Cirrhosis - Knowledge

2025: 2001: 2013: 1985: 2037: 3107: 2105: 3177: 2117: 3279:(DALY) rates have decreased from 1990 to 2017, with the values going from 656.4 years per 100,000 people to 510.7 years per 100,000 people. In males DALY rates have decreased from 903.1 years per 100,000 population in 1990, to 719.3 years per 100,000 population in 2017; in females the DALY rates have decreased from 415.5 years per 100,000 population in 1990, to 307.6 years per 100,000 population in 2017. However, globally the total number of DALYs have increased by 10.9 million from 1990 to 2017, reaching the value of 41.4 million DALYs. 2129: 567: 1331: 1946:(transjugular). Endoscopic ultrasound-guided liver biopsy (EUS), using the percutaneous or transjugular route, has become a good alternative to use. EUS can target liver areas that are widely separated, and can deliver bi-lobar biopsies. A biopsy is not necessary if the clinical, laboratory, and radiologic data suggest cirrhosis. Furthermore, a small but significant risk of complications is associated with liver biopsy, and cirrhosis itself predisposes for complications caused by liver biopsy. 1317: 11294: 1913: 53: 1035:, causes inflammation of the liver and a variable grade of damage to the organ. Over several decades, this inflammation and damage can lead to cirrhosis. Among people with chronic hepatitis C, 20–30% develop cirrhosis. Cirrhosis caused by hepatitis C and alcoholic liver disease are the most common reasons for liver transplant. Both hepatitis C and hepatitis B–related cirrhosis can also be attributed with heroin addiction. 1455: 958: 2823:. Hepatic encephalopathy is primarily caused by the accumulation of ammonia in the blood, which causes neurotoxicity when crossing the blood-brain barrier. Ammonia is normally metabolized by the liver; as cirrhosis causes both decreased liver function and increased portosystemic shunting (allowing blood to bypass the liver), systemic ammonia levels gradually rise and lead to encephalopathy. 2786:(TIPS) is occasionally indicated to relieve pressure on the portal vein. As this shunting can worsen hepatic encephalopathy, it is reserved for those patients at low risk of encephalopathy. TIPS is generally regarded only as a bridge to liver transplantation or as a palliative measure. Balloon-occluded retrograde transvenous obliteration can be used to treat gastric variceal bleeding. 2261:(MELD) score was later developed and approved in 2002. It was approved by the United Network for Organ Sharing (UNOS) as a way to determine the allocation of liver transplants to awaiting people in the United States. It is also used as a validated survival predictor of cirrhosis, alcoholic hepatitis, acute liver failure, and acute hepatitis. The variables included bilirubin, 718: 2291:. Nine variables were identified as effective predictors for 90-day mortality after a discharge from a cirrhosis-related hospital admission. The variables include all Model for End-Stage Liver Disease (MELD)'s components, as well as sodium, albumin, total cholesterol, white blood cell count, age, and length of stay. 6991:

The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies, in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all

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The cause of cirrhosis can vary; alcohol and non-alcoholic fatty liver disease are main causes in western and industrialized countries, whereas viral hepatitis is the predominant cause in low and middle-income countries. Cirrhosis is more common in men than in women. The cost of cirrhosis in terms of

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Little is known about factors affecting cirrhosis risk and progression. However, many studies have provided increasing evidence for the protective effects of coffee consumption against the progression of liver disease. These effects are more noticeable in liver disease that is associated with alcohol

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In the past, the Child-Pugh classification was used to determine people who were candidates for a liver transplant. Child-Pugh class B is usually an indication for evaluation for transplant. However, there were many issues when applying this score to liver transplant eligibility. Thus, the MELD score

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Especially in the later stages, people with cirrhosis experience significant symptoms such as abdominal swelling, itching, leg edema, and chronic abdominal pain which would be amenable for treatment through palliative care. Because the disease is not curable without a transplant, palliative care can

1276:. TGF-β1 have been implicated in the process of activating hepatic stellate cells (HSCs) with the magnitude of fibrosis being in proportion to increase in TGF β levels. ACTA2 is associated with TGF β pathway that enhances contractile properties of HSCs leading to fibrosis. Furthermore, HSCs secrete 2986:

Those with cirrhosis are at increased risk of infections as well as increased mortality from infections. This is due to a combination of factors including cirrhosis associated immune dysfunction, reduced gut barrier function, reduced bile flow, and changes in the gut microbiota, with an increase in

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The Child-Pugh score is a validated predictor of mortality after a major surgery. For example, Child class A patients have a 10% mortality rate and Child class B patients have a 30% mortality rate while Child class C patients have a 70–80% mortality rate after abdominal surgery. Elective surgery is

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is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness, such as cirrhosis. The goal of palliative care is to improve quality of life for both the patient and the patient's family and it is appropriate at any stage and for

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between these nodules. The pattern of fibrosis seen can depend on the underlying insult that led to cirrhosis. Fibrosis can also proliferate even if the underlying process that caused it has resolved or ceased. The fibrosis in cirrhosis can lead to destruction of other normal tissues in the liver:

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Each year, approximately one million deaths are due to complications of cirrhosis, making cirrhosis the 11th most common cause of death globally. Cirrhosis and chronic liver disease were the tenth leading cause of death for men and the twelfth for women in the United States in 2001, killing about

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Generally, liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. A healthy diet is encouraged, as cirrhosis may be an energy-consuming process. A recommended diet consists of high-protein, high-fiber diet plus supplementation

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Cirrhosis can take quite a long time to develop, and symptoms may be slow to emerge. Some early symptoms include tiredness, weakness, loss of appetite, weight loss, and nausea. Early signs may also include redness on the palms known as palmer erythema. People may also feel discomfort in the right

2983:. Signs and symptoms of infection may be nonspecific and are more difficult to recognize (for example, worsening encephalopathy but no fever). Moreover, infections in cirrhosis are major triggers for other complications (ascites, variceal bleeding, hepatic encephalopathy, organ failures, death). 553:

Cirrhosis affected about 2.8 million people and resulted in 1.3 million deaths in 2015. Of these deaths, alcohol caused 348,000 (27%), hepatitis C caused 326,000 (25%), and hepatitis B caused 371,000 (28%). In the United States, more men die of cirrhosis than women. The first

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In addition to pharmacotherapy, providing proper hydration and nutritional support is also essential. Appropriate quantities of protein uptake is encouraged. Several factors may precipitate hepatic encephalopathy, which include alcohol use, excess protein, gastrointestinal bleeding, infection,

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Key prevention strategies for cirrhosis are population-wide interventions to reduce alcohol intake (through pricing strategies, public health campaigns, and personal counseling), programs to reduce the transmission of viral hepatitis, and screening of relatives of people with hereditary liver

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Alcoholic cirrhosis caused by alcohol use disorder is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.

