07 Chronic Liver Disease

Chronic Liver Disease

Chronic liver disease (CLD) is a progressive deterioration of liver functions for more than six months, which includes synthesis of clotting factors, other proteins, detoxification of harmful products of metabolism, and excretion of bile

The three significant complications are because of portal hypertension (esophageal varices, ascites), hepatocellular insufficiency (e.g., jaundice, hepatic encephalopathy), and hepatocellular carcinoma.

Look for  consequences of long-standing Portal hypertension:

  • Esophageal varices: Cirrhosis of the liver leads to raised portal pressure, which can cause esophageal or gastric varices. 
  • Caput medusae
  • Rectal hemorrhoids
  • Ascites: It is an accumulation of fluid in the peritoneal cavity because of raised portal pressure (increased hydrostatic pressure), decreased albumin (reduced oncotic pressure), and splanchnic vasodilation (due to the release of nitric oxide)

Look for  consequences of long-standing Hepatocellular insuficiency:

i) Hepatic Encephalopathy

This is a neuropsychiatric syndrome caused by hepatic dysfunction.  In a patient with cirrhosis, the removal of these substances from the body is impaired, leading to an increased level of ammonia. Raised levels of ammonia can impair consciousness.

Grade of hepatic encephalopathy:

ii) Jaundice

iii) Spontaneous Bacterial Peritonitis (SBP)

iv) Hyperestrinism

v) Hepatorenal Syndrome (HRS)

vi) Coagulopathy

Prognosis

Decompensated liver cirrhosis patients (who have developed variceal bleeding, ascites, HCC, SBP, and hepatorenal syndrome) have a poor prognosis

The Child-Pugh Score can be useful in the prognosis of patients with cirrhosis, but more recent scores like the MELD score and MELD-Na have become more used given their better prognostic value.

References:

  1. Sharma A, Nagalli S. Chronic Liver Disease. [Updated 2021 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554597/
  2. https://www.2minutemedicine.com/the-child-pugh-score-prognosis-in-chronic-liver-disease-and-cirrhosis-classics-series/
  3. https://www.mdcalc.com/child-pugh-score-cirrhosis-mortality