Hayes et al. Cirrhosis and chronic liver failure. In: Suchy FJ, editor. Liver disease in children. Saint Louis: Mosby;
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Techniques used include transient elastography , acoustic radiation force impulse imaging , supersonic shear imaging and magnetic resonance elastography.
Compared to a biopsy, elastography can sample a much larger area and is painless. It shows a reasonable correlation with the severity of cirrhosis. Liver cirrhosis with ascites Liver cirrhosis as seen on a CT of the abdomen in transverse orientation caudate lobe hypertrophy in ultrasound due to cirrhosis Hepatofugal flow in portal vein in ultrasound Endoscopy[ edit ] Gastroscopy endoscopic examination of the esophagus, stomach, and duodenum is performed in patients with established cirrhosis to exclude the possibility of esophageal varices.
If these are found, prophylactic local therapy may be applied sclerotherapy or banding and beta blocker treatment may be commenced. Rarely are diseases of the bile ducts, such as primary sclerosing cholangitis , causes of cirrhosis. Pathology[ edit ] Macroscopically, the liver is initially enlarged, but with the progression of the disease, it becomes smaller. Its surface is irregular, the consistency is firm, and the color is often yellow if associated with steatosis. Depending on the size of the nodules, there are three macroscopic types: micronodular, macronodular, and mixed cirrhosis.
Mixed cirrhosis consists of nodules of different sizes. Pale macronodules of cirrhosis. Cirrhosis leading to hepatocellular carcinoma autopsy specimen However, cirrhosis is defined by its pathological features on microscopy: 1 the presence of regenerating nodules of hepatocytes and 2 the presence of fibrosis , or the deposition of connective tissue between these nodules.
The pattern of fibrosis seen can depend on the underlying insult that led to cirrhosis. Fibrosis can also proliferate even if the underlying process that caused it has resolved or ceased. The fibrosis in cirrhosis can lead to destruction of other normal tissues in the liver: including the sinusoids , the space of Disse , and other vascular structures, which leads to altered resistance to blood flow in the liver, and portal hypertension.
As cirrhosis can be caused by many different entities which injure the liver in different ways, cause-specific abnormalities may be seen. For example, in chronic hepatitis B , there is infiltration of the liver parenchyma with lymphocytes. This scoring system uses bilirubin , albumin , INR , the presence and severity of ascites , and encephalopathy to classify patients into class A, B, or C. Class A has a favourable prognosis, while class C is at high risk of death.
This system was devised in by Child and Turcotte, and modified in by Pugh and others. The hepatic venous pressure gradient, difference in venous pressure between afferent and efferent blood to the liver also determines the severity of cirrhosis, although it is hard to measure. Research has suggested that coffee consumption appears to help protect against cirrhosis. A healthy diet is encouraged, as cirrhosis may be an energy-consuming process.
Close follow-up is often necessary. Antibiotics are prescribed for infections, and various medications can help with itching. Laxatives, such as lactulose , decrease the risk of constipation; their role in preventing encephalopathy is limited.
Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.
Preventing further liver damage[ edit ] Regardless of the underlying cause of cirrhosis, consumption of alcohol and paracetamol acetaminophen , as well as other potentially damaging substances, are discouraged. Vaccination of susceptible patients should be considered for Hepatitis A and Hepatitis B. Treating the cause of cirrhosis prevents further damage; for example, giving oral antivirals such as entecavir and tenofovir in patients of cirrhosis due to Hepatitis B prevents progression of cirrhosis.
Similarly, control of weight and diabetes prevents deterioration in cirrhosis due to Non-alcoholic steatohepatitis. Main article: Liver transplantation If complications cannot be controlled or when the liver ceases functioning, liver transplantation is necessary.
The survival rate depends largely on the severity of disease and other medical risk factors in the recipient. Decompensated cirrhosis[ edit ] Manifestations of decompensation in cirrhosis include gastrointestinal bleeding , hepatic encephalopathy HE , jaundice or ascites. In patients with previously stable cirrhosis, decompensation may occur due to various causes, such as constipation , infection of any source , increased alcohol intake, medication , bleeding from esophageal varices or dehydration.
It may take the form of any of the complications of cirrhosis listed below. People with decompensated cirrhosis generally require admission to a hospital, with close monitoring of the fluid balance , mental status, and emphasis on adequate nutrition and medical treatment — often with diuretics , antibiotics , laxatives or enemas , thiamine and occasionally steroids , acetylcysteine and pentoxifylline. Life expectancy without liver transplant is low, at most 3 years.
Palliative care[ edit ] Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness, such as cirrhosis.
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