Liver Disease & Cirrhosis

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About Liver Disease & Cirrhosis

Liver disease encompasses a spectrum of conditions affecting liver structure and function, with cirrhosis representing the end-stage characterized by irreversible fibrosis and nodular regeneration. Common causes include chronic hepatitis B/C, alcohol use disorder, and non-alcoholic fatty liver disease (NAFLD). Early detection and management of underlying causes are crucial to prevent progression to cirrhosis and its life-threatening complications.

Pathophysiology

Chronic liver injury triggers inflammatory responses leading to hepatocyte death and activation of hepatic stellate cells, which produce excessive collagen and extracellular matrix proteins. This results in progressive fibrosis that distorts normal liver architecture, impairs hepatocyte function, and increases intrahepatic vascular resistance. In cirrhosis, the combination of reduced synthetic capacity and portal hypertension creates a cascade of complications including ascites, varices, and hepatic encephalopathy.

Clinical Reasoning

Clinical assessment focuses on identifying the underlying etiology through history (alcohol use, viral exposure, metabolic factors) and laboratory studies including liver function tests, viral serologies, and imaging. The Child-Pugh score and MELD score help stratify disease severity and guide treatment decisions, particularly for liver transplantation candidacy. Management involves treating the underlying cause, monitoring for complications like portal hypertension and hepatocellular carcinoma, and providing supportive care for decompensated disease.

References

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Imaging Reasoning

Ultrasound + CT/MRI

Key imaging focus: Nodular liver surface, caudate hypertrophy, ascites, portal hypertension signs, varices

📚 Radiopaedia Cases →
  1. Cirrhosis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482419/
  2. AASLD Cirrhosis Guidelines. Hepatology 2021. https://doi.org/10.1002/hep.31884
  3. Acute Liver Failure. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482374/
  4. AASLD Acute Liver Failure Guidelines. Hepatology 2005. https://doi.org/10.1002/hep.22759
  5. AASLD Practice Guidance: Acute Liver Failure. Hepatology. https://doi.org/10.1002/hep.31238
  6. AASLD Practice Guidance: Decompensated Cirrhosis. Hepatology. https://doi.org/10.1002/hep.32230

Related Topics

Cirrhosis & Liver DiseaseViral HepatitisAcute Liver FailureGastrointestinal Bleeding