Cirrhosis: Clinical

Cirrhosis is when chronic inflammation and liver damage causes the liver to become fibrotic and develop scar tissue.

At a cellular level, the hepatocytes become impaired and this leads to hepatic dysfunction and portal hypertension.

Cirrhosis is usually irreversible, so it’s usually called “end-stage” or “late-stage” liver damage, and often requires a liver transplant. However, in some cases, early treatment can slow down and even reverse the cirrhosis.

Compensated cirrhosis is when there are enough healthy cells to make up for the damaged ones, but minor complications like hemorrhoids can still occur.

Decompensated cirrhosis is when healthy cells can no longer keep up with the workload, causing major complications like hepatic encephalopathy, ascites, and esophageal and gastric variceal hemorrhage.

In compensated cirrhosis, although there aren’t any major complications, there may still be some symptoms such as loss of appetite, fatigue, and muscle cramps. There may also be easy bruising and excessive bleeding because there aren’t enough clotting factors produced by the liver.

Cirrhosis can also impair estrogen metabolism, causing amenorrhea and irregular menstrual bleeding in females, and low libido and gynecomastia in males.

On physical exam, there may be hepatomegaly - where the liver can feel firm and nodular, but when there’s a lot of scarring, the liver may be small so that it can’t be felt at all.

Another sign is spider angiomas- or spider nevi- which are swollen blood vessels just beneath the skin surface- on the truck, face and upper limbs.

Palmar erythema- which is redness of the hands- can sometimes be seen.