73 Cirrhosis, A A 63-year-old man with a long history of alcohol use presents to his new primary care physician with a 6-month history of increasing abdominal girth. He has also noted easy bruisability and worsening fatigue. He denies any history of GI bleeding. He continues to drink three or four cocktails a night but says he is trying to cut down. Physical examination reveals a cachectic man who appears older than his stated age. Blood pressure is 108/70 mm Hg. His scleras are anicteric. His neck veins are flat, and chest
examination demonstrates gynecomastia and multiple spider angiomas. Abdominal examination is significant fi for a protuberant abdomen with a detectable fluid fl wave, shift fting dullness, and an enlarged spleen. The Th liver edge is diffi fficult to appreciate. He has trace pitting pedal edema. Laboratory evaluation shows anemia, mild thrombocytopenia, and an elevated prothrombin time. Abdominal ultrasonogram confi firms a shrunken, heterogeneous liver consistent with cirrhosis, significant fi ascites, and splenomegaly.
1. What are the defi fining features of cirrhosis? • All forms of cirrhosis are characterized by three findings: — Marked distortion of hepatic architecture
— Scarring as a result of increased deposition of fi fibrous tissue and collagen — Regenerative nodules surrounded by scar tissue