EUH Morning Report: What are the causes of decompensated liver failure?

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The Bottom Line: “The occurrence of more than one causative factor in a single patient can lead to more rapid progression to cirrhosis. Aetiology might also influence the comorbidities associated with cirrhosis.”
“Cirrhosis develops after a long period of inflammation that results in replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules, leading to portal hypertension. The disease evolves from an asymptomatic phase (compensated cirrhosis) to a symptomatic phase (decompensated cirrhosis), the complications of which often result in hospitalisation, impaired quality of life, and high mortality.” (Gines)

Decompensated cirrhosis

    Decompensated cirrhosis: Defined by any one of: ascites, hepatic encephalopathy, and/or variceal bleed

    Etiologies of new decompensated cirrhosis: Infection, insults to the liver (drugs, toxins, herbs, shellfish), GI bleeding, ischemia/clotting (e.g., Budd-Chiari)

    Clinical features: Cirrhosis can cause clinical manifestations that affect almost any organ system (See Below) (Huppert)

Systemic clinical manifestations of liver cirrhosis. Cirrhosis can cause clinical manifestations that affect almost every organ

“Diseases and Pathophysiology in Gastroenterology.” Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine Eds. Laura A. Huppert, and Timothy G. Dyster. McGraw Hill, 2021

Ginès P, et al . Liver cirrhosis. Lancet. 2021 Oct 9;398(10308):1359-1376. Full Text for Emory Users