Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure

Abstract

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.

Overview of the immunological mechanisms in hepatitis B virus reactivation: Implications for disease progression and management strategies

“…Moreover, in their study, Jagdish et al [ 100 ] discussed the complex immunological mechanisms and intricate feedback loops that contribute to the pathophysiological processes of liver fibrosis and Cirrhosis in the context of HBV reactivation, according to examination by Peiseler et al [ 101 ], immune cell activation and the subsequent release of cytokines not only promote fibrogenesis but also maintain a state of chronic inflammation. A self-sustaining cascade of inflammation and fibrosis starts due to the persistent immunological responses, which trigger the release of additional pro-inflammatory cytokines and chemokines.…”

Effectiveness of albumin infusion for the management of hyponatremia in decompensated cirrhosis: a systematic review

“…Although few studies and a meta-analysis have looked into the decreased incidence of hyponatremia in patients already receiving albumin, the existing literature on albumin's therapeutic role is restricted to these 7 studies, of which one is a case series [27][28][29]. Moreover, even in limited studies, the broad classification of hyponatremia (hypervolemic/hypovolemic) has not been addressed [30,31]. Furthermore, comparator arms have been variable in the studies, and there is an evident lack of preplanned selection strategy and enrolment criteria.…”