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The aim of Complications of Cirrhosis: Evaluation and. Management is to review state-of-the-art evaluation and management of patients with cirrhosis. In short.
Table of contents

Clinical Presentation

Become a Member Register now for a personalized educational experience. Already a member? Log In. At least 6 characters Continue. What is your Healthcare Role? Back Complete. Please wait. Password Reset Forgot your password? Back to Login Page Cancel Send. To have full access to our FREE courses on our website, please register or log in now. Save 1. Educational objectives: Upon completion of this activity, participants should be able to: Recognize the clinical complications associated with cirrhosis Recognize the diagnosis, management and various presentations of ascites.

Runyon : https:ljwww. Malik, MD. Related Courses. Fasanella, MD. Dunn, MD. This system was devised in by Child and Turcotte, and modified in by Pugh and others. The hepatic venous pressure gradient, difference in venous pressure between afferent and efferent blood to the liver also determines the severity of cirrhosis, although it is hard to measure. Key prevention strategies for cirrhosis are population-wide interventions to reduce alcohol intake through pricing strategies, public health campaigns, and personal counseling , programs to reduce the transmission of viral hepatitis, and screening of relatives of people with hereditary liver diseases.

Little is known about factors affecting cirrhosis risk and progression. Research has suggested that coffee consumption appears to help protect against cirrhosis. Generally, liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. A healthy diet is encouraged, as cirrhosis may be an energy-consuming process.

Close follow-up is often necessary. Antibiotics are prescribed for infections, and various medications can help with itching. Laxatives, such as lactulose , decrease the risk of constipation; their role in preventing encephalopathy is limited. Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.

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Cirrhosis caused by Wilson's disease , in which copper builds up in organs, is treated with chelation therapy for example, penicillamine to remove the copper. Regardless of the underlying cause of cirrhosis, consumption of alcohol and paracetamol acetaminophen , as well as other potentially damaging substances, are discouraged. Vaccination of susceptible patients should be considered for Hepatitis A and Hepatitis B.

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Treating the cause of cirrhosis prevents further damage; for example, giving oral antivirals such as entecavir and tenofovir in patients of cirrhosis due to Hepatitis B prevents progression of cirrhosis. Similarly, control of weight and diabetes prevents deterioration in cirrhosis due to Non-alcoholic steatohepatitis. If complications cannot be controlled or when the liver ceases functioning, liver transplantation is necessary. The survival rate depends largely on the severity of disease and other medical risk factors in the recipient. Manifestations of decompensation in cirrhosis include gastrointestinal bleeding , hepatic encephalopathy HE , jaundice or ascites.

In patients with previously stable cirrhosis, decompensation may occur due to various causes, such as constipation , infection of any source , increased alcohol intake, medication , bleeding from esophageal varices or dehydration. It may take the form of any of the complications of cirrhosis listed below. People with decompensated cirrhosis generally require admission to a hospital, with close monitoring of the fluid balance , mental status, and emphasis on adequate nutrition and medical treatment — often with diuretics , antibiotics , laxatives or enemas , thiamine and occasionally steroids , acetylcysteine and pentoxifylline.

Life expectancy without liver transplant is low, at most 3 years. Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness, such as cirrhosis. The goal of palliative care is to improve quality of life for both the patient and the patient's family and it is appropriate at any stage and for any type of cirrhosis. Especially in the later stages, people with cirrhosis experience significant symptoms such as abdominal swelling, itching, leg edema, and chronic abdominal pain which would be amenable for treatment through palliative care.

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt sodium retention. Diuretics may be necessary to suppress ascites. Diuretic options for inpatient treatment include aldosterone antagonists spironolactone and loop diuretics. Aldosterone antagonists are preferred for people who can take oral medications and are not in need of an urgent volume reduction. Loop diuretics can be added as additional therapy.

If a rapid reduction of volume is required, paracentesis is the preferred option. This procedure requires the insertion of a plastic tube into the peritoneal cavity. Human albumin solution is usually given to prevent complications from the rapid volume reduction. In addition to being more rapid than diuretics, 4—5 liters of paracentesis is more successful in comparison to diuretic therapy. For portal hypertension, nonselective beta blockers such as propranolol or nadolol are commonly used to lower blood pressure over the portal system.

In severe complications from portal hypertension, transjugular intrahepatic portosystemic shunting TIPS is occasionally indicated to relieve pressure on the portal vein. As this shunting can worsen hepatic encephalopathy, it is reserved for those patients at low risk of encephalopathy. TIPS is generally regarded only as a bridge to liver transplantation [51] or as a palliative measure. High-protein food increases the nitrogen balance , and would theoretically increase hepatic encephalopathy ; in the past, this was therefore eliminated as much as possible from the diet.

Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition. People with ascites due to cirrhosis are at risk of spontaneous bacterial peritonitis.

Cirrhosis and chronic liver failure: part II. Complications and treatment.

This refers to changes in the mucosa of the stomach in people with portal hypertension, and is associated with cirrhosis severity. Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be nonspecific and are more difficult to recognize for example, worsening encephalopathy but no fever. Hepatocellular carcinoma is a primary liver cancer that is more common in people with cirrhosis. People with known cirrhosis are often screened intermittently for early signs of this tumor, and screening has been shown to improve outcomes.

Cirrhosis and chronic liver disease were the tenth leading cause of death for men and the twelfth for women in the United States in , killing about 27, people each year. Cirrhosis is more common in men than in women. The risk of death due to all causes is increased twelvefold; if one excludes the direct consequences of the liver disease, there is still a fivefold increased risk of death in all disease categories. From Wikipedia, the free encyclopedia.

Chronic disease of the liver, characterized by fibrosis. Main article: Liver transplantation.

Cirrhosis - Wikipedia

April 23, Archived from the original on 9 June Retrieved 19 May Archived from the original on Current medical diagnosis and treatment Chapter Andrews' Diseases of the Skin: Clinical Dermatology. Esherick, Daniel S. Clark, Evan D. Current practice guidelines in primary care Chapter 3: Disease Management. Seminars in Liver Disease. Harrison's principles of internal medicine 18th ed. New York: McGraw-Hill. Cirrhosis and Its Complications. Section Disorders of the nail apparatus. Section Disorders of the Nail Apparatus. Harrison's Principles of Internal Medicine, 18th ed.

Retrieved Liver Transplantation. The New England Journal of Medicine. The American Journal of Clinical Nutrition. McPhee, Gary D. Chapter Liver Disease. Comprehensive Physiology. The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68, percutaneous liver biopsies, in which all six patients who died did so from intraperitoneal haemorrhage.

Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding. Laboratory Medicine. Schiff, Michael F. Schiff's diseases of the liver 11th ed. Schiff, Willis C. Maddrey, Michael F. Evaluation of the Liver A: Laboratory Test. Gastroenterol Clin Biol. European Heart Journal. Rippe In Tadataka Yamada ed.

Textbook of Gastroenterology. Clin Liver Dis. Br J Surg. Fitoterapia Phytotherapy.


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