Via practica 2/2009

Liver cirrhosis – old but unbeaten disease

Cirrhosis of the liver is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. It represents the end stage of chronic liver damage resulting from several different causes and leading to altered hepatic function and portal hypertension. The main etiologic factors are: chronic hepatitis C (CHC), alcohol, chronic hepatitis B (CHB) and nonalcoholic steatohepatitis (NASH). Management of patient with liver cirrhosis focuses primarily on prevention of disease and on treating complications. Patients with decompensated cirrhosis have a high risk of spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome and hepatocellular carcinoma. The outcome of cirrhosis is determined by three major factors: survival time within the compensated phase, the intensity of transition from the compensated to the decompensated phase and survival while in the decompensated phase. The 10-year survival rate for compensated patients is nearly 90%, while the median survival after decompensation is about 2 years. The only causal therapy of decompensated cirrhosis is liver transplantation. The good cooperation between family physicians and hepatologists is very important for complex care and prognosis of patients with liver cirrhosis.

Keywords: liver cirrhosis, variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatocellular carcinoma