One in 400 adults suffer from liver cirrhosis in the United States with men being typically more prone to the condition than women. There may also be a high risk for bleeding during invasive procedures in patients with cirrhosis. Hence, an assessment of frailty is required to ascertain the risks associated with them. Paracentesis is among the most common bedside procedures for patients with cirrhosis.
Let’s explore the condition, its symptoms, treatments, and more with this article.
What Is Liver Cirrhosis?
Liver cirrhosis occurs when a patient’s liver is damaged due to several factors such as:
- Alcohol consumption, particularly among women
- Hepatitis C, hepatitis D, or hepatitis B which can cause inflammation and liver damage
- Non-alcoholic fatty liver diseases or steatohepatitis
- Prescription or over-the-counter medication including antidepressant drugs
- Bile duct malfunctioning
- Autoimmune hepatitis
- Wilson’s disease, hemochromatosis, and other disorders that inhibit the body’s ability to process iron and copper
In the United States, liver cirrhosis is usually a result of chronic alcohol misuse and hepatitis infections.
Liver cirrhosis occurs in two stages:
- Compensated cirrhosis: no symptoms of liver damage are evident during this stage even if the liver may be scarred
- Decompensated cirrhosis: liver damage has progressed to a point where symptoms such as ascites or jaundice occur, making this stage very serious
While liver cirrhosis cannot be cured or undone, it is possible to reverse the diagnosis from the decompensated to the compensated stage by effectively managing the root cause of the cirrhosis. For example, if excess alcohol consumption is the cause of cirrhosis, abstaining from alcohol can help.
Symptoms and Diagnosis of Cirrhosis
To determine the appropriate bedside procedures for patients with cirrhosis, it is crucial to first diagnose the condition.
Cirrhosis symptoms manifest once the liver is unable to produce clotting proteins, break down toxins, purify the blood, or aid in absorbing fats and fat-soluble vitamins.
Symptoms
Milder symptoms of cirrhosis include:
- Fatigue
- Weight loss
- Nausea
- Abdominal pain on the upper right side
- Enlarged veins
- Reduced appetite
If the symptoms are more serious, they manifest as:
- Swelling in the legs
- Abdominal swelling
- Itchy skin
- Easy bruising or bleeding
- Difficulty thinking or confusion
- Discoloration or yellowing of the skin and eyes
Managing cirrhosis by addressing the underlying cause can significantly reduce its symptoms, particularly those that are serious and could adversely impact the patient’s quality of life.
Diagnosis
Diagnosing cirrhosis requires a detailed medical history of the patient to ascertain whether the root cause is related to hepatitis, genetic autoimmune diseases, alcohol use, or other factors.
A physical exam is also required to check for:
- Palmar erythema
- Yellowed or discolored skin or eyes
- An enlarged liver or spleen
- Confusion
- Asterixis
Tests that can evaluate liver cirrhosis and reveal the extent of damage include:
- Blood count test to check for anemia
- Liver function tests
- Screening for liver cancer with alpha fetoprotein
- Albumin tests to ascertain the protein produced in the liver
- Coagulation blood tests to determine blood clotting
- MRI of the abdomen
- CT scan
- Ultrasound
- Upper endoscopy to check for esophageal varices
A liver biopsy can also be conducted as it is the most conclusive test for cirrhosis.
Potential Complications Associated With Liver Cirrhosis
Cirrhosis can prevent the blood from passing through the liver which can cause esophageal varices—a condition where the blood becomes backed up in other veins. Since veins are not built to withstand pressure, they may begin to bulge from the increased blood flow.
Cirrhosis can also cause other complications such as:
- Malnutrition
- Kidney failure
- Sensitivity to medications
- Increased bleeding
- Bacterial infections
- Thrombocytopenia
- Enlarged spleen or splenomegaly
- Hepatic encephalopathy
Liver cirrhosis is also responsible for around 80% of ascites cases, making it the biggest risk factor for the condition. This is characterized by a build-up of fluid in the abdominal region amounting to more than 25 milliliters.
This is an extremely serious complication that affects over 60% of patients with cirrhosis. The survival rate is 50% within 2 years from the diagnosis.
Bedside Procedures in Patients With Cirrhosis: Treatment Options
The tests the do NOT predict bleed risk for invasive procedures: prolonged prothrombin time/elevated INR, prolonged bleeding time, partial thromboplastin time. This is because decompensated cirrhosis is associated with a balanced hemostasis with decrease in prohemorrhagic factors AND decrease in procoagulant factors. The elevated INR is caused by a decrease in procoagulant factors but is not influenced by the decrease in prohemorrhagic factors.
The best test to assess the bleed risk in cirrhotic patients undergoing an invasive bedside procedure is the TEG (thromboelastogram) or ROTEM (rotational thromboelastometry) test.
Cirrhosis is associated with several severe health conditions. It is thus crucial to frequently test for comorbidities while monitoring the patient’s health.
Common treatments include:
Diuretics
Typically, diuretics are an effective treatment to address ascites and reduce the pressure on the veins surrounding the liver. This is achieved by increasing the water and salt content that is expelled from the body. The patient’s blood chemistry must be monitored when diuretics are administered.
Paracentesis
Paracentesis can be performed to reduce the buildup of fluid and treat the ascites if diuretics are not effective enough. In this procedure, a catheter is inserted into the peritoneal cavity with ultrasound guidance to aspirate the ascitic fluid. The fluid is then analyzed. This is among the most common therapeutic bedside procedures in patients with cirrhosis as it eliminates excess peritoneal fluid.
Paracentesis can significantly aid in cirrhosis management as it is associated with lower in-patient mortality among those with cirrhotic ascites.
Final Thoughts
Liver cirrhosis can significantly degrade a patient’s health and well-being. While there is no cure for the condition, it can be effectively managed with the proper therapies.
Complications such as ascites can also be treated with bedside procedures in patients with cirrhosis, particularly with paracentesis.
If you want to learn more about the procedure, our Hospital Procedures Consultants Paracentesis Course has everything you need. You can also enhance your knowledge of other medical procedures with our various training programs.
Resources:
Faiyaz, Bader. Rasheed, T. Sadagat, F. Bader, N. Sadaf, R. Assessment of frailty in cirrhosis using bedside measures and its correlation with Child-Turcotte-Pugh, MELD & MELD-Na Scores. Pak J Med Sci 2022 May-Jun; 38(5): 1086–1092
Roerecke, M. Vafaei, A. Hasan, O. Chrystoja, B. Cruz,M. Lee, R. Neuman, M. Rehn, J. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol. 2019 Oct; 114(10): 1574–1586
Chiejina, M. Kudaravalli, P. Samant, H. Ascites. CME, 2023
Zakeri, N. Tsochatzis, E. Bleeding risk with invasive procedures in patients with cirrhosis and coagulopathy Hepatology, Vol 65, No. 2, 2017