Cirrhosis represents the final common histologic pathway for a wide variety of chronic liver diseases. It is characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. Cirrhosis is irreversible, but the progression can be very slow, depending on its cause and other factors.
The gold standard for diagnosis is to view the liver architecture, this can only be done on autopsy or on a removed liver during transplantation. The next best test would be a biopsy. The sample may be obtained percutaneous, transjugular, or by a laparoscopic approach. The sensitivity is usually very good if done appropriately.
Other tests that may be asked for to access the liver function include, INR (international normalized ratio), protein, albumin levels and liver enzyme levels. The INR increases with advance disease, while albumin and protein level decrease with advancing disease. Other examinations include tests to look for infective causes as listed above and autoimmune diseases .
Ultrasonography is a reliable tool that can be used to access the liver non-invasively. It can also access the nodularity and size of the liver and suspicious nodules (malignant), may be seen. It can also be used to access the portal pressures  . Computed tomography may be used to diagnose hepatocellular carcinoma with specialized sequences.
The treatment is to find the underlying cause and remove or treat it. As cirrhosis is the end stage, most of the injury is non-reversible and transplantation is the only option left. Some modalities which are mostly supportive may help slow the symptomology, for example laxatives .
Many patients with liver cirrhosis will eventually decompensate and the treatment is liver transplantation. Without transplantation the options for decompensated liver cirrhosis are only supportive. Despite the dramatic improvements in survival in liver transplant patients, donor organs are rare and difficult to come by. Overall without transplantation, outlook is poor .
Alcohol is considered to be one of the major causes of cirrhosis, but other diseases such as hepatitis B and C are also common causes. The etiology may be divided into the following categories:
Many causes of chronic injury to the liver can lead to cirrhosis. In most cases of cirrhosis the cause may be found (80-90%). Previously alcohol was thought to be the commonest cause of liver cirrhosis, but infective causes are immerging, particularly hepatitis C has become the leading cause in the United States of America. It is in the top cause of cirrhosis currently.
The occurrence of fibrosis is due to an imbalance between the laying down of collagen within the extracellular matrix and it degradation with subsequent distortion of the normal architecture. The extracellular matrix is produced by stellate cells of the liver. These cells get activated and produce collagen. The activation is via cytokines released by Kupffer cells, and sinusoidal endothelium as a response to injury. The injury is usually chronic as in alcoholism.
The collagen is deposited in the space of Disse with subsequent reduction in the size of the sinusoids leading to their capillarization. The fibrosis continues with area of regeneration which eventually leads to the end stage of cirrhosis .
Liver cirrhosis is the end stage of progressive liver fibrosis with the characteristic regeneration nodules and fibrosis. This process may take weeks to years and is caused by a number of diseases and environmental factors. Cirrhosis is defined histologically as a diffuse hepatic process with fibrosis and areas of regeneration. The fibrosis is caused by the laying down of excess extracellular matrix. Initially it is reversible, but by the time it progresses to cirrhosis which is considered irreversible .