Chronic Liver Disease - Complications

Chronic Liver Disease - Complications

Complications of chronic liver disease and damage

• Impaired synthesis and storage:
• Coagulopathy, which results from decreased storage of vitamin K and synthesis of clotting factors.
• Impaired hepatic degradation, detoxification and clearance can cause:
  • Hepatic encephalopathy and asterixis
    Hepatic encephalopathy is the result of toxin build-up in the blood; ammonia, specifically, is thought to be a key culprit.
    Asterixis, aka, "flapping hand tremor" or "liver flap" is the inability for a patient to sustain a posture due to involuntary, brief, "shock-like" movements.
    To test for this, have a patient sit with closed eyes, outstretched arms, dorsiflexed wrists, and spread fingers – if they suddenly "flap" their hands, this is asterixis (which is indicative of metabolic encephalopathy, and not specific to hepatic dysfunction).
  • Drug reactions and sensitivities
  • Elevated estrogen levels, leading to spider angiomas (spider-looking collections of blood vessels visible beneath the skin), palmar erythema (reddening of the palms and fingers), and gynecomastia (enlargement of breast tissue in males).
  • Impaired bile flow can lead to hyperlipidemia, jaundice, and malabsorption of GI contents.
  • Glucose metabolism is dynamically altered in liver damage so that patients can be hyper- or hypoglycemic.

The complications we've addressed so far are largely the result of hepatic tissue dysfunction.

Next, let's consider vascular changes that result from portal hypertension, which causes systemic vasodilation and hypotension (via complicated mechanisms that are beyond the scope of this tutorial).

• Varices are collateral blood vessels that form to provide alternative blood flow routes; these pose a
  significant risk for hemorrhage, and are an important cause of GI bleeding.
• Ascites & Edema*.
  Ascites refers to the accumulation of fluid in the peritoneum caused by systemic dilation that allows fluid leakage. Ascites is a main complication of cirrhosis, and can lead to peritonitis.
• Spontaneous Bacterial Peritonitis (SBP) is an acute infection resulting from bacteria and endotoxins leaking from the GI tract, and can lead to septic shock if not treated promptly.
• Renal insufficiency and failure are the result of local vasoconstriction (in response to systemic hypotension) and inflammatory processes that reduce filtration. New research shows that spontaneous bacterial peritonitis is often a trigger for renal failure, as it induces the release of pro-inflammatory molecules that contribute to renal dysfunction.
• Hepatopulmonary syndrome, in which pulmonary vasodilation leads to a ventilation/perfusion mismatch, reduced oxygenation, and hypoxemia.
• Increased risk of liver cancer.