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Cirrhosis: Difference between revisions
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'''Cirrhosis''' is a chronic liver disease characterised by replacement of normal liver tissue by scar tissue. It’s the irreversible end-stage of [[hepatitis]] | <section begin="clinical biochemistry" />'''Cirrhosis''' is a chronic liver disease characterised by replacement of normal liver tissue by scar tissue and [[liver failure]]. It’s the irreversible end-stage of [[hepatitis]] and [[liver fibrosis]] and cause significant morbidity and mortality. There is continuous loss of functional liver tissue, which is initially compensated and asymptomatic as the remaining liver can compensate. However, acute insults precipitate decreases in liver function, causing hepatic decompensation and development of dramatic and life-threatening complications. Cirrhosis is also an important risk factor for [[hepatocellular carcinoma]].<section end="clinical biochemistry" /> | ||
Cirrhosis is a common condition worldwide. | Cirrhosis is a common condition worldwide. | ||
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In end-stage cirrhosis there is collapse of liver functions, causing liver failure with severe and refractory decompensation symptoms. | In end-stage cirrhosis there is collapse of liver functions, causing liver failure with severe and refractory decompensation symptoms. | ||
<section begin="clinical biochemistry" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Diagnosis of cirrhosis can usually be made based on clinical features, [[ultrasound]], and special non-invasive investigations like [[FibroScan]], [[transient elastography]] (TE) and [[acoustic radiation force impulse]] (ARFI). Ultrasound shows a shrunk liver with nodular surface and loss of homogeneity. | Diagnosis of cirrhosis can usually be made based on clinical features, [[ultrasound]], and special non-invasive investigations like [[FibroScan]], [[transient elastography]] (TE) and [[acoustic radiation force impulse]] (ARFI). Ultrasound shows a shrunk liver with nodular surface and loss of homogeneity. | ||
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* [[Thrombocytopaenia]] | * [[Thrombocytopaenia]] | ||
* [[Macrocytic anaemia and megaloblastic anaemia|Macrocytic anaemia]] | * [[Macrocytic anaemia and megaloblastic anaemia|Macrocytic anaemia]] | ||
* [[Hyperbilirubinaemia]] | |||
Proprietary formulas like FIB-4, FibroTest, and Hepascore estimate the degree of fibrosis based on the age and sex as well as the level of certain parametres like thrombocyte count, ALT, AST, haptoglobin, bilirubin, and GGT. This may be useful to rule out liver fibrosis or to distinguish between severe and non-severe fibrosis. | |||
Determination of the etiology is based on patient history as well as laboratory examination: | Determination of the etiology is based on patient history as well as laboratory examination: | ||
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* Iron studies – for [[haemochromatosis]] | * Iron studies – for [[haemochromatosis]] | ||
* Copper studies – for [[Wilson disease]] | * Copper studies – for [[Wilson disease]] | ||
<section end="clinical biochemistry" /> | |||
Histology is the gold standard for the evaluation of cirrhosis, but it’s not usually required for the diagnosis. | Histology is the gold standard for the evaluation of cirrhosis, but it’s not usually required for the diagnosis. | ||