Complication of Cirrhosis

It is commonly known that the liver has many functions which include protein production, production of immune factors in the blood stream, production of blood clotting factors, detoxification, and removal of bacteria caused by contamination of the digestive system.

Cirrhosis is a result of advanced liver disease which is characterized by regenerative nodules and fibrosis (scar).  Cirrhosis has two major effects on our body 1) less effective functioning of liver and 2) High blood pressure in the liver commonly known as Portal hypertension (caused by large amounts of fibrosis pressing on the capillaries of the liver).

1. Esophageal Varices are dilated submucosal veins in the lower esophagus.  They are a consequence of portal hypertension, commonly due to cirrhosis.  Patients with esophageal varices have a tendency to develop bleeding from ruptured which causes the patient to vomit blood.
2. Ascites is an excess accumulation of fluid in the abdomen.  It is caused by an increased blood pressure of the veins in the liver that leads to the leakage of fluid from the liver.  Also, patients with cirrhosis tend to have low levels of albumin, a type of protein that helps carry fluid in the blood vessels.  Patients will therefore suffer from swelling of the abdomen and legs as well as bulging belly button.  This can be treated by the consumption of diuretics.  Infection is a serious complication of ascites.  Patients may develop an infection in the abdomen, which may lead to a fever, stomachache and diarrhea.  Diagnosis is made by performing a paracentesis (abdominal tapping) and analyzing the fluid for the number of white blood cells or evidence of bacterial growth.
3. Hepatorenal Syndrome is a rare, but serious complication of ascites related to cirrhosis of the liver leading to progressive kidney failure.  The cause of this syndrome remains unknown, but it may result from shifts in fluid, impaired blood flow to the kidney, and over use of diuretics.
4. Hepatic Encephalopathy is the occurrence of confusion, altered level of consciousness as a result of liver failure.  It is caused by accumulation of toxic substances that are normally removed by the liver.  As a result, such toxic substances contaminate the blood circulation, affecting the function of the brain.  The patient will experience sleepiness during the day, trembling hands, confused speech or even unconsciousness.  The condition can be stimulated by infection or constipation in cirrhosis patient.
5. Bleeding tendency the liver produces the type of protein that forms blood clots.  Cirrhosis affects this function causing reduced production of the protein.  In addition, a low platelet count caused by portal hypertension and enlarged spleen causes patients with cirrhosis to bleed easier than normal.
6. Hormonal Imbalance patients with cirrhosis suffer from a weakened ability to remove some hormones, causing an increase in Estradiol (female sex hormone).  This leads to larger breast, sexual impotency and infertility.

1. Treatment of underlying disease Finding the cause and treating it to stop the damage of the liver tissue.  For example, curing or eliminates hepatitis B and C virus or by quitting alcohol.
2. Nutrition Patients with cirrhosis should have an intake of 35-40 kcal/1 kg.  Of these, at least 1.2 -1.5 grams/day should be of protein because the liver cannot store energy as well as it used to.  It is, therefore, advisable that patients eat 4-6 times a day, especially including a meal before going to bed.  Furthermore, in order to reduce swelling and the accumulation of fluid in the abdomen, patients with cirrhosis should avoid salty food.
3. Upper endoscopy to screen for esophageal varices If found, the doctor may medicate the patient or band the blood vessels of esophagus to prevent bleeding.
4. Screening for liver cancer Because patients with cirrhosis are more vulnerable to liver cancer,  it is important that they are screened by ultrasound every six months.
5. Have your immune system vaccinated against viral hepatitis A and B