ABSTRACT
Cirrhosis is irreversible liver damage with the formation of fibrosis and nodular regeneration secondary to the loss of normal hepatic architecture. The patient may be asymptomatic at presentation. It is important to examine them for evidence of chronic liver disease and decompensation. Hepatic encephalopathy should be graded according to the West Haven classification criteria. It is important to exclude potentially treatable precipitants. A raised blood ammonia level may be detected in some cases of encephalopathy. Caeruloplasmin is a copper-containing protein that normally binds 90% of the copper present in plasma. It is reduced in Wilson's disease, an autosomal recessive disorder in which copper accumulates in tissues which include the liver and brain. All patients with alcoholic liver disease must be advised to stop drinking alcohol. Deficiency of alpha-1-antitrypsin results in the breakdown of elastin in the liver and lungs by the enzyme elastase, leading to cirrhosis and chronic obstructive pulmonary disease.
