Causes of liver cirrhosis

• Alcoholic liver disease
• Hepatitis B and C infection
• Cryptogenic cirrhosis
• Non alcoholic fatty liver/steatohepatitis
• Autoimmune hepatitis
• Primary biliary cirrhosis
• Hemochromatosis
• Wilson disease
• Alpha 1 antitrypsin deficiency
• Granulomatous disease (sarcoidosis)
• Type IV glycogen storage disease
• Drug induced liver disease
• Budd-chiari syndrome
• Chronic right sided heart failure
• Tricuspid regurgitation
• Cardiac cirrhosis 

Signs and symptoms

Symptoms in cirrhosis are due to gradual failure of the liver and distortion of the liver architecture by scarring. 

• Tiredness or exhaustion
• Weakness or fatigue
• Nausea/Vomiting
• Loss of appetite leading to wt loss
• Loss of sex drive
• Jaundice
• Fever
• Diarrhea
• Itching
• Abdominal pain and swelling
• Swelling of ankles and legs
• Confusion, delusions, personality changes (hepatic encephalopathy)
• Extreme sleepiness, difficulty in awakening, or coma (encephalopathy)
• Easy bruising
• Blood in vomit and feces
• Bleeding from gums or nose
• Hemorrhoids
• Gynecomastia
• Scrotal swelling and small testis
• Abnormal menstrual period 

Specific signs in liver cirrhosis

• Spider angiomata or spider nevi
• Palmar erythema
• Muehrcke's nails (due to hypoalbuminemia)
• Hypertrophic osteoarthropathy
• Dupuytren's contracture
• Gynecomastia
• Hypogonadism
• Hepatomegaly
• Splenomegaly
• Ascites
• Caput medusa
• Fetor hepaticus
• Cruveilhier-Baumgarten murmur
• Asterixis 

Complications

• Bruising and bleeding
• Hepatic encephalopathy
• Hepatocellular carcinoma
• Portal hypertension
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Hepatopulmonary syndrome
• Portopulmonary hypertension  

Tests and diagnosis

• Liver function test (LFT)
• Serum electrolytes
• Complete blood count
• Renal function test
• Coagulation profile
• Ultrasound abdomen
• Liver biopsy 

Medical treatment

• Most treatment of cirrhosis is directed toward relief of complications.
• Medicines like steroids, D-penicillamine, Colchine
• Portal hypertension is treated with beta- blockers (Propranalol) to reduce the pressure in the blood vessels.
• Ascites- Diuretics (potassium sparing diuretic), IV antibiotics, and ascitic tap.
• Hepatic encephalopathy- Lactulose, hepamerz granules IV
• In alcoholic cirrhosis: Abstinence from alcohol intake and adequate balanced diet is required.
• In cirrhosis caused by viral hepatitis: Antivirals and interferon’s are given. 

General measures  

• Avoid alcohol
• Healthy diet
• Low sodium diet
• Low fat diet
• High protein diet
• Iron supplements
• Vitamin B12 supplements
• Treatment of underlying cause