Cirrhosis: Liver Scarring, Stages, Symptoms, and Management

Cirrhosis is late‑stage hepatic fibrosis where regenerative nodules are surrounded by fibrous septa, distorting architecture and impairing function.

Common Causes

• Chronic alcohol use.
• Chronic viral hepatitis (B, C).
• Non‑alcoholic fatty liver disease (NAFLD/NASH).
• Autoimmune hepatitis, cholestatic diseases (PBC, PSC), hemochromatosis, Wilson disease.

Clinical Features

• Compensated: Asymptomatic or fatigue, spider angiomas, palmar erythema.
• Decompensated: Ascites, variceal bleeding, hepatic encephalopathy, jaundice, coagulopathy, renal dysfunction (HRS).

Staging

• Child‑Pugh (A/B/C) – clinical/lab based.
• MELD‑Na – predicts 3‑month mortality; guides transplant listing.

Management

• Treat etiology (antivirals, abstinence, weight loss).
• Surveillance: HCC screening (US ± AFP q6mo), varices (EGD q1‑3yr).
• Complication prophylaxis: beta‑blockers for varices, lactulose/rifaximin for HE, diuretics for ascites.
• Transplant evaluation for MELD‑Na ≥15 or decompensation.