Complicaciones agudas del paciente cirrótico. Ascitis, encefalopatía hepática y síndrome hepatorrenal

Abstract

Hepatic cirrhosis is a disease that is initially silent (compensated cirrhosis) until advanced stages, when the patient presents with a symptomatic event known as decompensation, which is the consequence of progressive deterioration of liver function and an increase in portal pressure. Ascites, hepatic encephalopathy, and gastrointestinal bleeding due to varices are the classic decompensations of cirrhosis and their onset entails a marked worsening of the prognosis. The treatment of hepatic encephalopathy and ascites based on hygienic and dietary measures and a large treatment arsenal allows for a substantial improvement in quality of life. However, these patients must be evaluated for liver transplant, which is the only curative treatment of decompensated cirrhosis. Likewise, usually in the context of an infection or other triggering event, patients with cirrhosis and portal hypertension may present with acute deterioration of renal function known as hepatorenal syndrome (HRS), which emerges as a consequence of the local compensatory vasoconstriction due to loss of effective volume. The treatment of HRS is based on avoiding nephrotoxins, albumin infusion, and starting splanchnic vasoconstrictors, though again, liver transplant is the only curative treatment.