Cirrhosis

Ascites refers to the accumulation of excessive volumes of fluid within the peritoneal cavity. Cirrhosis is the most common cause of ascites. The other main causes are infection (acute and chronic, including tuberculosis), malignancy, pancreatitis, heart failure, hepatic venous obstruction, nephrotic syndrome, and myxedema.

Cirrhosis refers to the pathological changes in the liver of extensive fibrosis and regenerative nodules and the clinical syndromes associated with this pathological state. Although often clinically silent, suspected only by altered biochemistry or liver imaging, it is characteristically associated with jaundice, fluid retention, wasting, coagulopathy, altered mental status, and fulminant gastrointestinal bleeding. Genetics: Minority of cases clearly inherited (hemachromatosis, hepatolenticular degeneration [Wilson disease] and alpha-antitrypsin deficiency in adults, many other very rare inherited diseases in the first few years of life).

Variceal bleeding primarily reflects portal hypertension. The role of acid reflux and its contribution to initiation of variceal bleeding is not clear.

Cirrhosis is a disease state that is the consequence of a wide variety of chronic, progressive liver diseases. These result in diffuse destruction of hepatic parenchyma and its replacement with collagenous scar tissue and regenerating nodules with disruption of the normal hepatic lobular and vascular architecture.

Primary biliary cirrhosis is one of the more common forms of chronic liver disease. The estimated prevalence is four to 14 cases per 100,000 people. It is characterized by chronic inflammation and destruction of small interlobular intrahepatic bile ducts, leading to chronic cholestasis, cirrhosis and portal hypertension.

Hepatorenal syndrome is a progressive, functional renal failure that occurs in patients with severe liver disease. Most of these patients have decompensated cirrhosis and tense ascites.

Hepatic encephalopathy is a neuropsychiatric syndrome occurring in patients with acute or chronic liver failure. Patients with chronic liver disease develop a more indolent encephalopathy, called portosystemic encephalopathy.