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is necessary. Survival from liver transplantation has been improving over the 1990s, and the five-year survival rate is now around 80%. The survival rate depends largely on the severity of disease and other medical risk factors in the recipient. In the United States, the

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against hepatitis C is available. No specific treatment for cirrhosis is known, but many of the underlying causes may be treated by a number of medications that may slow or prevent worsening of the condition. Hepatitis B and C may be treatable with

2148:. This system was devised in 1964 by Child and Turcotte, and modified in 1973 by Pugh and others. It was first established to determine who would benefit from elective surgery for portal decompression. This scoring system uses multiple lab values including 972:(ALD, or alcoholic cirrhosis) develops for 10–20% of individuals who drink heavily for a decade or more. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates. This injury happens through the formation of 2664:(coagulation factors II, VII, IX, X, V, and VI). When damaged, the liver is impaired in its production of these proteins. This will ultimately increase bleeding as clotting factors are diminished. Clotting function is estimated by lab values, mainly 721: 733: 2498:, exercise capacity and anthropomorphic measures. These conclusions were based on low to very low quality research, which imposes the need to develop further research with higher quality, especially to evaluate its effects on clinical outcomes. 732: 731: 730: 729: 728: 727: 720: 888:

and related substances build up in the blood. This build-up affects brain function when they are not cleared from the blood by the liver. Symptoms can include unresponsiveness, forgetfulness, trouble concentrating, changes in sleep habits, or

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usually reserved for those in Child class A patients. There is an increased risk for Child class B individuals and they may require medical optimization. Overall, it is not recommended for Child class C patients to undergo elective surgery.

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Laursen TL, Rødgaard-Hansen S, Møller HJ, Mortensen C, Karlsen S, Nielsen DT, et al. (April 2017). "The soluble mannose receptor is released from the liver in cirrhotic patients, but is not associated with bacterial translocation".

726: 1502:, elastography can sample a much larger area and is painless. It shows a reasonable correlation with the severity of cirrhosis. Other modalities have been introduced which are incorporated into ultrasonagraphy systems. These include 632:

beneath the skin surface. There is a central, red spot with reddish extensions that radiate outward. This creates a visual effect that resembles a spider. It occurs in about one-third of cases. The likely cause is an increase in

2036: 2842:, an antibiotic that inhibits the function of ammonia-producing bacteria in the gastrointestinal tract, is recommended for use in combination with lactulose as prophylaxis against recurrent episodes of hepatic encephalopathy. 7784: 5995:

Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, et al. (September 2015). "Elastography Assessment of Liver Fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement".

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solution is usually given to prevent complications from the rapid volume reduction. In addition to being more rapid than diuretics, 4–5 liters of paracentesis is more successful in comparison to diuretic therapy.

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or portal cirrhosis), regenerating nodules are under 3 mm. In macronodular cirrhosis (post-necrotic cirrhosis), the nodules are larger than 3 mm. Mixed cirrhosis consists of nodules of different sizes.

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Loomba R, Noureddin M, Kowdley KV, Kohli A, Sheikh A, Neff G, et al. (February 2021). "Combination Therapies Including Cilofexor and Firsocostat for Bridging Fibrosis and Cirrhosis Attributable to NASH".

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Poonja Z, Brisebois A, van Zanten SV, Tandon P, Meeberg G, Karvellas CJ (April 2014). "Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management".

8855:"Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver: Vilstrup et al" 1024:. Though similar in signs to alcoholic liver disease, no history of notable alcohol use is found. Blood tests and medical imaging are used to diagnose NAFLD and NASH, and sometimes a liver biopsy is needed. 2857:

This is generally a subjective assessment, although several attempts at creating criteria to help standardize this assessment have been published. One example is the West Haven criteria, reproduced below.

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blood levels are both elevated, but at less than 300 IU/liter, with an AST:ALT ratio > 2.0, a value rarely seen in other liver diseases. In the United States, 40% of cirrhosis-related deaths are due to

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procedures. Nor do they suggest the routine use of blood products, such as platelets, for bleeding prevention. Cirrhosis is stable when there are no changes in baseline abnormalities of coagulation lab

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The best predictors of cirrhosis are ascites, platelet count < 160,000/mm, spider angiomata, and a Bonacini cirrhosis discriminant score greater than 7 (as the sum of scores for platelet count,

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As this cascade of processes continues, fibrous tissue bands (septa) separate hepatocyte nodules, which eventually replace the entire liver architecture, leading to decreased blood flow throughout. The

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Regardless of the underlying cause of cirrhosis, consumption of alcohol and other potentially damaging substances is discouraged. There is no evidence that supports the avoidance or dose reduction of

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between incoming and outgoing blood to the liver) also determines the severity of cirrhosis, although it is hard to measure. A value of 16 mm or more means a greatly increased risk of death.

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due to portal hypertension. Blood from the portal venous system may be forced through the paraumbilical veins and ultimately to the abdominal wall veins. The created pattern resembles the head of

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Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP (October 2006). "The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide".

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causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is dependent on the presence of hepatitis B and accelerates cirrhosis in co-infection.

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McDowell HR, Chuah CS, Tripathi D, Stanley AJ, Forrest EH, Hayes PC (February 2021). "Carvedilol is associated with improved survival in patients with cirrhosis: a long-term follow-up study".

1451:. A CT scan is non-invasive and may be helpful in the diagnosis. Compared to the ultrasound, CT scans tend to be more expensive. MRI provides excellent evaluation; however, is a high expense. 4047:"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" 1474:

techniques. When a liver becomes cirrhotic it will generally become stiffer. Determining the stiffness through imaging can determine the location and severity of disease. Techniques include

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Macroscopically, the liver is initially enlarged, but with the progression of the disease, it becomes smaller. Its surface is irregular, the consistency is firm, and if associated with

2750:. Aldosterone antagonists are preferred for people who can take oral medications and are not in need of an urgent volume reduction. Loop diuretics can be added as additional therapy. 4205:

Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. (2023). "AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma".

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is avoided, as it would add to the already high total body sodium content that typically occurs in cirrhosis. Life expectancy without liver transplant is low, at most three years.

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Kim MY, Choi H, Baik SK, Yea CJ, Won CS, Byun JW, et al. (December 2010). "Portal hypertensive gastropathy: correlation with portal hypertension and prognosis in cirrhosis".

