cirrhosis of the liver of liver refers to formation of nodules in liver parenchymal tissue which on later stage impair the performance of liver . It is important to manage cirrhosis of liver in initial stages so as to prevent later complication .
What Are The Final Stages Of Cirrhosis Of The Liver?
Final stage of cirrhosis of liver includes fibrosis and scarring of liver . The last stage of cirrhosis has multiple complications which includes portal hypertension , ascites , hepatorenal syndrome , coagulopathy , off-white disease ( osteopenia , osteoporosisandosteomalacia ) , anemia , thrombocytopenia , gastroesophageal varix .
Clinical Presentation of Terminal Stage of Cirrhosis
The final stage usually presents with portal high blood pressure , which refers to elevation of venous pressure level gradient to more than 5 millimeter of Hg . The major cause of portal hypertension is due to increased intrahepatic underground to line flow . As there is fibrosis of liver , there is commonly difficult transition of flow of blood through the liver and thus this lead to increase in portal pressure . The second cause of portal hypertension is due to increase in splanchnic blood flow . If portal pressure is not controlled it may result to ascites and variceal haemorrhage .
Other ramification let in oesophageal varices which in almost one third of the patient with portal high blood pressure . The risk vary from person to person . The handling for varices includes endoscopic variceal ligation , balloon tamponage with Sengstaken- Blakemore tube which contract the bleeding varix . Octreotide a lineal splanchnic vasoconstrictor can also be used . In some cases sclerotherapy is used when all medical treatment fails .
Another complication of cirrhosis of the liver which fall out in last stage includes ascites , which refer to accumulation of fluid within the peritoneal dental caries . The portal hypertension is the independent cause of ascites . Due to increase intrahepatic resistance there is increase in portal pressure . This along with increase splanchnic blood flow leads to formation of ascites .
The discussion of choice is draining of fluid .
Another knottiness include development of hepatorenal syndrome . The etiology is obscure but it is observed that along with liver disease nephritic symptom also appears . This term is also check in case of stubborn ascites ( when ascites remain even after giving great United States Department of State of diuretics in patient who are follow proper guideline , which includes humiliated intake of salt ) . The midodrine is look at the near selection for treat such patients .
Hepatic brain disease is another complication which develops in goal stage of cirrhosis . There is modification in mental status of the patient and impaired cognitive purpose . The liver is responsible for for removing bowel derived neurotoxin , which is not remove in cases of liver cirrhosis of the liver . Thus ammonia levels are elevate which get deposited in mind and precipitate neurologic symptoms . patient role may exhibit change in personality and at meter many electrolyte change are even seen . Asterixis can be elicited in such patient . affected role who have brain disorder have liver flap that is sudden forward-moving movement of wrist . The diagnosing of hepatic brain disease is made by expert ’s clinician .
The treatment is correction of electrolyte imbalance . Lactulose should be used . The alternate treatment is use of Flagyl which decreases the opportunity of encephalopathy in affected role of liver cirrhosis .
In last stages patient suffers from various coagulation link disorders . There is deficiency of vitamin K and clotting factor thus patient is prostrate for excessive bleeding . Apart from run disorder there occur many metabolic problem . Osteoporosis is unwashed in patient due to malabsorption of vitamin 500 and decrease calcium uptake . Various other hematological manifestations occur in patient of cirrhosis of the liver .
Ascites and portal high blood pressure should be dealt in early stages else chance of variceal hemorrhage and peritonitis increases . Once sepsis take place the condition of patient role worsens . Thus well timed management is important whole tone in management of cirrhosis .
Histopathological determination shows extensive scarring and fibrosis . In late stages it is difficult to discover the hepatocyte in microscopy due to extensive fibrosis .
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