's ABCDEs: Albumin, Bilirubin, Coagulation (i.e., ↑ INR), Distended abdomen (i.e., ascites), and Encephalopathy TreatmentPatients with cirrhosis are typically managed in consultation with specialists. Pathology
ComplicationsOverview [34]Cirrhosis-associated ascites and edema and elevated bleeding risk increase the risk for hypovolemic shock. Vitamin K infusion may improve clotting function in select patients with vitamin K deficiency; it is unlikely to be effective in patients with advanced liver disease and coagulopathy. We list the most important complications. The selection is not exhaustive. Decompensated cirrhosis
Pulmonary complications of cirrhosisSpecial patient groupsReferences
What is the pathophysiology of gynecomastia?Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications.
What causes unilateral gynecomastia?Unilateral gynecomastia can be caused by an acute infection process of the chest. This typically results in enlargement of the chest, pain, swelling and redness with fever and chills.
What causes breast swelling and pain in men?In men, breast pain is most commonly caused by a condition called "gynecomastia" (guy-nuh-koh-MAS-tee-uh). This refers to an increase in the amount of breast gland tissue that's caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.
Does gynecomastia cause swollen lymph nodes?Both sides are typically affected, although it can develop on only one side. The enlargement may be greater on one side even if both sides are involved. Gynecomastia is not accompanied by severe pain, although the enlarged area may be sensitive or tender. enlargement of the underarm (axillary) lymph nodes.
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Which pathophysiology leads to gynecomastia in a patient with cirrhosis of the liver?
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