Complications of Liver Cirrhosis

 

Complications of Liver Cirrhosis

Liver Cirrhosis means permanent irreversible damage to most of the liver. The complications develop when more than 80% of functioning parenchyma is lost. As liver has more than 500 functions, the complications are not limited to one or two systems but has systemic effects. Complications of Liver Cirrhosis should be managed in a tertiary care setup where multiple specialists are available round the clock. We describe complications of liver cirrhosis for all patients to comprehend in simple language.

 
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1. Ascites – Fluid accumulation in the tummy

This is a common feature of cirrhosis.It is an accumulation of excessive fluid within the peritoneal cavity due to the increased plasma volume ‘spilling over’ into the abdominal cavity. This isusually accompanied by swelling of the feet (Edema). Whenever you develop fluid in your tummy for the first time, you need a needle aspiration and testing. You also need to get at tested whenever you get admitted for any reason. Your doctor will start water tablets to shift this fluid out via urine. However, it requires dedicated monitoring to prevent side effects. You need to restrict salt intake to 4 grams and limit fluid intake as well. If the fluid fails to mobilise even after medicines, you may need tapping large volumes of fluid. You also need to discuss TIPS and Liver transplant with your doctor when you start developing this complication.

 

2. Vomiting of blood, Black Stools – Hematemesis and Malena

As a result of liver cirrhosis, the pressure in the veins supplying the liver (Portal vein) is increased which gets manifested as swelling of veins in your food pipe and stomach. When the pressure increases significantly, they tend to rupture causing massive loss of blood via vomit and via stools. The stool is seen as black tarry foul smelling and not red. You need urgent admission, blood products replacement, antibiotics, medicines to reduce the pressure in the veins and an endoscopy to stop the bleeding via applying bands or glue. In order to prevent such episodes, you need repeat endoscopies and medicines to keep pressure of these veins low

 

3. Hepatic Encephalopathy – Altered mental status

As the toxins which are metabolized by liver are spared, they enter the blood stream and affect the brain functions. The manifestations may be subtle in form of loss of memory and repeated forgetfulness. As it worsens person can become aggressive and abusive. This culminates into deep coma. There are specific medicines to treat and prevent this complication. However, you need to make sure that the patients open bowels (passes stools) at least twice daily. Constipation can worsen this complication.

 

4. Anaemia, Low Platelets, and bleeding tendency

All patients with low platelets should be investigated for diagnosis of cirrhosis and low platelets are one of the earliest markers of worsening portal hypertension. These patients have poor clotting tendencies. Patients should not go even a minor procedure like dental extraction unless cleared by treating hepatologist.

 

5. Sarcopenia – Muscle wasting

You may start losing your muscle mass. The lesser the muscle mass, more the likelihood of developing multi organ failure at slightest complications. One should exercise regularly and take high protein diet to maintain muscles

 

6. Infections

Being cirrhotic, you are a sitting duck for all infections. As liver has cells to filter all infections and take care it (Kupffer cells), when you develop cirrhosis and edema of intestine, a lot of bacteria can get a free access to your blood. The immune system cannot handle these and you can develop sepsis.

 

7. Other Complications

Cirrhotic cardiomyopathy – there is cardiac hypertrophy and a blunted stress response of the heart. May cause significant problems perioperatively and mean that liver transplantation may be too dangerous.
Hepatopulmonary syndrome – there is pulmonary arteriolar vasodilation, shunting and hypoxaemia. Transplantation may reverse this.
Portopulmonary hypertension – an irreversible condition that can occur in those with refractory ascites
 

The list of certain complications is mentioned below in table

1.      Ascites
2.      Hyponatremia
3.      Gastrointestinal Bleeding
4.      Renal Dysfunction
5.      Hepatic encephalopathy
6.      Infections
7.      Underlying primary disease
8.      Obesity
9.      Cardiopulmonary complications
10.  Osteopenia
11.  Sarcopenia
12.  Hepatocellular carcinoma screening
 

If you suffer from cirrhosis and have developed any of above, please contact your hepatologist.

Dr Pathik Parikh
Liver Specialist / hepatologist in Ahmedabad
Contact no.: +91 86521 19730
Website: Drpathikparikh.com

Zydus Hospitals Road,
Nr. Sola Bridge, S.G. Highway,
Ahmedabad, Gujarat 380054


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