Liver cirrhosis complications

Liver disease is the most common medical complication of alcohol abuse an estimated 15-30% of chronic heavy drinkers eventually develop severe liver disease. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the United States, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Concurrent infection with hepatitis or C virus increases the risk of severe liver disease. 

Erythropoietic porphyrias The erythropoietic porphyrias (congenital erythropoietic porphyria and erythropoietic proto porphyria) are characterized by skin rashes and blisters lhat appear in early childhood. The diseases are complicated by cholestatic liver cirrhosis and progressive hepatic failure. 

The patient was a 35-year-old white male with a x-antitrypsin deficiency. He received a combined liver-kidney transplant for cirrhosis complicated by portal hypertension, renal insufficiency secondary to membranoproliferative glomerulonephritis, and combined restrictive and obstructive pulmonary disease at age 18 years. 

Scintigraphic proof of cirrhosis is based on (i.) enlarged rectangular liver, (2.) reduced and patchy uptake of radioactivity by the hepatic RES ( mottled liver ), (3.) shift in the maximum activity from the right to the left lobe of liver, and (4.) increased uptake by the spleen and bone RES. The recorded scintigraphic findings permit assessment of the course of liver cirrhosis and provide information on focal complications such as .) occlusion of the branches of the portal vein with locally impaired perfusion and (2.) development of hepatocellular carcinoma. 

Siciliano, M., de Candia, E., Ballarin, S., Vecchlo, FJM., Senidei, S., Annese, R., Landolfi, R., Rossi, L. Hepatocellular carcinoma complicating liver cirrhosis in type Ilia glycogen storage disease. X Chn. Gastroenterol. 2000 31 80-82... 

Acute upper or lower gastrointestinal bleeding is a common complication in liver cirrhosis and is often life-threatening. Several bleeding sources have to be taken into account, which may occur in combination in the individual case, (see chapters 19.2-19.4 )... 

Complications such as variceal bleeding, hepatic encephalopathy, ascites and infections as well as reduced renal function also influence the mortality rate of liver cirrhosis (in Germany some 25,000/year). The main causes of death are hepatic coma or liver failure (25-40%), bleeding (20-30%), infections (about 10%) and HCC (about 5%). Spontaneous bacterial peritonitis is fatal in 50-70%, and with liver dysfunction even in 90% of cases. Occurrence of the hepatorenal syndrome is almost invariably fatal. 

Prognosis of liver cirrhosis depends upon preventing complications as far as possible. At the same time, all options should be used to stabilize compensation and improve liver function. 

In principle, six treatment forms can be implemented to combat the complex pathological events in liver cirrhosis, which may be extremely variable due to numerous complications. These are (1.) causal treatment, (2.) treatment of pathogenetic primary reactions, (3.) treatment to prevent progression of cirrhosis, (4.) treatment of symptoms, (5.) treatment of complications, and (6.) liver transplantation. 

When liver cirrhosis has already been confirmed by detailed diagnosis and its (possible) secondary reactions or complicative developments have been determined (this is the primary prerequisite of the physician ), it is possible to apply symptomatic treatment measures in a more effective and more targeted and thus also more efficient way (which is what the patient principally expects). In most cases, this forms a basis of mutual trust as it generally guarantees the patient s readiness to cooperate with regard to strict directions, certain treatment and follow-up measures as well as invasive therapy. 

Liver cirrhosis is the final stage of disease of the largest metabolic organ, with diverse functionally, biochemically and morphologically related complications. Decompensa-... 

Caturelli, E., Solmi, L., Anti, M., Fusilli, S., Roselli, R, Andriulli, A., Fornari, F., del Vecchio Blanco, C., de Sio, I. Ultrasound guided fine needle biopsy of early hepatocellular carcinoma complicating liver cirrhosis A multicentre study. Gut 2004 53 1356-1362... 

In patients whose maldigestion is difficult to control, other underlying conditions should be considered, such as noncompliance, infections of the gastrointestinal tract, celiac disease, lactose deficiency, inflammatory bowel disease, anatomical abnormalities, diabetes, and liver cirrhosis. This question is complicated by the abundance of small intestinal viscous glycoproteins in cystic fibrosis, prolonged intestinal transit times, which may provoke bacterial overgrowth [104], and absorption of the enzymes in their macromolecular form [105]. 

