Cirrhosis is among the top 10 causes of death in the western world. Cirrhosis or chronic intestinal hepatitis of the liver is characterized by progressive fibrosis of the liver and gradual hardening that result in distortion of lobular architecture caused by destruction of the liver parenchyma and compression of the portal, occasionally hepatic veins and the bile duct giving the liver a tawny color. The diseases that lead to cirrhosis do so because they injure and kill liver cells and the inflammation and repair that is associated with the dying liver cells causes scar \tissue to form.

The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue.

Symptoms Patients with cirrhosis may have few or no symptoms and signs of liver disease. Some of the symptoms may be nonspecific, that is, they don't suggest that the liver is their cause. Some of the more common symptoms and signs of cirrhosis include:

• Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood
• Fatigue
• Weakness
• Loss of appetite
• Itching
• Easy bruising from decreased production of blood clotting factors by the diseased liver.
• Patients with cirrhosis also develop symptoms and signs from the complications of cirrhosis.

Causes They include chemicals such as alcohol, fat, and certain medications, viruses.

• Toxic metals such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body’s immune system attacks the liver.
• Alcohol is a very common cause of cirrhosis, particularly in the Western world.
• The development of cirrhosis depends upon the amount and regularity of alcohol intake. Chronic, high levels of alcohol consumption injure liver cells.
• Thirty percent of individuals who drink daily at least eight to sixteen ounces of hard liquor or the equivalent for fifteen or more years will develop cirrhosis.
• Alcohol causes a range of liver diseases; from simple and uncomplicated fatty liver to the more serious fatty liver with inflammation called alcoholic hepatitis), to cirrhosis
• Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver diseases that, like alcoholic liver disease, ranges from simple steatosis, to nonalcoholic steatohepatitis (NASH), to cirrhosis.
• All stages of NAFLD have in common the accumulation of fat in liver cells. The term nonalcoholic is used because NAFLD occurs in individuals who do not consume excessive amounts of alcohol
• Cryptogenic cirrhosis which is due to unidentified causes is a common reason for liver transplantation.
• It is termed cryptogenic cirrhosis because for many years doctors have been unable to explain why a proportion of patients developed cirrhosis.
• Now it is believed that cryptogenic cirrhosis is due to NASH caused by long standing obesity, type 2 diabetes, and insulin resistance
• Chronic viral hepatitis is a condition where hepatitis B or hepatitis C virus infects the liver for years. Most patients with viral hepatitis will not develop chronic hepatitis and cirrhosis. some patients infected with hepatitis B virus and most patients infected with hepatitis C virus develop chronic hepatitis, which, in turn, causes progressive liver damage and leads to cirrhosis, and, sometimes, liver cancers.
• Inherited (genetic) disorders result in the accumulation of toxic substances in the liver which lead to tissue damage and cirrhosis. Examples include the abnormal accumulation of iron (hemochromatosis) or copper (Wilson's disease).
• Primary biliary cirrhosis (PBC) is a liver disease caused by an abnormality of the immune system that is found predominantly in women. It causes chronic inflammation and destruction of the small bile ducts within the liver.
• The destruction of the small bile ducts blocks the normal flow of bile into the intestine. As the inflammation continues to destroy more of the bile ducts, it also spreads to destroy nearby liver cells. As the destruction of the hepatocytes proceeds, scar tissue (fibrosis) forms and spreads throughout the areas of destruction. The combined effects of progressive inflammation, scarring, and the toxic effects of accumulating waste products culminates in cirrhosis.
• Primary sclerosing cholangitis (PSC) is an uncommon disease found frequently in patients with Ulcerative colitis . In PSC, the large bile ducts outside of the liver become inflamed, narrowed, and obstructed. Obstruction to the flow of bile leads to infections of the bile ducts and jaundice and eventually causes cirrhosis.
• Autoimmune hepatitis is a liver disease caused by an abnormality of the immune system that is found more commonly in women. The abnormal immune activity in autoimmune hepatitis causes progressive inflammation and destruction of liver cells (hepatocytes), leading ultimately to cirrhosis.
• Infants can be born without bile ducts and ultimately develop cirrhosis. Other infants are born lacking vital enzymes for controlling sugars that leads to the accumulation of sugars and cirrhosis.
• Less common causes of cirrhosis include unusual reactions to some drugs and prolonged exposure to toxins, as well as chronic cardiac cirrhosis. In certain parts of the world (particularly Northern Africa), infection of the liver with a parasite is the most common cause of liver disease and cirrhosis.
• Parasitic cirrhosis
• Intake of certain drugs

Complications

• Ascites
• Hepatic encephalopathy
• Hepatorenal syndrome
• Spontaneous bacterial peritonitis