CIRRHOSIS NATURAL HISTORY

Definition: in which normal liver tissue is replaced by scar tissue micro residual and macronodular with subsequent consequences such as portal hypertension, ascites, hepatic encephalopathy, variceal with profuse bleeding, hepatocellular carcinoma, hepatorenal syndrome and death terminal advanced liver disease.

Causes or Etiology alcohol intake, Viral Hepatitis C and B, primary biliary cirrhosis, hemochromatosis, autoimmune hepatitis and Wilson’s disease among others.

Overall cirrhosis can be divided into 2 phases:

A. Compensated cirrhosis characterized by the absence of sangraso, ascites, portal-systemic encephalopathy and jaundice. The average survival is 12 years; descompensándose on average at 10 years and

B. Decompensated Cirrhosis whose average survival drops to two years and all patients die from causes associated with liver disease.

In turn these two phases are divided and grouped into five (5) Steps 2 correspond to the first Compensated Cirrhosis and the last three (3,4 and 5) Phase decompensated cirrhosis. These are:

Stages of Cirrhosis:

STEP 1. esophageal varices. Average survival five years. At that time 21% developed varices. 13% and 3% ascites bleeding. The mortality of this stage is 7%.

STEP 2. Esophageal varices. The 5-year survival is 85%. At this time 25% have ascites; 10% bleeding. Mortality at this stage is 8%.

STEP 3. Bleeding without ascites. The 5-year survival is 55%. 36% develop ascites and mortality is 19%

STEP 4. Ascites without bleeding. A five years; Bleed 17.6% and mortality is 45%.

STEP 5. Ascites with bleeding. 5-year mortality of 56%.

Predictors of esophageal varices

• The annual incidence of 5-8% in Cirrhotic

• The main predictor of esophageal varices in HVPG greater than 10mmHg (portal venous pressure gradient)

• Factors side predictors: platelet count, albumin and MELD score.

PREDICTIVE FACTORS OF DECOMPENSATION

• 5% per year decompensate

• HVPG greater than 10 mmHg; increases 4 times the risk

• BMI greater than 3 times the risk 30aumenta

• Child Pugh score

• Platelet counts and leukocyte

• Relationship AST / ALT in alcoholic cirrhosis

PREDICTIVE FACTORS OF DEATH

• Child- Pugh

• albumin, bilirubin, platelet count

• Size of the Spleen

• Esophageal varices

• encephalopathy

• Hepatocellular Carcinoma

• Bleeding

• Creatinine Levels

Hepatocellular Carcinoma

• Advocacy at 5 years is 15-17%

• Survival depends on the presence of varices

HCC’s esophageal varices 24 months

HCC without varices 36 months

Bibliography

CIRRHOSIS: Current Challenges and Future Directions. Nov . 4-5 2011 . Moscone Est San Francisco , California.

DR. GUILLERMO SEGUNDO GONZALEZ PEREZ MD. Gastroenterologist. Bogotá. Colombia. Digestive Endoscopy. Gastroenterology and Endoscopy Unit.

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