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Tuesday, 3 December 2013

Cirrhosis - The Complications

Cirrhosis is defined as a condition of irreversible scarring liver as a result of liver tissue by fibrosis due to final phase of chronic liver diseases of that can lead to poor function of the liver and liver failure. According to the statistics, Number of discharges with chronic liver disease or cirrhosis as the first-listed diagnosis: 101,000 in 2009 and Deaths per 100,000 population: 10.3 in 2010(a). Hepatitis B infection cause of the disease is very prevalent in South-East Asia.
Complications
1. Liver Cancer
Following development of liver cirrhosis in patients with chronic hepatitis B, liver disease may continue to progress and decompensation or hepatocellular carcinoma (HCC) may occur, especially in those with active viral replication. Decompensation may manifest with jaundice, ascites, variceal bleeding or hepatic encephalopathy(26).

2. Short life expentency
Cirrhosis can lead to shorten life expectancy in patients, according to the study of retrospectively analysed 59 patients from western Austria over 15 years (mean 6 yearsby the Universit├Ątsklinik f├╝r Innere Medizin, indicated that the mean survival time in our study was 112.7 months, 25% were dead by 132(27).

3. Liver cancer
An estimated 170 million people worldwide are chronically infected with the Hepatitis C Virus (HCV), which is characterized histologically by a persistent immune and inflammatory response that fails to clear HCV from hepatocytes of that can lead to Liver Cancer(28).

4. Ascites
In the study to provide an evidence-based overview of the pathophysiology, diagnosis and clinical management of ascites secondary to liver cirrhosis, showed that portal hypertension, splanchnic vasodilatation and renal sodium retention are fundamental in the pathophysiology of ascites formation. The SAAG (serum-ascites albumin gradient) allows reliable assessment of the cause of ascites. The majority of cirrhotic patients with ascites can be managed with dietary sodium restriction in combination with diuretic agents. Large volume paracentesis with albumin suppletion and TIPS are therapeutic options in patients with refractory ascites(29).

5. Variceal bleeding
There is a report of a case of a 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia. An esophagogastroduodenoscopy did not demonstrate any bleeding source, and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus(30). Other indicated that due to portal hypertension and bleeding disorders, patients with liver cirrhosis are at increased risk for severe gastrointestinal bleedings (GIB)(31).

6. Hepatic encephalopathy
Hepatic encephalopathy is defined as a condition of deteriotion of brain function due to failure of liver in toxic removeal. According to the study by the Medical Clinic II, Diakoniekrankenhaus, the pathogenesis of hepatic encephalopathy (HE) is unknown. Many theories have been proposed. Most established therapies are based on such theories but since no theory has have ever been proved, therapies have to be considered empiric. The spectrum of HE ranges from minimal cerebral functional deficits, which can only be found by sensitive psychometric tests, to coma with signs of decerebration(32).

7. Frequent Hospital readmission
According to the study by the University of Pittsburgh, in the study to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population, showed that a small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation(33).

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Sources
(a) http://www.cdc.gov/nchs/fastats/liverdis.htm
(26) http://www.ncbi.nlm.nih.gov/pubmed/22504333
(27) http://www.ncbi.nlm.nih.gov/pubmed/8165815
(28) http://www.ncbi.nlm.nih.gov/pubmed/23322900
(29) http://www.ncbi.nlm.nih.gov/pubmed/18081661
(30) http://www.ncbi.nlm.nih.gov/pubmed/23345957
(31) http://www.ncbi.nlm.nih.gov/pubmed/23315647
(32) http://www.ncbi.nlm.nih.gov/pubmed/11152016
(33) http://www.ncbi.nlm.nih.gov/pubmed/23383085