Cirrhosis is defined as chronic liver injury leading to diffuse necrosis and fibrosis. Early stages are asymptomatic, but later stages involve fatigue, itching, leg swelling, jaundice, bruising, and fluid in the abdomen. Complications of advanced cirrhosis include hepatic encephalopathy, bleeding from esophageal veins, infections of abdominal fluid, and liver cancer. Clinical features are related to the extent of liver damage and include disorders due to liver dysfunction like jaundice, edema, and coagulopathy, as well as disorders from distorted vasculature like portal hypertension and ascites.

1. Malik Jauhar
43/2012
ASCOMS

2.  Term coined by Rene’ Laennec (1826)
 Defined as chronic liver injury leading to diffuse
necrosis followed by fibrosis

3.  Early Stages: Asymptomatic
 Progression: Tired, Weak, Itchy, Swelling in legs, Yellow
skin, Bruise, Fluid in abdomen, Spider like blood vessels
on the skin, loss of libido, pain abdomen
 Abdominal fluid may become spontaneously infected
 Advanced Complications: Hepatic encephalopathy,
Bleeding from veins in esophagus

4. Clinical features associated with cirrhosis are related to the
extent of liver damage rather than the cause
 Disorders due to liver Dysfunction(loss of hepatic mass) :
 Jaundice (liver cell death)
 Edema (decreased albumin synthesis)
 Hepatic encephalopathy (ammonia, toxins accumulation)
 Coagulopathy (bruise, purpura, bleeding)
 Disorders due to distorted vasculature:
 Portal Hypertension
 Ascites
 Varices
 Splenomegaly

5.  Skin pigmentation
 Pruritus
 Clubbing fingers
 Spider angioma (1/3 cases)
 Palmar erythema
 Purpura
 Hypogonadism
 Gynaecomastia (2/3 cases)
 Testicular atrophy
 Decreased testosterone
 Decreased sexual drive
 Menstrual irregularities
Increased Estrogen due
to Impaired clearance

7.  Haematemesis
 Malaena
 Ascites
 Dyspepsia
 Abdominal discomfort/pain
 Splenomegaly (35-50%)
Variceal
hemorrhage

8.  GI bleed (major complication, high mortality)
 Esophageal varices (60-80%)
 Gastric varices (7%)
 Encephalopathy (Altered mental status, Fetor
hepaticus, Personality disorder, Drowsiness, deep Coma)
 Infection
 Hepatorenal syndrome
 Liver cancer
 Electrolyte imbalance