Cirrhosis

Organ system: The digestive system

Organ: The liver

Disease class:  Liver diseases

Cirrhosis is a disease caused by long-term damage and fibrosis of the liver.
Functional hepatocytes are lost and the liver is unable to regenerate because the normal fibrotic architecture is lost and space is occupied by fibrosis.

It is a type of chronic liver disease. 

 

Causes  

• Chronic hepatitis
• Medications 
• Aflatoxin

 

Symptoms

• Gynaecomastia 
• Fatigue 
• Pruritus 

 

Signs

• Jaundice 
• Spider naevi
• Palmar erythema
• Nail clubbing 
• Dupuytren's contracture (alcohol related)
• Parotid enlargement (alcohol related)
• Peripheral neuropathy (alcohol related)
• Cerebellar signs (alcohol related)
• Hepatomegaly (alcohol related) (non-alcoholic fatty liver disease) (haemochromatosis)
• Hyperpigmentation (haemochromatosis)
• Kayser-Fleisher rings (Wilson's disease)

 

Complications

• Hepatic encephalopathy. Causing:
• Drowsiness
• Confusion
• Coma
• Metabolic flap (asterixis) (sign)
• Confusion
• Impaired excretion. Causing:
• Jaundice
• Itching (pruritus)
• Hypoalbuminaemia
• Ascites
• Peripheral oedema
• Leukonychia (sign)
•  Coagulopathy
• Easy bruising
• Haemorrhages
• Portal hypertension
• Ascites
• Oesophageal varices and bleeding
• Rectal varices and bleeding
• Caput Medusae (sign)
• Acid-base imbalance
• Respiratory compensation and alkalosis (sign)
• Hepatic encephalopathy
• Hepato-renal syndrome
• Hepatocellular carcinoma

 

Decompensation

Even a cirrhotic liver can compensate for the loss of functional liver tissue. However if the function of the liver is impaired for any reason, the patient may decompensate and rapidly develop life-threatening physiological abnormalities. As liver function becomes critically low the patient will experience these abnormalities more and more frequently.

 

Management 

This depends on the underlying cause and the consequences of the liver failure for this patient.

• Vitamin K. This allows the body to produce clotting factors as efficiently as possible, despite the liver pathology.  This helps to manage coagulopathy.

• Endoscopy and variceal banding

• Beta blockers
• Propranolol lowers the portal vein pressure, reducing portal hypertension. It also reduces renin secretion. This helps to reduce variceal bleeding and hepato-renal syndrome.
• Vasopressin analogues
• Terlipressin seems to be the most effective vasopressin treatment for hepato-renal syndrome.
• These have vasoconstrictive effects on the dilated splanchnic blood vessels. This reduces portal hypertension and improves variceal bleeding.
• This reduces sympathetic nervous system activity. There is an increase in glomerular filtration rate and deactivation of the vasoconstrictor and sodium-conserving hormones, particularly the renin-aldosterone system. There is reduced plasmsa renin activity, improving naturesis. This helps to reverse hepato-renal syndrome.

• TIPS: Transjugular Intrahepatic Portosystemic Shunt

Future management 

• Reversing liver cirrhosis