The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis

Abstract

Background: Cirrhosis of the liver is the end stage of chronic liver disease. Among the many liver disorders that can lead to cirrhosis, some progress rapidly (years) and others more slowly (decades). In Germany, cirrhosis is often a consequence of fatty liver disease due to alcoholism or other causes, but can also be caused by hepatitis B and hepatitis C. Cirrhosis is more common in overweight persons and smokers. The underlying causes of cirrhosis determine its rate of progression and are the focus of preventive efforts and treatment. The prevalence of cirrhosis in Germany is rising; it now ranks among the top 20 causes of death in the country.

Methods: This article is based on a selective review of pertinent literature, including reviews and current guidelines.

Results: Strictly speaking, cirrhosis is a pathological diagnosis; it is, nevertheless, usually diagnosed clinically, by history, physical examination (e.g., cutaneous signs of liver disease), ancillary testing (e.g., ultrasonography, transient elastography) and laboratory analyses (e,g., APRI, which is the quotient of the GOT concentration and the platelet count). There are no laboratory cutoff values for the diagnosis of cirrhosis. Early detection of chronic liver disease, followed by individually tailored, risk-adapted treatment, is the best way to prevent it. Esophagogastroduodenoscopy can be performed early on to assess the risk of variceal bleeding. In most patients, the progression of fibrosis can be averted by early detection and appropriate treatment.

Conclusion: Screening for chronic liver disease should include history and physical examination, serum transaminase measurement, upper abdominal ultrasonography, and, in some cases, transient elastography.

Figure 1

The course of chronic liver disease: Worsening hepatic fibrosis leads to cirrhosis, which can become decompensated and lead, in turn, to hepatocellular carcinoma. Timely intervention can prevent progression to the next disease stage. In particular, it can prevent hepatocellular carcinoma. Appropriate treatment can bring about the regression of disease from a worse stage to a better one. Even cirrhosis can regress, but hepatocellular carcinoma cannot.

Figure 2

Causes of liver cirrhosis

Figure 3

Macroscopic pathology of liver cirrhosis

Figure 4

Prevention of liver cirrhosis

Figure 5

Relative frequency of newly diagnosed liver diseases in gastroenterological private practice in the USA (32)

Figure 6

Relative frequency of liver cirrhosis by underlying newly diagnosed liver disease in gastroenterological private practice in the USA (32)

eFigure 1

Transient elastography in cirrhosis: the measured liver stiffness of 69.1 kPa implies cirrhosis, while the CAP value of 275 dB/m implies steatosis of one-third to two-thirds of the hepatocytes

eFigure 2

ARFI ultrasonography in cirrhosis: the measured value of 3.82 m/s implies cirrhosis