Discuss four common acute complications of Cirrhosis of liver.

How to Approach

This question requires a concise yet comprehensive understanding of the acute complications arising from cirrhosis. The approach should be to directly list and briefly explain four common complications. Focus on pathophysiology, clinical presentation, and potential severity. Structure the answer by dedicating a paragraph to each complication, ensuring clarity and conciseness within the 150-word limit. Avoid delving into management details, as the question only asks for a discussion of the complications themselves.

Model Answer

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Introduction

Cirrhosis, a late stage of scarring (fibrosis) of the liver caused by long-term liver damage, is associated with numerous acute complications. These arise due to the liver’s impaired ability to perform its vital functions – detoxification, protein synthesis, and bile production – coupled with portal hypertension. Prompt recognition of these complications is crucial as they can rapidly become life-threatening. This answer will discuss four common acute complications of cirrhosis.

Four Common Acute Complications of Cirrhosis

1. Hepatic Encephalopathy: This neuropsychiatric syndrome results from the accumulation of toxins, primarily ammonia, in the bloodstream due to the liver’s inability to detoxify them. Clinically, it manifests as altered mental status, ranging from subtle personality changes to coma. Portal hypertension contributes by shunting blood away from the liver.

2. Variceal Bleeding: Portal hypertension leads to the development of esophageal and gastric varices – enlarged veins in the esophagus and stomach. These fragile vessels are prone to rupture, causing massive upper gastrointestinal bleeding. This is a medical emergency requiring immediate intervention.

3. Ascites: This is the pathological accumulation of fluid in the peritoneal cavity. It’s caused by a combination of portal hypertension, hypoalbuminemia (reduced protein production by the liver), and sodium retention by the kidneys. Large-volume ascites can cause abdominal discomfort and respiratory compromise.

4. Spontaneous Bacterial Peritonitis (SBP): This is an infection of the ascitic fluid, usually caused by Gram-negative bacteria. Patients with cirrhosis and ascites are at high risk due to impaired immune function and translocation of bacteria from the gut. SBP presents with fever, abdominal pain, and worsening ascites, and can lead to sepsis.

Conclusion

In conclusion, cirrhosis is a serious condition with a range of potentially fatal acute complications. Hepatic encephalopathy, variceal bleeding, ascites, and spontaneous bacterial peritonitis represent some of the most common and clinically significant. Early diagnosis and appropriate management are essential to improve patient outcomes and prevent mortality in individuals with cirrhosis.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

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Additional Resources

Key Definitions

Cirrhosis

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by long-term liver damage. It impairs liver function and can lead to liver failure.

Portal Hypertension

Portal hypertension is increased pressure in the portal vein, which carries blood from the digestive organs to the liver. It's a common complication of cirrhosis.

Key Statistics

Approximately 5.5 million adults in the United States have cirrhosis.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2023 (Knowledge Cutoff)

Cirrhosis is the 12th leading cause of death in the United States.

Source: Centers for Disease Control and Prevention (CDC), 2021 (Knowledge Cutoff)

Examples

Alcohol-Related Liver Disease

A 55-year-old male with a history of chronic alcohol abuse develops jaundice, ascites, and confusion. Investigations reveal cirrhosis secondary to alcohol-related liver disease, complicated by hepatic encephalopathy and ascites.

Frequently Asked Questions

▶What is the role of the Model for End-Stage Liver Disease (MELD) score?

The MELD score is a scoring system used to assess the severity of liver disease and predict survival. It’s based on bilirubin, creatinine, and INR levels and is used to prioritize patients for liver transplantation.

Topics Covered

GastroenterologyMedicineCirrhosisComplicationsLiver Disease

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