Cirrhosis

Causes + Complications

Appropriate Tests

 

The diagnosis is suspected on the basis of clinical assessment and supported by pathology tests.

Although Liver biopsy provides the definitive pathological diagnosis, it is not always indicated or feasible.

Liver function can be assessed by Albumin, Bilirubin, Prothrombin time.

Ongoing inflammation, necrosis and cholestasis are assessed by Aspartate aminotransferase, Alanine aminotransferase (AST/ALT ratio), Gamma glutamyltransferase, Alkaline phosphatase, Lactate dehydrogenase, Immunoglobulins G, A, M.

Liver function tests may be normal in quiescent cirrhosis.

The findings may be complicated by the coexistence of acute hepatitis and/or hepatic failure.

Causes

 

Chronic Alcoholism

See Alcoholism

Hepatitis B virus infection

 

Hepatitis D virus infection

 

See Hepatitis C virus infection

 

Autoimmune hepatitis

Smooth muscle Ab, Liver/kidney microsome Ab. See Hepatitis chronic.

Metabolic, including

 

  • Hereditary haemochromatosis

 

  • Cystic fibrosis

 

  • Alpha-1-antitrypsin deficiency

Alpha-1-antitrypsin, with phenotyping, genotyping.

  • Wilson's disease

 

  • Galactosaemia

 

  • Type IV glycogen storage disease

See under Glycogen storage diseases.

  • Tyrosinaemia type I

Amino acids urine, Organic acids urine (succinylacetone).

Cholestasis (prolonged), especially

See Cholestasis.

  • Primary biliary cirrhosis

Mitochondrial Ab.

  • Prolonged large duct obstruction

 

  • Biliary atresia

 

Drugs and toxins, including

 

  • Methotrexate

 

  • Aflatoxin

In some geographic areas eg, Southeast Asia.

Cryptogenic

 

Anaemia

Full blood count. Anaemia is often multifactorial: likely cause(s) are indicated by the red cell indices and blood film findings.

Complications

 

Ascites

 

Bleeding, due to:

See Bleeding disorders.

  • Failure of synthesis of coagulation factors, related to

Prothrombin time (PT), APTT, Fibrinogen. The APTT is less sensitive than the PT to the coagulation factor deficiency of liver disease.

  • Vitamin K deficiency

 

  • Hepatocellular failure

See Hepatic failure.

  • Thrombocytopenia, due to

Full blood count.

  • Alcohol marrow toxicity

See Alcoholism.

  • DIC (usually low grade)

 

  • Hypersplenism

 

  • Primary fibrinolysis

Usually low grade: Thrombin time, Fibrinogen, euglobulin clot lysis time. See Fibrinolysis.

  • Dysfibrinogenaemia

Thrombin time, Reptilase time.

Hepatic encephalopathy

 

Hepatic failure

 

Hepatocellular carcinoma

 

Hepato-renal syndrome

See Renal failure.

Peritonitis

See under Alcoholism.

Portal hypertension, causing

 

  • Splenomegaly

May be associated Hypersplenism.

  • Variceal bleeding

See Alcoholism.