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The AGA does not recommend for extensive pre-procedural testing, including repeated measurements of PT/INR or platelet count before patients with stable cirrhosis undergo common

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with branched-chain amino acids. Close follow-up is often necessary. Antibiotics are prescribed for infections, and various medications can help with itching. Laxatives, such as

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constipation, and vomiting/diarrhea. Drugs such as benzodiazepines, diuretics, or narcotics can also precipitate encephalopathic events. A low protein diet is recommended with

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Sellers CM, Nezami N, Schilsky ML, Kim HS (April 2019). "Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: Current state and future directions".

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and assists immune cells and antibodies in destroying pathogens. The liver produces compliment factors, but this may be reduced in cirrhosis, raising the risk of infections.

1264:, in the development of cirrhosis. Damage to the liver tissue from inflammation leads to the activation of stellate cells, which increases fibrosis through the production of 722: 3022:(which help immune cells to identifiy pathogens) are also reduced in those with cirrhosis, leading to further immune dysfunction. Cirrhosis is also associated with reduced 2486:

programs, there is currently insufficient scientific evidence regarding either the beneficial or harmful effects of physical exercise in people with cirrhosis on all-cause

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and cirrhosis. It was observed to have led to improvements in NASH activity with a potential antifibrotic effect. Lanifibranor is also shown to prevent worsening fibrosis.

12152: 417: 787:). When the blood vessels in this circulation become enlarged, they are called varices. Varices are more likely to rupture at this point. Variceal rupture often leads to 6439:

Maiwall R, Kumar S, Chaudhary AK, Maras J, Wani Z, Kumar C, et al. (July 2014). "Serum ferritin predicts early mortality in patients with decompensated cirrhosis".

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the color is yellow. Depending on the size of the nodules, there are three macroscopic types: micronodular, macronodular, and mixed cirrhosis. In the micronodular form (

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Cirrhosis is often preceded by hepatitis and fatty liver (steatosis), independent of the cause. If the cause is removed at this stage, the changes are fully reversible.

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Most pharmaceutical approaches to treating hepatic encephalopathy focus on reducing ammonia levels. Per 2014 guidelines, the first-line treatment involves the use of

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is of importance in trying to determine the most likely cause. Globally, 57% of cirrhosis is attributable to either hepatitis B (30%) or hepatitis C (27%).

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where cirrhosis is due to hepatitis B prevents progression of cirrhosis. Similarly, control of weight and diabetes prevents deterioration in cirrhosis due to

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The mortality rate for infections in those with cirrhosis is higher than that of the general population. In those with cirrhosis and severe infections with

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in the fifth century BCE. The term "cirrhosis" was derived in 1819 from the Greek word "kirrhos", which describes the yellowish color of a diseased liver.

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As cirrhosis can be caused by many different entities which injure the liver in different ways, cause-specific abnormalities may be seen. For example, in

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are increased (such as nitric oxide and carbon monoxide) reducing afterload with compensatory increase in cardiac output, mixed venous oxygen saturation.

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by the liver. If a medication that harms the liver is still recommended by a doctor, the dosage can be adjusted to aim for minimal stress on the liver.

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from alcohol. Acetaldehyde is reactive and leads to the accumulation of other reactive products in the liver. People with ALD may also have concurrent

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Ilić G, Karadžić R, Kostić-Banović L, Stojanović J, Antović A (February 2010). "Ultrastructural Changes In The Liver Of Intravenous Heroin Addiction".

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may be useful if the disease is due to blockage of the bile duct. Other medications may be useful for complications such as abdominal or leg swelling,

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Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, et al. (February 2012). "Does this patient with liver disease have cirrhosis?".

10634: 10039: 7663:"Effect of a high-protein, high-fiber diet plus supplementation with branched-chain amino acids on the nutritional status of patients with cirrhosis" 6593:"Macrophage activation marker, soluble CD163, is an independent predictor of short-term mortality in patients with cirrhosis and bacterial infection" 1400:. Portal vein pulsatility are usually measured by a pulsatility indices (PI). A number above a certain values indicates cirrhosis (see table below). 8701: 1108:. This causes inflammation and eventually scarring as well as cirrhosis. Findings include elevations in serum globulins, especially gamma globulins. 11834: 3041:, antibiotic overuse, and hospitalizations or invasive procedures (which increase the risk of bacterial translocation to other areas of the body). 318:. Damage to the liver leads to repair of liver tissue and subsequent formation of scar tissue. Over time, scar tissue and nodules of regenerating 11016: 10578: 7367:"Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies" 4179: 1364:

is routinely used in the evaluation of cirrhosis. It may show a small and shrunken liver in advanced disease. On ultrasound, there is increased

253:), avoiding alcohol, losing weight, exercising, low-carbohydrate diet, controlling hypertension and diabetes may help in those with NAFLD or NASH 9366:

Evans L, Ray Kim W, Poterucha J, Kamath P (April 2003). "Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites".

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Markers of inflammation and immune cell activation are typically elevated in cirrhotic patients, especially in the decompensated disease stage:

9438:"Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis" 3542:

Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016).

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For patients with stable cirrhosis and low platelet count undergoing common low-risk procedures, the AGA does not recommend the routine use of

1676:, typically multifactorial, is due to alcoholic marrow suppression, sepsis, lack of folate, platelet sequestering in the spleen, and decreased 1518: 2458:

People with cirrhosis or liver damage are often advised to avoid drugs that could further harm the liver. These include several drugs such as

2783: 647:, a reddening of the palm below the thumb and little finger, is seen in about 23% of cirrhosis cases, and results from increased circulating 3604: 1831:

IgG level is elevated in chronic hepatitis, alcoholic and autoimmune hepatitis. It's slow and sustained increase is seen in viral hepatitis.

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Ruiz-Margáin A, Macías-Rodríguez RU, Ríos-Torres SL, Román-Calleja BM, Méndez-Guerrero O, Rodríguez-Córdova P, et al. (January 2018).

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Qin N, Yang F, Li A, Prifti E, Chen Y, Shao L, et al. (September 2014). "Alterations of the human gut microbiome in liver cirrhosis".

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levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver.

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colitis (2.4-4%). It is estimated that 3.5% of people with cirrhosis and ascites may have asymptomatic spontaneous bacterial peritonitis.

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Chapman J, Goyal A, Azevedo AM. Splenomegaly. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

4312: 1522: 686:, normal, or shrunken in people with cirrhosis. As the disease progresses, the liver will typically shrink due to the result of scarring. 8312:

Sanchez W, Talwalkar JA (March 2006). "Palliative care for patients with end-stage liver disease ineligible for liver transplantation".

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Machado MV, Diehl AM (2018). "Pathogenesis of Nonalcoholic Fatty Liver Disease". In Sanyal AJ, Boyer TD, Terrault NA, Lindor KD (eds.).

