# Cirrhosis --- **Cirrhosis** is a condition of irreversible, scarring damage to the [[liver]]. The liver is a vital organ that performs many functions, so damage to it impedes its function and ultimately leads to death. - *repeated* damage to the cells of the liver - causes inflammation and cell death - the cells are replaced with scar tissue, or fibrosis - the liver is unable to function ![[cirrhosis.png]] With such scarring in the liver, it has lost a large capacity to move blood through it, which backs up the flow of blood in the [[hepatic portal system|hepatic portal vein]]. This then causes congestion in the organs that drain into the portal vein, which can in turn affect their functions: - [[stomach]] - [[pancreas]] - we might see trouble with [[insulin]] production - [[spleen]] - we might see splenomegaly - [[intestines]] - water and nutrient absorption troubles ## Risk Factors - [[alcohol use disorder]] - see: [[hepatitis#Non-Viral Hepatitis|alcohol-related hepatitis]] - viral [[hepatitis]] - injection drug use - [[hepatotoxic substances]] or recreational drugs - fatty liver ## Signs & Symptoms There are a wide range of signs and symptoms of cirrhosis, since this touches so many systems and has such a widespread effect. - The liver is able to clear ammonia - [[hepatic encephalopathy]], altered mental status, asterixis - The liver is unable to clear bilirubin - [[jaundice]], icterus (yellow sclera) - The liver is unable to make [[albumin]] - blood osmotic pressure goes down, fluid escapes into the tissues, [[ascites]] - The liver does not trigger platelet production - bleeding, prolonged INR - bruising, petechia - Blood backs up in the portal system - [[esophageal varices]], caput medusae ## Diagnostic Tests - liver enzymes (AST, ALT) *elevated* - bilirubin elevated - albumin lowered - PT/INR prolonged - ammonia elevated - RBC/HGB/HCT/PLT lowered ## Treatment Cirrhosis is incurable, so treatment consists of symptom management. The only possible "cure" for cirrhosis is a [[organ transplant|liver transplant]]. ___