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CIRRHOSIS OF THE LIVER A COMPARATIVE STUDY OF THE FOUR MAJOR ÆTIOLOGICAL GROUPS
Author(s) -
Powell L. W.,
Mortimer R.,
Harris O. D.
Publication year - 1971
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1971.tb87962.x
Subject(s) - medicine , cirrhosis , alcoholic liver disease , gastroenterology , complication , incidence (geometry) , hepatocellular carcinoma , etiology , alcoholic hepatitis , hepatitis , physics , optics
Four hundred and fourteen unselected patients with hepatic cirrhosis, who were admitted to the Royal Brisbane and Princess Alexandra Hospitals between 1960 and 1969, were reviewed. The incidence of the four common causes was alcoholic cirrhosis, 35·3%; cryptogenic cirrhosis, 21·2%; hæmochromatosis, 10·9%; active chronic hepatitis, 7·7%. A further 6·8% of patients, grouped as “unclassified” because of inadequate information about alcohol intake, were probably mostly alcoholic. “Latent” hepatic cirrhosis, diagnosed incidentally during life or unexpectedly at necropsy, accounted for 6·2% of alcoholics, 26·2% of patients with cryptogenic cirrhosis, and 8·8% of patients with hæmochromatosis. These four etiological groups differed with respect to sex incidence, presenting symptoms and signs, pathological features, associated diseases, complications and prognosis. However, there was little difference in the incidence of portal hypertension and hepatocellular failure between alcoholic and cryptogenic patients. Tissue antibodies were usually absent in patients with alcoholic cirrhosis or hæmochromatosis, and there was considerable overlap between the other groups. Australia antigen was present in none of 40 patients tested. Gastro‐intestinal hæmorrhage occurred in about one‐third of patients in each group except those with hæmochromatosis, but surgery for this complication was performed in only 18 cases. Primary liver cell carcinoma is probably becoming a more frequent complication of cirrhosis. It accounted for 9·1% of deaths in alcoholics, 10·6% in patients with cryptogenic cirrhosis and 36·6% in patients with hæmochromatosis. Cirrhosis of the liver, particularly in the alcoholic, is an important cause of prolonged morbidity and frequent hospitalization in Australia. However, it should not be regarded as a chronic, irreversible disease with a uniformly poor prognosis. The life span of affected patients, particularly those diagnosed in the compensated phase, is significantly longer than that of thirty years ago. This is probably due to closer supervision of patients and the application of improved methods for treating the causes and complications of the disease.