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flow of blood through the organ, raising the blood pressure and disturbing normal function. Research has shown the pivotal role of the

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The pathological hallmark of cirrhosis is the development of scar tissue that replaces normal tissue, which is normally organized into

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Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. (GBD 2013 Mortality Causes of Death Collaborators) (January 2015).

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Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, et al. (GBD 2017 Cirrhosis Collaborators) (March 2020).

3378: 2800:) is performed in cases of established cirrhosis. If esophageal varices are found, prophylactic local therapy may be applied such as 2283:

is a further risk score to assess severity of chronic liver disease. It was developed in 2017 as a result of a collaboration between

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Piano S, Singh V, Caraceni P (April 2019). "Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide".

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level of the colon when it is metabolized by intestinal bacteria. The lower colonic pH causes increased conversion of ammonia into

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Bansal MB, Friedman SL (8 June 2018). "Chapter 6: Hepatic Fibrinogenesis". In Dooley JS, Lok AS, Garcia-Tsao G, Pinzani M (eds.).

12630: 11323: 10759: 10278: 1308:, which are needed for normal blood clotting. Portal hypertension is responsible for the most severe complications of cirrhosis. 1140:

in the blood and increased copper of the liver. Copper in the urine is also elevated. People with Wilson's disease may also have

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defects occur, as the liver produces most of the coagulation factors, thus coagulopathy correlates with worsening liver disease.

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The diagnosis of cirrhosis in an individual is based on multiple factors. Cirrhosis may be suspected from laboratory findings,

7568: 6803:"Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis" 11696: 10742: 9599: 7022: 6294: 6269: 5951: 5657: 5514: 5455: 5322: 5280: 5092: 4667: 4634: 4306: 4102: 3813: 3708: 3422: 11608: 11348: 5190: 3804:

McCormick PA, Jalan R (8 June 2018). "Chapter 8: Hepatic Cirrhosis". In Dooley JS, Lok AS, Garcia-Tsao G, Pinzani M (eds.).

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is a potential complication of cirrhosis. It may lead to functional neurological impairment ranging from mild confusion to

7936: 7590: 6264:(11th ed.). Chichester, West Sussex, UK: John Wiley & Sons. pp. Evaluation of the Liver A: Laboratory Test. 1686:

AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferase levels do not preclude cirrhosis.

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As cirrhosis progresses, symptoms can include neurological changes. This can consist of cognitive impairments, confusion,

12713: 10976: 10901: 8730: 6134:"Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease" 4148: 2463: 334:, as well as impairment in other aspects of liver function. The disease typically develops slowly over months or years. 9668: 5414: 3888: 12739: 11909: 11316: 10874: 10700: 10312: 9974: 9487: 3858: 3106: 1990:

No fibrosis, but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (

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process. This leads to liver damage. Some people may have no symptoms. While other people could present with fatigue,

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Cirrhosis is known to cause immune dysfunction in numerous ways. It impedes the immune system from working normally.

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are commonly used to lower blood pressure over the portal system. In severe complications from portal hypertension,

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In the case of cirrhosis with atrial fibrillation, the AGA recommends using anticoagulation over no anticoagulation.

432:. Heavy drinking over a number of years can cause alcoholic liver disease. Liver damage has also been attributed to 12744: 12326: 10693: 10489: 9913: 6353:

Halfon P, Munteanu M, Poynard T (September 2008). "FibroTest-ActiTest as a non-invasive marker of liver fibrosis".

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is recommended early in the course of illness due to decline in effectiveness of the vaccines with decompensation.

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IgM significantly increased in primary biliary cirrhosis and moderately increased in viral hepatitis and cirrhosis.

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As the disease progresses, complications may develop. In some people, these may be the first signs of the disease.

6708:"Increased sTREM-1 levels identify cirrhotic patients with bacterial infection and predict their 90-day mortality" 6310:

Van Thiel DH, Gavaler JS, Schade RR (February 1985). "Liver disease and the hypothalamic pituitary gonadal axis".

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Kim SM, Yalamanchi S, Dobs AS (2017). "Male Hypogonadism and Liver Disease". In Winters SJ, Huhtaniemi IT (eds.).

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at the National Digestive Diseases Information Clearinghouse (NDDIC). NIH Publication No. 04-1134, December 2003.

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Lee EW, Shahrouki P, Alanis L, Ding P, Kee ST (June 2019). "Management Options for Gastric Variceal Hemorrhage".

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may be the preferred option. This procedure requires the insertion of a plastic tube into the peritoneal cavity.

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is used to prioritize patients for transplantation. Transplantation necessitates the use of immune suppressants (

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In hospitalized patients who meet standard guidelines for clot prevention, the AGA suggests standard prevention.

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Aamann L, Dam G, Rinnov AR, Vilstrup H, Gluud LL, et al. (Cochrane Hepato-Biliary Group) (December 2018).

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scan can detect this cancer and is often carried out for early signs which has been shown to improve outcomes.

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Histopathology of steatohepatitis with established cirrhosis, with thick bands of fibrosis (Van Gieson's stain)

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Zacharias HD, Kamel F, Tan J, Kimer N, Gluud LL, Morgan MY (2023-07-19). Cochrane Hepato-Biliary Group (ed.).

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is also included in the scoring. The classification system includes class A, B, or C. Class A has a favorable

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intestinal peptide is increased as blood is shunted into the intestinal system because of portal hypertension.

1004:(NAFLD), fat builds up in the liver and eventually causes scar tissue. This type of disorder can be caused by 586:, and personality changes.Steatorrhea or presence of undigested fats in stool is also a symptom of cirrhosis. 12532: 12378: 10034: 8705: 7732: 3276: 3180: 3019: 1935: 1828:

levels (IgG, IgM, IgA) – these immunoglobins are nonspecific, but may help in distinguishing various causes.

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People with decompensated cirrhosis generally require admission to a hospital, with close monitoring of the

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Coenen IC, Houwen RH (January 2019). "Indian childhood cirrhosis and other disorders of copper handling.".

1133: 808: 337:

Stages of cirrhosis include compensated cirrhosis and decompensated cirrhosis. Early symptoms may include

2006:

Histopathology of steatohepatitis with mild fibrosis in the form of fibrous expansion (Van Gieson's stain)

1904:. These could potentially be used to discriminate patients with liver cirrhosis from healthy individuals. 1778:

is increased (as well as sodium retention in kidneys) secondary to a fall in systemic vascular resistance.

