Cirrosis hepática

Abstract

Cirrhosis is the end-stage manifestation of every chronic progressive liver disease. It is a diffuse process characterized by loss of hepatic parenchymna, formation of fibrous septa and regeneration nodules resulting in the distortion of the normal architecture and vascular anatomy. Approximately 40-60% of cases of liver cirrhosis in Europe and North America are due to alcohol abuse and nonalcoholic fatty liver disease, while 25-30% result from chronic viral hepatitis. The modern paradigm considers cirrhosis as a dynamic and potentially reversible disease. It consists of two different entities, compensated and decompensated cirrhosis, each with a distinct prognosis and different predictors of survival. Ascitis is the most common complication of cirrhosis, and approximately 60% of patients with compensated cirrhosis develop ascitis within 10 years during the course of their disease. Within the compensated stage, patients can be subclassified into those without varices {stage l] and those with {stage 2l. The threshold pressure of hepatic venous pressure gradient {HVPGl that predicts development of varices and decompensation is 10 mm Hg {clinically significant portal hypertensionl. In decompensated stage, HVPG retains prognostic value but other parameters of liver insufficiency such as the MELD score are more predictive of death.