List 6 complications of cirrhosis.
Cirrhosis is the result of progressive scarring of the liver, secondary to one or several pathologic processes (commonly: Hepatitis B/C, alcohol, non-alcoholic fatty liver disease).
Six possible complications of cirrhosis are:
- Ascites
- Spontaneous bacterial peritonitis
- Hepatic encephalopathy (caused by metabolic abnormalities – can present with confusion and neuromuscular dysfunction (i.e. asterixes))
- Hepatorenal syndrome
- Esophageal varices/bleeding
- Coagulopathy
The Childs-Pugh score is a useful tool to determine the severity of a patient’s cirrhosis. The following factors are used to determine this score:
- Encephalopathy grade
- Ascites
- Total bilirubin level
- Serum albumin level
- PT/INR
How do you treat hepatic encephalopathy?
Treatment of hepatic encephalopathy involves:
- Lactulose – decrease levels of serum ammonia
- Rifaximin (can be used if hepatic encephalopathy is refractory to lactulose)
- Potassium (if hypokalemic – hypokalemia increases renal production of ammonia)
Diagnosis and management of hepatic encephalopathy should be rapid to prevent coma and death.
Resources
- Heidelbaugh JJ and Bruderly M. Cirrhosis and Chronic Liver Failure: Part 1. Diagnosis and Evaluation. Am Fam Physician. 2006;74:756-762.
- Heidelbaugh JJ and Sherbondy M. Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment. Am Fam Physician. 2006;74:767-776.
- Vilstrup H et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715-735.