12623: 11501: 11297: 10649: 9963: 9906: 9730: 9709: 9685: 8709: 2071: 1801: 1053: 461: 6390:"Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients: a cohort study" 5387: 2557:. In patients with previously stable cirrhosis, decompensation may occur due to various causes, such as 2323:

may be more important. Drinking two or more cups of coffee a day is associated with improvements in the

2018:

Histopathology of steatohepatitis with moderate fibrosis, with thin fibrous bridges (Van Gieson's stain)

12734: 11867: 11796: 11397: 11165: 11128: 10906: 10157: 10049: 9680: 9095:

Merli M, Berzigotti A, Zelber-Sagi S, Dasarathy S, Montagnese S, Genton L, et al. (January 2019).

8440:"AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis" 6132:

Pavlov CS, Casazza G, Nikolova D, Tsochatzis E, Burroughs AK, Ivashkin VT, et al. (January 2015).

1695: 1448: 1147: 1111: 898: 849: 481: 8017: 7529:

Patch D, Armonis A, Sabin C, Christopoulou K, Greenslade L, McCormick A, et al. (February 1999).

1384:, which normally measures less than 11–12 cm (4.3–4.7 in) in adults, may suggest underlying 12140: 12096: 12049: 11855: 11473: 11064: 10730: 10619: 10172: 10081: 10024: 9520:

Asrani SK, Devarbhavi H, Eaton J, Kamath PS (January 2019). "Burden of liver diseases in the world".

8219:

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FI, Soares-Weiser K, Uribe M (September 2010).

6216:

Gudowska M, Gruszewska E, Panasiuk A, Cylwik B, Świderska M, Flisiak R, et al. (February 2016).

2847: 2542: 2443:

Treating the cause of cirrhosis prevents further damage; for example, giving oral antivirals such as

2335: 1141: 4246:"Current Concepts of Precancerous Lesions of Hepatocellular Carcinoma: Recent Progress in Diagnosis" 3176: 2730:

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention).

12486: 12166: 11801: 11759: 11572: 11447: 11434: 11404: 11375: 11193: 9801: 8398:

Bajaj JS, Kamath PS, Reddy KR (17 June 2021). "The Evolving Challenge of Infections in Cirrhosis".

6481:"Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections" 6033:"Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions" 6031:

Srinivasa Babu A, Wells ML, Teytelboym OM, Mackey JE, Miller FH, Yeh BM, et al. (2016-11-01).

3083: 3049: 2429:

in people with compensated cirrhosis; it is thus considered a safe analgesic for said individuals.

2045:, showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue). 1974:, and other vascular structures, which leads to altered resistance to blood flow in the liver, and 1483: 1389: 1285: 589:

Worsening cirrhosis can cause a build-up of fluid in different parts of the body such as the legs (

547: 10595: 4024:. Vol. 10, no. 1. Journal of the Association of Basic Medical Sciences. pp. 36–43. 12411: 12188: 11929: 11721: 11380: 11244: 11049: 10986: 10884: 10859: 10131: 8950: 7876:

Francque SM, Bedossa P, Ratziu V, Anstee QM, Bugianesi E, Sanyal AJ, et al. (October 2021).

7531:"Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding" 6949:"Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology" 1361: 1017: 969: 203: 160: 8676: 8145: 6591:

Tornai T, Vitalis Z, Sipeki N, Dinya T, Tornai D, Antal-Szalmas P, et al. (November 2016).

6083:

Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. (March 2006).

823:). It is due to extra connections forming between the portal system and the paraumbilical veins. 12690: 12616: 12491: 12215: 12198: 11582: 11458: 11409: 11370: 11340: 10817: 10764: 10720: 10605: 10573: 10364: 10337: 7259: 4629:(18th ed.). New York: McGraw-Hill. pp. Chapter 308. Cirrhosis and Its Complications. 3003: 2999: 2816: 2739: 2710: 2692: 2546: 2405:(NAFLD or NASH). A drug called semaglutide was shown to provide greater NASH resolution versus 2359:. Diuretics in combination with low salt diet reduce fluid in body which helps reduce oedema. 2331: 2165: 2094: 2059: 1811: 1698: – correlates with AP levels. Typically much higher in chronic liver disease from alcohol. 1491: 1475: 1095: 881: 784: 780: 527: 485: 386: 169: 11006: 9841: 8764: 8539:

Piano S, Tonon M, Angeli P (February 2018). "Management of ascites and hepatorenal syndrome".

7441: 7292: 5957: 5532:"Dysregulated epidermal growth factor and tumor growth factor-beta receptor signaling through 5509:(6th ed.). New York: McGraw-Hill Medical. pp. Chapter 14: Liver Disease. Cirrhosis. 5340:"Mortality of NAFLD According to the Body Composition and Presence of Metabolic Abnormalities" 5109: 4296: 1098:. A strong association with inflammatory bowel disease is seen, especially ulcerative colitis. 12423: 12342: 12331: 12292: 12220: 11523: 10610: 10194: 10189: 10093: 10055: 9948: 5636:

Puche JE, Saiman Y, Friedman SL (October 2013). "Hepatic stellate cells and liver fibrosis".

3304:, meaning "yellowish, tawny" (the orange yellow colour of the diseased liver) and the suffix 3034: 3033:

Extrinsic factors may also increase the risk of infection in those with cirrhosis, including

2513: 2507: 1991: 1943: 1797: 1397: 1257: 1253: 1195: 1157: 315: 6592: 4551:

Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al. (2000).

2573:

or dehydration. It may take the form of any of the complications of cirrhosis listed below.

12462: 12406: 12227: 12123: 11706: 11701: 11535: 11453: 11419: 11170: 11157: 11101: 10916: 10534: 10327: 10246: 10179: 10076: 9045:"Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis" 7982:

Bajaj JS, Kamath PS, Reddy KR (2021). "The Evolving Challenge of Infections in Cirrhosis".

7483: 6756: 6479:

Papp M, Vitalis Z, Altorjay I, Tornai I, Udvardy M, Harsfalvi J, et al. (April 2012).

6388:

Tornai D, Antal-Szalmas P, Tornai T, Papp M, Tornai I, Sipeki N, et al. (March 2021).

5584: 4752: 3973:"Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease" 3091: 3015: 3011: 2949: 2327: 2145: 1927: 1689: 1342: 1289: 1101: 1069: 946: 919: 742: 705: 602: 543: 515: 457: 354: 60: 10879: 8853:

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. (2014-07-08).

8438:

O'Shea RS, Davitkov P, Ko CW, Rajasekhar A, Su GL, Sultan S, et al. (November 2021).

7783:

Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V, et al. (March 2021).

7104:

Giallourakis CC, Rosenberg PM, Friedman LS (November 2002). "The liver in heart failure".

