Etiologies of Liver Cirrhosis and Their Clinical Presentation among Inpatients in Medical City Complex - Baghdad Teaching Hospital

BACKGROUND: Liver cirrhosis is one of common diseases that doctors deal with during working days, so it is important for all doctors to have a basic knowledge about its etiologies, clinical presentations, complications and prognosis.

AIM OF THE STUDY: 1) To detect the most common causes of liver cirrhosis among Iraqi patients. 2) To Find the most common clinical presentations and look for any association between them and a particular etiology. 3) To make recommendations regarding screening for the most common etiology among population and deal with it and treat it early prior to development of liver fibrosis and cirrhosis.

PATIENT & METHODS: A cross-sectional study was conducted from January 2016 to January 2019. 1000 patients were enrolled in the current study and followed at medical wards at Baghdad teaching hospital, taking detailed history from them including history of alcohol intake, drug history, etc... and sending them for complete work up including Abdominal US, virology screening, autoimmune, Wilson, iron study etc... and calculating Child - Pugh score for each patient.

RESULTS: 1) The most common causes of liver cirrhosis are alcoholic liver disease (20%) and HCV (20%) followed by HBV (18%), NAFLD (14%), cryptogenic (14%), AIH (6%), Wilson (4%), PBC (4%). 2) the most common presentation of liver cirrhosis from all causes are ascites (38%) and encephalopathy (38%). followed by bleeding varices (21%), jaundice (11%). 3) HCV was associated significantly with Encephalopathy, NAFLD significantly associated with bleeding varices, Cryptogenic significantly associated with ascites, Wilson disease and PBC significantly associated with jaundice.

CONCLUSIONS: HCV and alcoholism are so common among Iraqi patients with liver cirrhosis, while NAFLD cases are commonly related to diabetes mellitus and obesity. Ascites and encephalopathy are the most common presentation at medical wards from all causes of liver cirrhosis. Most cases of liver cirrhosis due to HCV are within middle and elderly. While Wilson disease should be kept at the top of differential diagnosis of liver cirrhosis among young individuals as it is significantly related to young age group. Cryptogenic cases of liver cirrhosis need aggressive work up and screening for uncommon causes.