The most common cause of cirrhosis in the U.S is alcohol.
However, the most common reason to need a liver transplantation is chronic hepatitis C.
In the cirrhotic patient, gynecomastia arises from hyperestrinism due to increased adrenal production of androstenedione with aromatization to estrone end eventual conversion to estradiol. Estradiol induces sex hormone-binding globulin production (primarily in the liver. but also in the uterus and testes), which results in increased testosterone binding and a decreased free testosterone/estrogen ratio.
Other manifestations of hyperestrinism in the cirrhotic patient include spider angiomata and, in males, testicular atrophy with decreased body hair.
Spider angiomata are subcutaneous vascular lesions consisting of a central arteriole surrounded by many smaller vessels that blanch on compression. They are
most frequently found on the trunk, face, and upper limbs.
Acquired spider angiomata may also occur with other hyperestrogenic states (eg. pregnancy), possibly due to estrogen's effects on arteriolar dilation. The number and size of these skin lesions generally correlate with the severity of liver disease.
Dupuytren's contracture has a prevalence of about 5%. It is more common in older male patients and around 60-70% have a positive family history
Specific causes include: