Liver Cirrhosis Causes Diagnosis And Treatment Pdf
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Cirrhosis is the pathologic end-stage of any chronic liver disease and most commonly results from chronic hepatitis B and C, alcohol-related liver disease, and nonalcoholic fatty liver disease. The main complications of cirrhosis are related to the development of liver insufficiency and portal hypertension and include ascites, variceal hemorrhage, jaundice, portosystemic encephalopathy, acute kidney injury and hepatopulmonary syndromes, and the development of hepatocellular carcinoma. Once a patient with cirrhosis develops signs of decompensation, survival is significantly impaired.
- Cirrhosis: Diagnosis, Management, and Prevention
- Everything you need to know about hepatitis B
- Ascites: Causes, Diagnosis, and Treatment
- Chronic liver disease
Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.
It can be acute and resolve without treatment. However, some forms can be chronic, and these could lead to cirrhosis and liver cancer. HBV is a major global health concern.
Cirrhosis: Diagnosis, Management, and Prevention
Liver cirrhosis LC is a worldwide health problem that is associated with various complications and high mortality. Although, in the past four decades, the incidence of hepatitis B continuously decreased and a promising cure for hepatitis C was developed, LC remains a formidable challenge in clinical practice due to the ever-increasing incidences of alcoholic and non-alcoholic fatty liver diseases, autoimmune-related liver disease and drug-induced liver disease [ 1—3 ].
Our survey data showed a significant increase in the inpatient percentages of alcoholic LC and autoimmune LC, with concomitant decreases in viral hepatitis LC, which contributes to the overall increasing incidence of LC in China [ 4 ]. As a spacious country with a large population, a discrepancy exists in medical specialties and several topics should therefore receive more attention in the management of LC. To aid broad gastroenterologists and heatologists as well as physicians, we identified the following critical issues in the diagnosis and treatment of LC.
Cirrhosis with two or more mixed etiologies should be carefully identified, despite high prevalences of hepatitis B virus HBV and hepatitis C virus HCV cirrhosis. When considering the fact that multi-etiologic cirrhosis may result in a worse prognosis, treatments that target all of the underlying etiologies are necessary to achieve favorable curative effects. Inflammatory evaluations have always been ignored when staging fibrosis, but the measurement of liver stiffness is emphasized.
Instead, more attention should be focused on the focal inflammation of the liver parenchyma by liver biopsies and on systemic inflammation by the detection of serum or humoral inflammatory biomarkers. The control of the liver parenchyma and systemic inflammation has been observed to be able to slow the progression of decompensated LC or even reverse fibrosis to some extent [ 8 ].
Cirrhosis usually develops from chronic hepatitis and transitions into compensated cirrhosis, after which there is a progression into decompensated cirrhosis. Traditional liver biopsies have been widely accepted as the gold standard for the evaluation of liver fibrosis and liver parenchymal inflammation. Although liver biopsies are very safe with the use of ultrasonic guidance, these biopsies are still invasive procedures.
However, none of the fibrotic markers is liver-specific; thus, these markers may be influenced by non-hepatic inflammation. On the other hand, numbers of composite score models combining multiple serum markers have been developed to accurately evaluate the degree of liver fibrosis. As two of the most validated models, the AST-platelet ratio index and fibrosis-4 FIB-4 index have shown comparable results in excluding advanced, but not moderate, fibrosis [ 9 ].
Liver-specific markers and new score models are being exploited and show promise for more specific diagnoses in the near future. With regard to imaging methods for the diagnosis of liver fibrosis, routine ultrasound, computed tomography CT or magnetic resonance imaging MRI is not accurate enough for early diagnoses, whereas FibroScan and FibroTouch tests have certain reference values but are subject to inter-observer variation. Increasing amounts of data have shown that real-time shear wave elastography and magnetic resonance elastography are the most promising and efficient evaluations for the early diagnosis of LC with respect to multi-sectional inspection, objectivity, sensitivity for early fibrosis and the ability to examine the entire liver [ 10 , 11 ].
Recent studies have observed that the ultrasound measurements of the stiffnesses of the liver or spleen are promising tools for detecting clinically significant portal hypertension and for excluding severe portal hypertension, although these methods were limited by heterogeneous values and an inapplicability in hepatic decompensation [ 12 ].
The Child-Pugh-Turcotte classification system is still of clinical value and has long been regarded as the most convenient measurement for LC clinical staging, although the score may be influenced by inter-observer variance. The Model for End-Stage Liver Disease MELD score incorporates serum creatinine levels, serum bilirubin levels and the international normalized ratio INR ; thus, it is likely to be more accurate in evaluating the disease severity and in predicting prognoses.
Furthermore, the MELD score is crucial in assessing the need for liver transplantations. HVPG is the best indicator for portal pressure.
Hepatic vein catheterization with the use of a balloon-tipped catheter is currently the preferred technique in determining HVPG, which is highly recommended in qualified liver care centers. Non-invasive HVPG measurements have been introduced; however, these measurements are pending until they can be proved to be effective in clinical practice and practically accurate, non-invasive approaches for HVPG measurements are highly expected.
The etiological treatment of LC is critical, although it is usually ignored in the decompensated stage. Hepatitis B cirrhosis is the predominant etiology in China and mounting data have shown that the early use of antiviral therapy may alleviate cirrhotic progression and reduce the risk of HCC [ 16 ].
Alcohol cessation is the key issue for alcoholic LC treatment, whereas psychological interventions may be essential for alcohol addicts. Adequate physical exercise, the treatment of comorbid metabolic syndrome and an early referral to a dietician are helpful for patients with non-alcoholic fatty liver disease that is related to LC. With regard to AIH-related LC, physicians should optimize a therapy of steroids and immunosuppressants for the etiological treatment.
Given that the liver is an organ with a dual blood supply from the portal vein and the hepatic artery, the maintenance of sufficient perfusion is significant for ensuring the nourishment of this organ. Injuries to the portal vein, which may occur as a result of devascularization surgery, a surgical portosystemic shunt, a splenectomy, an endoscopic tissue glue injection or radio-interventional therapy, should be carefully avoided to reduce the possibility of a portal vein thrombosis PVT.
PVTs have long been a difficult clinical problem. Although warfarin has been a traditionally efficient treatment, the dose titration highly relies on repeated INR tests and may result in poor patient compliance [ 19 ].
New generations of oral anticoagulants, including rivaroxaban and dabigatran, have been proved to be effective, but they are also expensive. Failed cases that result from the use of anticoagulation therapy should consider the use of interventional portal vein recanalization techniques, including balloon angioplasty, stent-placement, thrombectomy and thrombolysis [ 20 ].
This complication comprises protein malnutrition, energy malnutrition and mixed malnutrition, which are highly related to insufficient intake, absorption dysfunction and a high catabolic status. Impaired nutritional situations will induce ascites and infection, will aggravate variceal bleeding and will increase mortality; therefore, cirrhotic patients should adhere to an adequate diet of sufficient calories and protein.
Food supplements involving essential amino acids are able to promote protein synthesis and improve the outcomes of malnutrition, whereas proper physical exercise also helps in energy intake and nutritional rehabilitation [ 22 ]. When considering that LC patients also have intestinal variceal bleeding risks due to portal hypertension, early endoscopy screening should be advocated for the evaluation of the bleeding risk of not only GEV, but also of the small intestinal and colorectal varices.
The endoscopic management of GEV has been proven to be effective and has been widely used in primary hospitals. However, it is common in China that patients will attend one or two treatment sessions for acute bleeding but will not attend subsequent follow-up sessions until recurrent bleeding occurs.
Our preliminary data from a cirrhotic cohort showed that, after variceal eradication by endoscopic sequential therapy that combined band ligation, tissue glue injection and sclerotherapy, the 5-year occurrence rate of rebleeding and all-cause death rate were reduced to 9.
Furthermore, endoscopic treatments should be repeated and sequenced until complete variceal eradication occurs, after which the patients should receive follow-ups with regular 6- to month intervals. Primary liver cancer contributes to 4. Cancer statistics in China showed that the incidence of liver cancer ranks third in men and sixth in women, and the mortality ranks third in men and fourth in women [ 24 ].
Early interventions with DAA drugs may prevent cancerization and may prolong the cancer-free survival period. The early diagnosis rate of HCC is still low, which is partially due to asymptomatic features and neglect by the patients. Biomarkers represent a promising direction.
However, even though alpha-fetoprotein AFP is a classical marker, its sensitivity and specificity are not high. Therefore, the use of this biomarker is more convenient for clinic follow-ups and community surveys than traditional AFP detection [ 25 ].
Regular surveillance will promote early detection and may benefit subsequent treatments. Regular follow-ups involving clinic visits and laboratory tests are able to monitor disease progression and modulate the timely use of therapies. Regular endoscopic examinations of the upper and lower gastrointestinal tract are recommended to investigate the variceal situation and bleeding risk. The medical center should establish a comprehensive follow-up database to systematically manage patients.
In addition, health education for the patients themselves, as well as their family members, is also important to guide rehabilitation, to improve the quality of life and to increase the survival of LC patients. Palliative care PC as an approach for improving the quality of life of patients and families who are facing a life-limiting illness has become an emerging debated issue in the field of ESLD treatment.
Increasing amounts of data have shown beneficial effects of PC, including the alleviation of patient-reported symptoms, a reduction in the overall cost of care and even prolonged survival. The broader implementation of PC is hindered by a shortage of qualified providers, a lack of public reimbursement, the misconceptions of patients and healthcare providers, and a dearth of relevant research.
Access to PC services is mainly limited to Western countries and little is known about the clinical application of PC in developing countries, including China. Better organization and financing of PC services are greatly needed and more data focusing on how to best integrate PC into the ESLD workflow are highly needed in the future.
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World J Gastroenterol ; 20 : — J Clin Transl Hepatol ; 6 : — Heavy alcohol consumption increases the incidence of hepatocellular carcinoma in hepatitis B virus-related cirrhosis. J Hepatol ; 58 : — 5. Noor MT , Manoria P. Immune dysfunction in cirrhosis. J Clin Transl Hepatol ; 5 : 50 — 8. Bernardi M , Caraceni P. Novel perspectives in the management of decompensated cirrhosis. Nat Rev Gastroenterol Hepatol ; 15 : — Non-invasive diagnosis of liver fibrosis and cirrhosis.
World J Gastroenterol ; 21 : — Deep learning radiomics of shear wave elastography significantly improved diagnostic performance for assessing liver fibrosis in chronic hepatitis B: a prospective multicentre study. Gut ; 68 : — Procopet B , Berzigotti A.
Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep Oxf ; 5 : 79 — Performance of spleen stiffness measurement in prediction of clinical significant portal hypertension: a meta-analysis.
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Everything you need to know about hepatitis B
Liver cirrhosis LC is a worldwide health problem that is associated with various complications and high mortality. Although, in the past four decades, the incidence of hepatitis B continuously decreased and a promising cure for hepatitis C was developed, LC remains a formidable challenge in clinical practice due to the ever-increasing incidences of alcoholic and non-alcoholic fatty liver diseases, autoimmune-related liver disease and drug-induced liver disease [ 1—3 ]. Our survey data showed a significant increase in the inpatient percentages of alcoholic LC and autoimmune LC, with concomitant decreases in viral hepatitis LC, which contributes to the overall increasing incidence of LC in China [ 4 ]. As a spacious country with a large population, a discrepancy exists in medical specialties and several topics should therefore receive more attention in the management of LC. To aid broad gastroenterologists and heatologists as well as physicians, we identified the following critical issues in the diagnosis and treatment of LC. Cirrhosis with two or more mixed etiologies should be carefully identified, despite high prevalences of hepatitis B virus HBV and hepatitis C virus HCV cirrhosis. When considering the fact that multi-etiologic cirrhosis may result in a worse prognosis, treatments that target all of the underlying etiologies are necessary to achieve favorable curative effects.
The liver is a large organ with an important job in your body. It filters the blood of toxins, breaks down proteins, and creates bile to help the body absorb fats. Doctors call this condition alcoholic liver cirrhosis. As the disease progresses, and more of your healthy liver tissue is replaced with scar tissue, your liver will stop functioning properly. According to the American Liver Foundation , between 10 and 20 percent of heavy drinkers will develop cirrhosis. The disease is part of a progression.
A normal liver left shows no signs of scarring. In cirrhosis right , scar tissue replaces normal liver tissue. Cirrhosis is a late stage of scarring fibrosis of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function decompensated cirrhosis. Advanced cirrhosis is life-threatening.
The underlying causes of cirrhosis determine its rate of progression and are the focus of preventive efforts and treatment. The prevalence of.
Ascites: Causes, Diagnosis, and Treatment
Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. Scar tissue keeps your liver from working properly. Many types of liver diseases and conditions injure healthy liver cells, causing cell death and inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair process.
A liver biopsy is a procedure to remove a small sample of liver tissue for laboratory testing. A liver biopsy is commonly performed by inserting a thin needle through your skin and into your liver. People with early-stage cirrhosis of the liver usually don't have symptoms.
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Chronic liver disease
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Find out about symptoms and treatment of this life-threatening liver condition. Not everyone with chronic hepatitis will develop cirrhosis, but it's one of the world's leading causes of liver disease. Diagnosis & treatment. Feb.
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- Ты думаешь, что в ТРАНСТЕКСТ проник вирус.