Liver cirrhosis

From WikiLectures

Liver cirrhosis is the transformation of the lobular structure of the liver into a nodular one (hepatocytes disappear, replaced by fibrous tissue, the remaining parenchyma regenerates + forms nodules) as a result of chronic liver diseases.

Etiology[edit | edit source]

  • chronic hepatitis C, B, B + D – posthepatic cirrhosis,
  • alcoholic liver damage – alcoholic cirrhosis,
  • long-term obstruction of the bile ductsbiliary cirrhosis,

The consequence of liver cirrhosis (and the basis of complications) are:

  • impairment of the synthetic function of the liver (especially proteosynthesis) due to the destruction of hepatocytes – liver insufficiency,
  • portal hypertension.
Micronodular liver cirrhosis

Complications of liver cirrhosis [1][edit | edit source]

Clinical picture[edit | edit source]

Liver cirrhosis can be asymptomatic for a long time and is diagnosed randomly (preventive examinations, abdominal surgery, etc.).

Compensated cirrhosis (latent, subclinical)[edit | edit source]

Decompensated cirrhosis (advanced)[edit | edit source]

  • varied symptomatology
  • symptoms of parenchymal liver disorder (metabolic decompensation) – icterus, hemorrhagic diatheses, hypoalbuminemia with fluid retention with ascites and edema
  • symptoms from developed portal hypertension (vascular decompensation) – ascites, esophageal varices, portosystemic encephalopathy
  • subjectively – insurmountable fatigue, weakness, exhaustion, loss of appetite, weight loss, abdominal enlargement, swelling; in women, menstrual disorders to amenorrhea, in men, a decrease in libido and potency, gynecomastia, often arthralgia and back pain
  • objectively – the patient is tired, emaciated (large abdomen, thin limbs), slowed reactions (encephalopathy), subfebrile, hypothermia or isothermia, skin is pale, often icteric, numerous spider nevi, lips and tongue are red (lacquered), hands have palmar erythema, Dupuytren's contracture, white nails, clubbed fingers, hemorrhagic diatheses (petechiae, haematomas, bleeding from the gums, nose, gynecological), chest hair loss in men (Chvostk's habitus), gynecomastia

Physical Finding:

  • aspects: bulging of the right hypochondrium, icterus, spider nevi, palmar erythema, etc.
  • palpation: splenomegaly, may be hepatomegaly
  • percussion: may be hepatomegaly, evidence of ascites (glacial sign)

Diagnostic[edit | edit source]

Microscopic image of liver cirrhosis
  • medical history and physical examination
  • laboratory examination
  • imaging methods (US or CT of the liver, endoscopy to detect varices)
  • liver biopsy

Treatment[edit | edit source]

  1. influencing the underlying disease – abstinence in alcoholics, treatment of hepatitis, penicillamine in Wilson's disease
  2. supportive measures – regimen measures (alcohol abstinence, omission of hepatotoxic drugs), administration of vitamins A, D, E, K, hepatoprotectors, corticoids are given for autoimmune hepatitis (nowhere else)
  3. liver transplant
  4. treatment of complications:
  • bleeding from esophageal varices (endoscopic sclerotization or ligation + terlipressin (Remestyp), in case of TIPS failure or surgery, after bleeding GIT and ATB lavage, preventive administration of non-selective β-blockers and nitrates)
  • hepatic encephalopathy (restriction of protein intake, lactulose, ATB, administration of branched-chain amino acids)
  • ascites (restriction of fluid and salt intake, diuretics (spironolactone + furosemide), puncture, TIPS, shunt)
  • hepatorenal syndrome (Remestyp in combination with i.v. albumin)
  • hepatocellular carcinoma (surgical resection or radiofrequency ablation, palliative chemoembolization)

Prognosis[edit | edit source]

The Child-Pugh score is used to predict liver cirrhosis.

A score used to assess the prognosis of a patient with chronic liver failure. MediaWiki:Lékařská kalkulačka/Child-Pugh

Links[edit | edit source]

related articles[edit | edit source]

Reference[edit | edit source]

  1. Prof. MUDr. Marie Brodanová, DrSc.,MUDr. Tomáš Vaňásek, PhD.,odborná společnost hepatologická,Česká lékařská společnost Jana Evangelisty Purkyně,<>

External links[edit | edit source]

  • Cirhóza – video on explaining the pathophysiology and complications of cirrhosis

References[edit | edit source]

  • KLENER, Pavel. Vnitřní lékařství. třetí vydání. Praha : nakladatelství Galen, 2006. s. 642 – 644. ISBN 80-7262-430-X.