6255: 6253: 2482:

According to a 2018 systematic review based on studies that implemented 8 to 14 week-long

1392:

and portal hypertension. This is done by assessing flow in the hepatic vein. An increased

8: 12685: 12668: 12658: 12556: 12366: 12259: 12242: 12203: 12176: 12128: 11971: 11948: 11941: 11890: 11862: 11784: 11779: 11774: 11691: 11308: 11249: 11123: 10864: 10849: 10799: 10504: 10494: 10273: 10203: 9991: 9790: 8780: 8218: 5681:

Wu M, Sharma PG, Grajo JR (September 2020). "The Echogenic Liver: Steatosis and Beyond".

5134: 2758: 2367: 2356: 2338:. Even in those with liver disease, coffee consumption can lower fibrosis and cirrhosis. 2153: 2051: 1975: 1459: 1444: 1385: 1161: 1129: 977: 915: 837: 746: 518:. Avoiding alcohol is recommended in all cases. Autoimmune hepatitis may be treated with 506: 477: 331: 250: 9069: 9044: 8854: 7785:"A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis" 7487: 6760: 6706:

Tornai D, Vitalis Z, Jonas A, Janka T, Foldi I, Tornai T, et al. (September 2021).

4272: 4245: 3917:

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. (2024).

2660:

Cirrhosis can increase the risk of bleeding. The liver produces various proteins in the

2644:. Despite proven benefit, people with cirrhosis are rarely referred to palliative care. 12568: 12433: 12416: 12401: 12388: 12371: 12237: 11872: 11764: 11736: 11670: 11496: 11392: 11357: 11081: 11024: 10940: 10839: 10832: 10794: 10754: 10560: 10461: 10376: 10354: 10208: 10167: 9929: 9646: 9621: 9545: 9464: 9437: 9418: 9316: 9289: 9267: 9219: 9194: 9170: 9145: 9121: 9096: 8926: 8893: 8800: 8650: 8607: 8564: 8516: 8491: 8469: 8268:

Ferrell B, Connor SR, Cordes A, Dahlin CM, Fine PG, Hutton N, et al. (June 2007).

8245: 8220: 8201: 8122: 8097: 8073: 8046: 7964: 7917: 7858: 7814: 7745: 7692: 7638: 7613: 7555: 7506: 7471: 7391: 7366: 7342: 7317: 7079: 7046: 6992:

had either cirrhosis or malignant disease, both of which are risk factors for bleeding.

6973: 6924: 6899: 6880: 6829: 6802: 6780: 6685: 6630: 6565: 6538: 6537:

Papp M, Tornai T, Vitalis Z, Tornai I, Tornai D, Dinya T, et al. (November 2016).

6508: 6416: 6389: 6335: 6250: 6158: 6133: 6109: 6084: 6057: 6032: 5873: 5819: 5794: 5752: 5725: 5706: 5609: 5560: 5531: 5461: 5447: 5364: 5339: 5243: 5218: 5022: 4968: 4941: 4917: 4900: 4533: 4485: 4458: 4396: 4379: 4355: 4330: 4071: 4046: 4030: 3997: 3972: 3758: 3733: 3568: 3543: 3514: 3489: 3432: 3327: 3308:, i.e. "condition" in medical terminology. While the clinical entity was known before, 2637: 2580:, mental status, and emphasis on adequate nutrition and medical treatment – often with 2570: 1853: 912:

Sensitivity to medication can be caused by decreased metabolism of the active compounds

798: 772: 701: 672: 629: 531: 453: 398: 390: 346: 338: 173: 132: 9637: 9406: 8286: 8269: 7152: 7117: 6366: 5793:

Iranpour P, Lall C, Houshyar R, Helmy M, Yang A, Choi JI, et al. (January 2016).

5275:. : Mcgraw-Hill. pp. Chapter 16. Liver, Biliary Tract, & Pancreas Disorders. 4729: 4062: 3639: 3559: 3505: 2952:

is a serious complication of end-stage cirrhosis when kidney damage is also involved.

2713:. If there is a portal vein thrombosis, the AGA suggests treatment by anticoagulation. 1722:

increase due to shunting of bacterial antigens away from the liver to lymphoid tissue.

436:

usage over an extended period of time as well. MASH has a number of causes, including

322:

can replace the parenchyma, causing increased resistance to blood flow in the liver's

12639: 12546: 12527: 11900: 11111: 10981: 10844: 10822: 10725: 10600: 10544: 10322: 10261: 10251: 10223: 10199: 9812: 9651: 9595: 9572: 9537: 9469: 9410: 9321: 9259: 9224: 9175: 9126: 9074: 9025: 9017: 8996:

Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. (2010-03-25).

8978: 8970: 8931: 8913: 8874: 8792: 8784: 8696: 8642: 8599: 8556: 8521: 8473: 8461: 8365: 8329: 8291: 8250: 8193: 8127: 8078: 7999: 7968: 7956: 7921: 7909: 7862: 7850: 7818: 7806: 7763: 7749: 7737: 7696: 7684: 7643: 7560: 7511: 7396: 7347: 7234: 7183: 7156: 7121: 7084: 7066: 7018: 6978: 6948: 6929: 6872: 6834: 6784: 6772: 6729: 6677: 6634: 6622: 6570: 6500: 6496: 6456: 6421: 6370: 6327: 6290: 6265: 6239: 6198: 6163: 6114: 6062: 6013: 5947: 5917: 5865: 5824: 5757: 5710: 5698: 5663: 5653: 5614: 5565: 5510: 5451: 5369: 5318: 5276: 5248: 5172: 5088: 5026: 5014: 4973: 4922: 4872: 4733: 4663: 4630: 4560: 4525: 4521: 4490: 4433: 4401: 4360: 4302: 4277: 4226: 4076: 4002: 3950: 3819: 3809: 3763: 3714: 3704: 3668: 3643: 3573: 3519: 3418: 2995: 2633: 2613: 2375: 1962: 1393: 1373: 1273: 1223: 1166: 1150:

is a form of neonatal cholestasis characterized by deposition of copper in the liver

1064:, or skin hyperpigmentation. The liver is typically enlarged which is referred to as 1056:(previously known as primary biliary cirrhosis), the bile ducts become damaged by an 1032: 757: 473: 311: 223: 116: 9795: 9549: 9422: 9271: 8997: 8804: 8654: 8611: 8221:"Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding" 8205: 7660: 6884: 6801:

McCarty TR, Bazarbashi AN, Njei B, Ryou M, Aslanian HR, Muniraj T (September 2020).

6689: 6512: 6339: 5912: 5895: 5877: 5465: 4537: 3488:

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (October 2016).

