Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure
Cirrhosis transcends various progressive stages from compensation to decompensation driven by the severity of portal hypertension. The downstream effect of increasing portal hypertension severity leads to various pathophysiological pathways, which result in the cardinal complications of cirrhosis, i...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-06-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1060073/full |
| _version_ | 1797803823772729344 |
|---|---|
| author | Rakesh Kumar Jagdish Akash Roy Karan Kumar Madhumita Premkumar Mithun Sharma Padaki Nagaraja Rao Duvvur Nageshwar Reddy Anand V. Kulkarni |
| author_facet | Rakesh Kumar Jagdish Akash Roy Karan Kumar Madhumita Premkumar Mithun Sharma Padaki Nagaraja Rao Duvvur Nageshwar Reddy Anand V. Kulkarni |
| author_sort | Rakesh Kumar Jagdish |
| collection | DOAJ |
| description | Cirrhosis transcends various progressive stages from compensation to decompensation driven by the severity of portal hypertension. The downstream effect of increasing portal hypertension severity leads to various pathophysiological pathways, which result in the cardinal complications of cirrhosis, including ascites, variceal hemorrhage, and hepatic encephalopathy. Additionally, the severity of portal hypertension is the central driver for further advanced complications of hyperdynamic circulation, hepatorenal syndrome, and cirrhotic cardiomyopathy. The management of these individual complications has specific nuances which have undergone significant developments. In contrast to the classical natural history of cirrhosis and its complications which follows an insidious trajectory, acute-on-chronic failure (ACLF) leads to a rapidly downhill course with high short-term mortality unless intervened at the early stages. The management of ACLF involves specific interventions, which have quickly evolved in recent years. In this review, we focus on complications of portal hypertension and delve into an approach toward ACLF. |
| first_indexed | 2024-03-13T05:26:50Z |
| format | Article |
| id | doaj.art-d2bf6bb845c049a28bf3e282aa346c3c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-13T05:26:50Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-d2bf6bb845c049a28bf3e282aa346c3c2023-06-15T05:48:49ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-06-011010.3389/fmed.2023.10600731060073Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failureRakesh Kumar Jagdish0Akash Roy1Karan Kumar2Madhumita Premkumar3Mithun Sharma4Padaki Nagaraja Rao5Duvvur Nageshwar Reddy6Anand V. Kulkarni7Department of Hepatology, Gastroenterology and Liver Transplant Medicine, Metro Hospital, Noida, IndiaDepartment of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Hospitals, Kolkata, IndiaDepartment of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, IndiaDepartment of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Hepatology, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, IndiaDepartment of Hepatology, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, IndiaDepartment of Hepatology, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, IndiaDepartment of Hepatology, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, IndiaCirrhosis transcends various progressive stages from compensation to decompensation driven by the severity of portal hypertension. The downstream effect of increasing portal hypertension severity leads to various pathophysiological pathways, which result in the cardinal complications of cirrhosis, including ascites, variceal hemorrhage, and hepatic encephalopathy. Additionally, the severity of portal hypertension is the central driver for further advanced complications of hyperdynamic circulation, hepatorenal syndrome, and cirrhotic cardiomyopathy. The management of these individual complications has specific nuances which have undergone significant developments. In contrast to the classical natural history of cirrhosis and its complications which follows an insidious trajectory, acute-on-chronic failure (ACLF) leads to a rapidly downhill course with high short-term mortality unless intervened at the early stages. The management of ACLF involves specific interventions, which have quickly evolved in recent years. In this review, we focus on complications of portal hypertension and delve into an approach toward ACLF.https://www.frontiersin.org/articles/10.3389/fmed.2023.1060073/fullportal hypertensionliver cirrhosisHVPGacute-on-chronic liver failurechronic liver disease |
| spellingShingle | Rakesh Kumar Jagdish Akash Roy Karan Kumar Madhumita Premkumar Mithun Sharma Padaki Nagaraja Rao Duvvur Nageshwar Reddy Anand V. Kulkarni Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure Frontiers in Medicine portal hypertension liver cirrhosis HVPG acute-on-chronic liver failure chronic liver disease |
| title | Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure |
| title_full | Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure |
| title_fullStr | Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure |
| title_full_unstemmed | Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure |
| title_short | Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure |
| title_sort | pathophysiology and management of liver cirrhosis from portal hypertension to acute on chronic liver failure |
| topic | portal hypertension liver cirrhosis HVPG acute-on-chronic liver failure chronic liver disease |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1060073/full |
| work_keys_str_mv | AT rakeshkumarjagdish pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT akashroy pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT karankumar pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT madhumitapremkumar pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT mithunsharma pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT padakinagarajarao pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT duvvurnageshwarreddy pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure AT anandvkulkarni pathophysiologyandmanagementoflivercirrhosisfromportalhypertensiontoacuteonchronicliverfailure |