• A generally irreversible fibrotic scarring of the liver parenchyma resulting in liver failure
  • The twelfth leading cause of death in men and women in 2013[1]


Clinical Features

Jaundice of the skin
Spider angioma
Ascites secondary to cirrhosis.

Differential Diagnosis

Abdominal distention


Ascites appearance on ultrasound
Liver cirrhosis with ascites on CT


Complications of cirrhosis

Pain management in cirrhotic patients


  • Often complex and should be based on presence/absence of acute complications
  • If no complications present, discussion with patient's primary care provider or gastroenterologist recommended


Child-Pugh Score[2]

+1 +2 +3
Bilirubin <2mg/dL 2-3mg/dL >3 Mg/dL
Albumin >3.5mg/dL 2.8-3.5mg/dL <2.8mg/dL
INR <1.7 1.7-2.2 >2.2
Ascites No ascites Ascites, medically controlled Ascites, poorly controlled
Encephalopathy No encephalopathy Encephalopathy, medically controlled Encephalopathy, poorly controlled
  • Score ≤ 7 = Class A = 100% and 85% one and two-year patient survival
  • Score 7 - 9 = Class B = 80% and 60% one and two-year patient survival
  • Score ≥ 10 = Class c = 45% and 35% one and two-year patient survival

MELD Score[3]

MELD-Na Score 3-month mortality
40 71.3%
30-39 52.6%
20-29 19.6%
10-19 6.0%
<9 1.9%

See Also

External Links


  1. Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.
  2. Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64
  3. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70.