3381:. National Institute of Diabetes and Digestive and Kidney Diseases. April 23, 2014. 745:. This resistance creates a backup of blood and increases pressure. This results in 12593: 12513: 12508: 12498: 12360: 12232: 12160: 11978: 11885: 11880: 11810: 11769: 11577: 11542: 11094: 11044: 10688: 10624: 10590: 10583: 10466: 10433: 10423: 9852: 9641: 9633: 9529: 9459: 9449: 9402: 9375: 9348: 9311: 9301: 9251: 9214: 9206: 9165: 9157: 9116: 9108: 9064: 9060: 9056: 9009: 8962: 8921: 8905: 8866: 8776: 8634: 8591: 8568: 8548: 8511: 8503: 8451: 8407: 8357: 8321: 8281: 8240: 8236: 8232: 8183: 8117: 8113: 8109: 8068: 8058: 7991: 7948: 7899: 7889: 7842: 7796: 7727: 7719: 7674: 7633: 7625: 7550: 7542: 7530: 7501: 7491: 7386: 7378: 7337: 7329: 7148: 7139:

Heathcote EJ (November 2003). "Primary biliary cirrhosis: historical perspective".

7113: 7074: 7058: 6968: 6960: 6919: 6911: 6864: 6824: 6814: 6764: 6719: 6669: 6612: 6604: 6560: 6550: 6492: 6448: 6411: 6401: 6362: 6319: 6229: 6190: 6153: 6149: 6145: 6104: 6096: 6085:"Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study" 6052: 6044: 6005: 5907: 5855: 5814: 5806: 5747: 5737: 5690: 5645: 5604: 5596: 5555: 5547: 5443: 5359: 5351: 5310: 5238: 5230: 5164: 5004: 4963: 4953: 4912: 4725: 4696: 4655: 4517: 4480: 4470: 4391: 4350: 4342: 4267: 4257: 4222: 4214: 4066: 4058: 4025: 3992: 3984: 3940: 3930: 3919:"A multisociety Delphi consensus statement on new fatty liver disease nomenclature" 3789: 3753: 3745: 3635: 3563: 3555: 3509: 3501: 3038: 2669: 2401:

As of 2021, there are recent studies studying drugs to prevent cirrhosis caused by

2262: 1883: 1713: 1683: 1673: 1563: 1557: 1539: 1535: 906: 841: 566: 539: 362: 327: 145: 121: 76: 7952: 5971: 5480: 4684: 4094: 1957:: (1) the presence of regenerating nodules of hepatocytes and (2) the presence of 1330: 570:

Person with cirrhosis and associated pain in the right upper region of the abdomen

12551: 12481: 12347: 12282: 12247: 12118: 11983: 11919: 11821: 11740: 11731: 11681: 11621: 11506: 11483: 11264: 10945: 10930: 10911: 10416: 10411: 10285: 9806: 9690: 9454: 9352: 8456: 8439: 7496: 7062: 7010: 6724: 6707: 5694: 4659: 4218: 3988: 2624: 2495: 2299: 2042: 1920: 1186: 942: 902: 776: 693: 644: 519: 496: 449: 394: 232: 9855: 9146:"Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles" 7382: 7175: 5775: 4262: 3935: 3918: 3662: 3309: 3026:

function, further increasing the risk for infections. Kupfer cells are resident

2853:

The severity of hepatic encephalopathy is determined by assessing the patient's

2632:

also help with discussions regarding the person's wishes concerning health care

2176:

Child-Pugh Score in Relation to Liver Function, Prognosis and Post-op Mortality

1463: 1316: 12697: 12680: 12588: 12503: 12057: 12030: 11895: 11830: 11826: 11716: 11686: 11279: 11089: 11069: 11031: 10896: 10317: 10307: 10297: 10105: 10071: 9937: 9533: 9112: 8638: 8595: 7679: 7662: 7629: 7582: 7333: 7228: 6915: 6452: 6406: 5585:"Cirrhosis: new research provides a basis for rational and targeted treatments" 5168: 4864: 4625:

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. (2012).

4552: 4425: 3288: 2971:

in people with portal hypertension, and is associated with cirrhosis severity.

2743: 2609: 2605: 2601: 2538: 2487: 2467: 2459: 2270: 1971: 1901: 1825: 1677: 1320: 1265: 1191: 1119: 929: 833: 788: 625: 621: 583: 546:, possibly with additional blood tests, is recommended due to the high risk of 378: 9817: 9776: 9772: 9255: 9161: 8742: 8552: 8361: 8325: 7470:

Kartoun U, Corey KE, Simon TG, Zheng H, Aggarwal R, Ng K, et al. (2017).

6868: 6009: 5338:

Golabi P, Paik JM, Arshad T, Younossi Y, Mishra A, Younossi ZM (August 2020).

4331:"Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope" 3823: 3718: 509:

can prevent hepatitis B and the development of cirrhosis from it, but no

12728: 12663: 12653: 12521: 12474: 12267: 12210: 12193: 12105: 11850: 11677: 11552: 11518: 11463: 11254: 11135: 11039: 10935: 10524: 10456: 10406: 10401: 10386: 10381: 10359: 10268: 10235: 10100: 9969: 9704: 9676: 9306: 9021: 8974: 8917: 8788: 7878:"A Randomized, Controlled Trial of the Pan-PPAR Agonist Lanifibranor in NASH" 7070: 7047:"Medical liver biopsy: background, indications, procedure and histopathology" 6555: 5921: 5896:"Changes of portal vein flow in heart failure patients with liver congestion" 5600: 5018: 4456: 3322: 2801: 2747: 2577: 2491: 2383: 2379: 1859: 1819: 1788:

Other laboratory studies performed in newly diagnosed cirrhosis may include:

1249: 1215: 1170: 1137: 1123: 845: 794: 535: 9866: 9780: 9379: 8507: 7227:

Tsoris A, Marlar CA (2022). "Use Of The Child Pugh Score In Liver Disease".

6964: 6234: 6217: 6100: 5742: 5551: 5314: 5009: 4992: 4701: 2512:

If complications cannot be controlled or when the liver ceases functioning,

1704:

levels are normal when compensated, but may elevate as cirrhosis progresses.

941:

Cirrhosis has many possible causes, and more than one cause may be present.

