Affiliation:
1. Yevdokimov Moscow State University of Medicine and Dentistry
Abstract
Liver cirrhosis (LC) is an advanced stage of liver disease in which healthy liver tissue is replaced with scar tissue and the liver is irreversibly damaged. The clinical course of LC is mostly determined by the progressive increase of portal hypertension, hyperdynamic circulation, bacterial translocation, and activation of systemic inflammation. Different degrees of disease severity in patients, including compensated and decompensated cirrhosis, are related to the progression of these mechanisms and may be recognized by hemodynamic or clinical characteristics. A multi-state approach has been considered to describe the clinical course of the disease. An acute exacerbation of a chronic liver failure may occur either in decompensated or in compensated cirrhosis and is always associated with a high short-term mortality. The increasing severity of disease states prompted the assessment of the LC states using different diagnostic and prognostic scales accounting for competing risks for prognosis and LC treatment efficacy. When choosing the disease management in patients with LC, it is required to assess the severity of their condition, taking into account the results of various liver function tests. The Child-Turcotte-Pugh score is most often used for this purpose. The diagnosis of LC includes evaluation of patients for alcohol disorder and signs of advanced liver disease. The degree of liver fibrosis is determined using ultrasound imaging, transient elastography, MRI, measurements of serum biomarkers, and liver biopsy histology. Alcohol abstinence achieved through psychosomatic intervention is the best non-drug treatment for all stages of the disease. The concept of pharmacotherapy of alcoholic LC and their complications is based on the influence on the pathogenetic components of this pathology. If the disease progresses to decompensated cirrhosis or hepatocellular carcinoma, liver transplantation may be required. The clinical case discusses the management of a patient with LC of alcoholic origin using modern methods of differential diagnosis and treatment of this pathology
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