Complications of Liver Cirrhosis
The Consequences of End-Stage Liver Disease
When the liver becomes cirrhotic, a variety of clinical abnormalities result.
Cirrhosis of the liver is the final endpoint of liver disease. It is characterized by diffuse fibrosis with remaining liver cells arranged in an abnormal structure of nodules. There are many causes of liver cirrhosis, most commonly alcoholic liver disease and hepatitis C. Autoimmune hepatitis, hemochromatosis, Wilson's disease, and other causes can also play a role.
The focus here are the conditions that stem from liver cirrhosis.
Portal Hypertension
The blood circulation of many organs of the gastrointestinal tract involves a unique pathway. Instead of going directly into the inferior vena cava, one of the big veins entering the heart, blood from these organs goes into the portal vein, the big vein entering the liver. After passing through the liver, the blood can then enter the inferior vena cava. The reason for this is that the liver has functions in metabolism of nutrients and breakdown of toxic substances. It is advantageous to have blood from the gastrointestinal tract, which has absorbed many substances from the gut, to reach the liver immediately.
With liver cirrhosis, blood to the portal vein has difficulty getting through, increasing the pressure in this vein (portal hypertension). Blood can back up to the GI organs they came from. This is a problem, because veins in the esophagus and stomach can widen (varices). If these veins burst, upper GI bleeding results. Additionally, the blood can back up far enough and enter other veins going directly into the inferior vena cava (portosystemic shunt).
Portal hypertension can also lead to ascites, described in the next section.
Ascites
With portal hypertension, the increased blood pressure can cause gradual leakage of fluid from capillaries. This fluid accumulates in the abdominal cavity (ascites), causing abdominal distension when several liters are present. Treatment for ascites includes medications for increased urination (diuretics), insertion of a needle through the abdominal wall to drain the ascitic fluid (paracentesis), and a surgical procedure to create a portosystemic shunt.
Hepatic Encephalopathy
Because the liver functions in metabolism, a cirrhotic liver essentially has this function diminished. This, along with portosystemic shunt (resulting from cirrhosis or made surgically), makes a patient prone to altered level of consciousness and cognitive changes due to accumulation of waste products (hepatic encephalopathy). There are several hypotheses about what substance is involved, but ammonia is widely believed to play a role. Ammonia is produced in the gut by bacteria and absorbed into the bloodstream. Treatment of hepatic encephalopathy involves medications to minimize ammonia production, such as lactulose.
Other Complications
Liver cirrhosis is associated with other complications, including anemia, low platelets in the blood (thrombocytopenia), proneness to bleeding due to diminished clotting factors (coagulopathy), and hepatocellular carcinoma.
Final Words
Liver cirrhosis presents with many challenges. Given the preventability of some of the causes, namely alcohol and hepatitis C, this is another reason to consider how current lifestyle can ultimately affect future health.
