Fact-sheet: Cirrhosis


Updated on 04/29/2021 at 9:51 AM

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Definition

Chronic fibrosing liver disease

End-stage evolution of chronic liver disease:

  • Chronic alcoholism (approx. 50%)
  • Hepatitis C virus, hepatitis B (approx. 20%)
  • NASH - Non-Alcoholic Steatohepatitis (10-15%)
  • Other: Hemochromatosis
  • Primary biliary cirrhosis
  • Sclerosing cholangitis
  • Autoimmune

Clinical features

1-3% of the general population

Mean age at diagnosis: 55 years

Responsible for 15,000 deaths/year in France

Ultrasound

Role of ultrasound:

  • Screening for cirrhosis
  • Diagnostic confirmation
  • Assessment of fibrosis (elastography)
  • Initial workup
  • Semiannual follow-up: Screening for hepatocellular carcinoma
  • Progression of portal hypertension
  • Progression of fibrosis

Basic semiology:

  • Regenerative nodules
  • Dysmorphism: hypertrophy of segment I, atrophy of segment IV
  • Portal hypertension Portal pressure > 15 mmHg
  • Portosystemic gradient > 5 mmHg
  • Morphological signs Main portal vein > 12 mm
  • Dilated splenic vein
  • Splenomegaly > 12 cm
  • Collateral pathways. The presence of a paraumbilical collateral with hepatofugal flow invalidates portal flow measurements
  • Functional sign: Doppler To-and-fro or reversed portal flow. Assessment for thrombus
  • Fibrosis: Shear wave elastography Normal liver: 1.1 m/s
  • Hepatology referral: 1.6 m/s
  • Stage 2: 1.7 m/s = 9.1 kPa
  • Stage 3: 1.84 m/s = 10 kPa
  • Stage 4: 2 m/s = 13.3 kPa
  • Hepatocellular carcinoma