Common end response of liver to variety of insults, injuries, regeneration, and progressive fibrosis

Nodular contour, coarse or heterogeneous echotexture ± hypoechoic nodules

General atrophy with enlargement of caudate/left lobes

Atrophy of right lobe and medial segment of left lobe

Coarsened echotexture, increase parenchymal echogenicity

Regenerating nodules (siderotic)

Signs of portal hypertension

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  Dilated hepatic and splenic arteries with increased flow

  
  
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  Splenomegaly

  
  
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  Varices

  
  
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  Ascites

Signs of hypoalbuminemia

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  Edematous, thickened gallbladder wall and bowel wall (especially right colon)

  
  
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  Ascites

Budd-Chiari syndrome

Hepatocellular carcinoma (HCC)

Treated metastatic disease

Micronodular (Laennec) cirrhosis: Alcohol

Macronodular (postnecrotic) cirrhosis: Viral

Nonalcoholic fatty liver disease → nonalcoholic steatohepatitis → fibrosis → cirrhosis

USA: Alcohol (60-70%), chronic viral hepatitis B or C (10%)

3rd leading cause of death for men 34-54 years

USA: Hepatitis C (cirrhosis) causes 30-50% of HCC cases

Japan: Hepatitis C (cirrhosis) causes 70% of HCC cases

Liver fibrosis staging

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  Determines prognosis and management

  
  
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  Liver biopsy is current reference standard

Emerging noninvasive techniques to quantify liver fibrosis

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  US: Transient elastography and shear wave elastography

  
  
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  May replace liver biopsy

Use linear 9-MHz transducer to evaluate liver capsule for subtle nodularity, which may be early finding in cirrhosis that may otherwise be difficult to visualize