Rare complications of liver cirrhosis are chronic persistent hepatic encephalopathy and hepatic myelopathy. Both occur in less than 1% of the patients, and both are accompanied by extensive porto-systemic shunts. Chronic persistent hepatic encephalopathy is also known as acquired hepato-lenticular degeneration (Victor, Adams and Cole, 1965). In contrast to the nsnal cirrhotic patient with HE, these patients show obvions neuronal alterations a patchy, spongy degeneration most consistently observed in the deep layers of the cerebral cortex and subcortical white matter, particularly in the parieto-occipital cortex, basal ganglia and cerebellum. 

The diagnostic work-up of a patient with suspected hepatic encephalopathy should include in any case a cerebral computed tomography. Subdural haematoma and also parenchymal bleeding are rare but significant complications of liver cirrhosis that must be ruled out before the diagnosis of HE is made. 

Liver tumors account for a considerable number of deaths every year (World Health Organization, 2004). One of type of primary liver tumors is hepatocellular carcinoma, which arises frequently as a complication of liver cirrhosis. Additionally, almost any tumor can seed metastasis within the liver, colorectal cancer being at the top of the list. 

First, generally, the critical cause of main liver cirrhosis might be whether ehronie aleohol abuse or the previous infectious disease by some hepatitis virus B, C, D. As the liver cirrhosis is one of the intractable diseases, the purpose of the eirrhosis treatment is to stop or delay the desease progression and minimize the damage to the liver cells, and finally prevent and reduce the complications by the liver cirrhosis. 

Chemoembolization can be used in patients with ether primary or metastatic malignant hepatic tumors who are not surgical candidates (Table 2.5.1). Surgery is not feasible in advanced malignant disease involving both lobes of the liver, or complicating factors such as cirrhosis or failure of systemic chemotherapy. Likewise, TACE should be reserved for those patients who have liver-dominant disease, because the predominant effect is local. 

O Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease—ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality. 

Cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue. This scarring is accompanied by the loss of viable hepatocytes, which are the functional cells of the liver. Progressive cirrhosis is irreversible and leads to portal hypertension that is in turn responsible for many of the complications of advanced liver disease. These consequences include (but are not limited to) spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and variceal bleeding.1... 

Ascites is the accumulation of fluid in the peritoneal space and is often one of the first signs of decompensated liver disease. Ascites is the most common complication of cirrhosis and portends a dire prognosis.14... 

Progression of alcoholic liver disease moves through several distinct phases from development of fatty liver to the development of alcoholic hepatitis and cirrhosis. Fatty liver and alcoholic hepatitis may be reversible with cessation of alcohol intake, but cirrhosis itself is irreversible. Although the scarring of cirrhosis is permanent, maintaining abstinence from alcohol can still decrease complications and slow development to end-stage liver disease.22 Continuing to imbibe speeds the advancement of liver dysfunction and its complications. 

Lifestyle modifications can limit disease complications and slow further liver damage. Avoidance of additional hepatic insult is critical for successful cirrhosis treatment. The only proven treatment for alcoholic liver disease is the immediate cessation of alcohol consumption. Patients who have cirrhosis from etiologies other than alcoholic liver disease should also abstain from alcohol consumption to prevent further liver damage. 

Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. Chronic viral hepatitis may lead to the development of cirrhosis, which may induce end-stage liver disease (ESLD). Complications of ESLD include ascites, edema, jaundice, hepatic encephalopathy, infections, and bleeding esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD. 

The incidence of liver complications associated with PN ranges from approximately 7% to 84%, and end-stage liver disease develops in as many as 15% to 40% of adult patients on long-term PN.35 Patients often develop a mild increase in liver enzymes within 1 to 2 weeks of initiating PN, but this generally resolves when PN is discontinued. Severe liver complications include hepatic steatosis (fat deposition in liver), steatohepatitis (a severe form of liver disease characterized by hepatic inflammation that may progress rapidly to liver fibrosis and cirrhosis), cholestasis, and cholelithiasis.35... 

Approximately 11% of patients with ulcerative colitis have hepatobiliary complications including fatty liver, pericholangitis, chronic active hepatitis, cirrhosis, sclerosing cholangitis, cholangiocarcinoma, and gallstones. 

Decompensated liver disease is complicated by jaundice, refractory ascites, bacterial peritonitis, coagulopathy, and variceal bleeding and may require liver transplantation. The number of liver transplants for decompensated cirrhosis doubled from 1990 to 2004, when 5845 cadaveric (orthotopic) liver transplants were performed (65). 

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