What Is The Life Expectancy For Decompensated Cirrhosis?
The survival of patients with compensated liver cirrhosis (patients who have never had ascites, digestive hemorrhage or hepatic encephalopathy) is relatively long. Most patients live more than 10 years. However, once the cirrhosis has decompensated, the prognosis is bad in a short period of time. The probability of being alive three years after decompensation is only 30%.
The evolution of patients with advanced cirrhosis is complicated by a series of symptoms that are independent of the disease cause; they appear equally in patients with cirrhosis of alcoholic origin or hepatitis C virus. These effects are produced by severe impairment of liver function and indicate that the organ is failing. The most frequent complications are the following:
Esophageal Varices: They are dilations of the esophagus veins. The alteration of the liver tissue obstructs the vessels and increases the pressure. If they break, they can bleed resulting in a digestive hemorrhage that can be very serious. This can be manifested by vomiting blood or eliminating blood in the stool.
Bleeding: In cirrhotic patients, the liver does not produce enough amount of the substances that act in blood coagulation, so if there is a wound, no matter how small, it can bleed without the control mechanisms being effective enough to produce it the tamponade. It is common for patients to bleed through the gums or the nose, or to bruise small bumps.
Episodes of Ascites: The accumulation of fluid in the abdominal cavity is called ascites. The patient may notice an increase in the abdominal perimeter (as if it swelled) and may even gain weight. Sometimes this is accompanied by the appearance of edema (swelling) of the legs.
Bacterial Peritonitis: Sometimes the fluid in the abdomen (ascites fluid) can become infected, which can cause fever, abdominal pain and decompensation of the patient’s situation. It occurs more frequently when the disease is advanced and the fluid has almost no proteins that can defend against bacteria. It is treated with antibiotics and in some cases (if the peritonitis is frequent or the risk of it reappearing very high) the patient is given antibiotics in a prolonged way to prevent them from appearing again.
Hepatic Encephalopathy: The specific cause of this complication is not known. The liver, which acts under normal conditions as a filter, loses some of its capacity and that leads to the accumulation in the blood of toxic substances that have not been properly purified by the liver. It seems that the increase of ammonia in the blood could be responsible for some of the symptoms of this condition. Patients become disoriented; have a tendency to sleep and confusion, and tremors appear. The affectation is divided into degrees: initially the patient may be euphoric or depressed, a little confused. In more advanced degrees they tend to fall asleep and become disoriented (they do not know where they are, they confuse their relatives, or they do not remember their age). If the condition progresses, the patient becomes asleep, although they may wake up if stimulated. The most advanced degree is coma: patients may not wake up or only with intense stimuli.
Splenomegaly: The increase of the spleen size is due to the increase of the blood pressure of the vessels that leave the liver. The most important consequence is that more number of red and white blood cells, and more platelets are destroyed than necessary, so patients may have anemia, leukopenia or low platelets.
Liver Cancer: Chronic liver diseases predispose to the development of liver cancer. Patients with cirrhosis are much more likely to have the disease than the healthy population. Many times the tumors go unnoticed and the symptoms can be confused with those of cirrhosis. The worsening of a stable disease can help to suspect the presence of a cancer that can be diagnosed with an ultrasound, or a scan. The diagnosis is made with a liver biopsy (a sample is taken from the part of the liver that is suggestive of the tumor and is looked under a microscope).
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