12396: 12308: 12181: 12084: 12035: 12020: 12015: 12011: 11924: 11749: 11665: 11557: 11547: 11513: 11214: 11204: 10994: 10290: 9655: 9576: 9541: 9473: 9414: 9325: 9263: 9228: 9179: 9130: 9078: 9029: 8982: 8909: 8878: 8796: 8646: 8603: 8560: 8525: 8465: 8369: 8333: 8295: 8254: 8197: 8131: 8082: 8003: 7960: 7913: 7904: 7854: 7810: 7741: 7688: 7647: 7515: 7400: 7351: 7238: 7187: 7160: 7125: 7088: 6982: 6933: 6876: 6838: 6776: 6733: 6681: 6626: 6574: 6504: 6460: 6425: 6374: 6323: 6243: 6202: 6167: 6118: 6066: 6017: 5869: 5828: 5761: 5702: 5667: 5618: 5569: 5373: 5252: 5176: 4977: 4926: 4876: 4737: 4564: 4529: 4494: 4475: 4437: 4364: 4281: 4230: 4080: 4006: 3954: 3767: 3749: 3672: 3647: 3596: 3577: 3523: 3087: 3072: 3061: 3044:

Infections that are common in those in the hospital with cirrhosis include

2854: 2805: 2771: 2754: 2684: 2558: 2395: 2391: 2324: 2067: 2063: 1939: 1931: 1793: 1769: 1763: 1730: 1471: 1377: 1369: 1365: 1301: 1288:(MMPs), which prevent MMPs from breaking down the fibrotic material in the 1239: 1199: 1176: 1065: 1057: 1013: 981: 973: 766: 683: 664: 654: 500: 441: 402: 374: 236: 177: 9563:

Anderson RN, Smith BL (November 2003). "Deaths: leading causes for 2001".

9013: 8935: 8411: 7995: 7894: 7801: 7564: 6331: 6194: 6048: 4958: 4457:

Kur P, Kolasa-Wołosiuk A, Misiakiewicz-Has K, Wiszniewska B (April 2020).

4405: 2277:

was added to the variables and the score is often referred to as MELD-Na.

1368:

with irregular appearing areas. Other suggestive findings are an enlarged

12576: 12338: 12316: 12147: 12067: 11711: 11612: 11365: 11145: 11140: 11011: 10891: 10781: 10674: 10446: 10391: 9996: 9887: 9836: 9725: 9210: 9097:"EASL Clinical Practice Guidelines on nutrition in chronic liver disease" 8951:"Rifaximin: A Novel Nonabsorbed Rifamycin for Gastrointestinal Disorders" 8063: 7546: 6289:. New York: McGraw-Hill Medical. pp. Chapter 3: Disease Management. 5649: 3808:(13th ed.). Hoboken, New Jersey: Wiley Blackwell. pp. 107–126. 3734:"The Inside-Out of End-Stage Liver Disease: Hepatocytes are the Keystone" 3027: 3023: 2789: 2775: 2661: 2522: 2437: 2433: 2426: 2410: 2082:. Lastly in alcoholic cirrhosis, there is infiltration of the liver with 2055: 1950: 1754: 1748: 1738: 1734: 1335: 1323: 1219: 1105: 1091: 1039: 1028: 961: 876: 820: 816: 661:(a potent type of estrogen). This can occur in up to two-thirds of cases. 555: 510: 445: 429: 425: 350: 323: 246: 211: 207: 6819: 6768: 5219:"Pathophysiology and Management of Alcoholic Liver Disease: Update 2016" 4346: 3945: 1268:, and obstructs hepatic blood flow. In addition, stellate cells secrete 1214:

The liver plays a vital role in the synthesis of proteins (for example,

617:

These features are a direct consequence of liver cells not functioning:

12352: 12025: 12003: 11648: 11587: 11274: 11106: 11054: 10854: 10827: 10737: 10519: 10499: 10428: 10011: 10001: 9861: 9393:

Forner A, Llovet JM, Bruix J (March 2012). "Hepatocellular carcinoma".

6617: 5810: 3703:(13th ed.). Hoboken, New Jersey: Wiley Blackwell. pp. 82–92. 3057: 2988: 2585: 2566: 2526: 2471: 2352: 2320: 2266: 2083: 2075: 1954: 1916: 1744: 1733:) due to inability to excrete free water resulting from high levels of 1680:. However, this rarely results in a platelet count < 50,000/mL. 1269: 1203: 1115: 872: 671:. This can result in impotence, infertility, loss of sexual drive, and 492: 319: 303: 228: 125: 9755: 8870: 8188: 8171: 7846: 7723: 6673: 6608: 5944:

Clinical Hepatology: Principles and Practice of Hepatobiliary Diseases

5860: 5843: 5507:

Pathophysiology of disease : an introduction to clinical medicine

5355: 4899:

Masoodi I, Farooq O, Singh R, Ahmad N, Bhat M, Wani A (January 2009).

2991:(native bacteria, that under certain conditions may cause infection). 2409:. No improvement in fibrosis was observed. A combination of cilofexor/ 1837:

IgA is increased in alcoholic cirrhosis and primary biliary cirrhosis.

1692:– slightly elevated but less than 2–3 times the upper limit of normal. 12302: 12272: 12113: 11966: 11817: 11791: 11653: 11643: 11530: 11491: 11424: 11209: 11116: 10950: 10749: 10715: 10568: 10539: 10509: 10441: 10396: 10369: 10217: 10152: 9986: 9981: 9898: 9847: 6658: 5234: 4716:

Plauth M, Schütz ET (September 2002). "Cachexia in liver cirrhosis".

3053: 2980: 2839: 2827: 2793: 2753:

Where salt restriction and the use of diuretics are ineffective then

2562: 2448: 2444: 2387: 2348: 2280: 2169: 2149: 2090: 1967: 1912: 1897: 1865: 1782: 1701: 1261: 1227: 1073: 894: 890: 692:

is the yellowing of the skin. It can additionally cause yellowing of

658: 637:. Cirrhosis causes a rise of estrogen due to increased conversion of 469: 52: 9594:(5th ed.). Philadelphia, PA: F. A. Davis Company. p. 422. 6855:

Mok SR, Diehl DL (January 2019). "The Role of EUS in Liver Biopsy".

4620: 4618: 4616: 4614: 4612: 4610: 4608: 4606: 4604: 4602: 4600: 4019: 3732:

Haep N, Florentino RM, Squires JE, Bell A, Soto-Gutierrez A (2021).

11936: 11914: 11626: 10809: 10473: 9094: 8966: 7877: 7472:"The MELD-Plus: A generalizable prediction risk score in cirrhosis" 7009:

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is a biomarker for fibrosis that may be used instead of a biopsy.

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is another major cause, accounting for about 20–40% of the cases.

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usually presents with skin hyperpigmentation, diabetes mellitus,

1005: 885: 761: 753: 676: 594: 579: 437: 420:, previously called non-alcoholic fatty liver disease or NAFLD), 366: 153: 137: 12608: 6215: 6082: 4835: