Decoding cirrhosis: the liver's "secret battle"

Author: Ma Xuemei, deputy chief physician of the Fifth Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

Liver cirrhosis is a chronic progressive diffuse liver disease caused by various etiologies. The pathological features are extensive hepatocyte degeneration and necrosis, regenerative nodule formation, fibrosis, and destruction of normal liver lobule structure or pseudolobule formation. The main clinical manifestations of liver cirrhosis are liver function damage and portal hypertension, which may affect multiple systems. In the late stage, serious complications such as gastrointestinal bleeding, infection, and hepatic encephalopathy often occur.

1. How to determine the degree of liver cirrhosis?

The texture of the liver is generally divided into three levels: soft, tough (medium hard) and hard. A normal liver is soft and feels like pouting lips; in acute hepatitis and fatty liver, the liver is slightly tough, in chronic hepatitis and liver congestion, the liver is tough and feels like the tip of the nose (medium hard); in cirrhosis, the liver is hard, and in liver cancer, the liver is the hardest and feels like the forehead.

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2. What are the main causes of cirrhosis?

Common causes of cirrhosis include: hepatitis B virus and hepatitis C virus infection; alcoholic liver disease; non-alcoholic fatty liver disease; autoimmune liver disease, including primary biliary cirrhosis (primary biliary cholangitis), autoimmune hepatitis and primary sclerosing cholangitis; genetic and metabolic diseases; drugs or chemical toxins; parasitic infections; circulatory disorders; cirrhosis of unknown cause.

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3. What is the relationship between viral hepatitis and cirrhosis?

There are many causes of cirrhosis. In foreign countries, especially in North America and Western Europe, alcoholic cirrhosis is the most common, while in China, cirrhosis caused by hepatitis B is the most common. Hepatitis C and D can also develop into cirrhosis. Acute and subacute hepatitis can directly develop into cirrhosis if there is a large amount of liver cell necrosis and fibrosis, but more often it will develop into chronic hepatitis. The continued presence of the virus is the main reason for the development of cirrhosis. The course of disease from viral hepatitis to cirrhosis can be as short as a few months or as long as 20 to 30 years. Overlapping infection of hepatitis B and hepatitis C can often accelerate the development of cirrhosis.

4. What are the common complications of cirrhosis?

1. Ascites: It is the most common complication of liver cirrhosis. Once ascites occurs, the one-year mortality rate is about 15%, and the five-year mortality rate is 44% to 85%. The most basic initiating factors for ascites in patients with liver cirrhosis are portal hypertension and liver dysfunction. The appearance of ascites not only makes patients feel uncomfortable such as abdominal distension, but also increases the incidence of infection, bleeding, renal insufficiency, etc.

2. Upper gastrointestinal bleeding: It is caused by esophageal and gastric varicose bleeding, which is the most serious and fatal complication of this disease. It is often caused by sudden increase in intra-abdominal pressure due to nausea, vomiting, coughing, weight bearing, etc., or mechanical damage caused by eating rough food, and corrosion and damage to the mucosa caused by gastric acid reflux, which can cause sudden vomiting of blood or black stool. In severe cases, it can lead to hemorrhagic shock or induce hepatic encephalopathy.

3. Infection: Due to the patient's low resistance and open portal vein collateral circulation, the chances of pathogen invasion and reproduction are increased, making it prone to complications such as spontaneous bacterial peritonitis, pneumonia, biliary tract infection, Gram-negative bacterial sepsis, etc.

4. Hepatic encephalopathy: also known as "hepatic coma", is a serious complication of advanced liver cirrhosis and one of the common causes of death in patients with cirrhosis.

5. Primary liver cancer: 10% to 25% of patients with cirrhosis may develop primary liver cancer. If the condition of a patient with cirrhosis rapidly deteriorates in a short period of time, the liver progressively enlarges, there is persistent pain or fever in the liver area for unknown reasons, and ascites increases and is bloody, etc., primary liver cancer should be considered.

6. Hepatorenal syndrome: also known as "functional renal failure", is the most common and most serious complication of end-stage liver cirrhosis. Clinical manifestations include oliguria or anuria, azotemia, dilutional hyponatremia and hyponatremia, but there is no obvious organic damage to the kidneys.

7. Electrolyte and acid-base disorders: Electrolyte and acid-base disorders become more obvious after patients develop ascites and other complications, such as hyponatremia, hypokalemia, hypochloremia, metabolic acidosis or alkalosis.

8. Hepatopulmonary syndrome: clinical manifestations are hypoxemia and dyspnea.

9. Portal vein thrombosis: manifested as abdominal distension, severe abdominal pain, vomiting, upper gastrointestinal bleeding, shock, rapid enlargement of the spleen, accelerated formation of ascites, and often induces hepatic encephalopathy.