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Cirrhosis

Cirrhosis is the pathological replacement of functional liver tissue with scarred, fibrous, nonfunctional tissue (Bohm 2010). Most forms of late-stage chronic liver disease often manifest cirrhosis (Liou 2014).

Cirrhosis can progress for years before the patient experiences any symptoms (Liou 2014). In this phase, which is called "compensated cirrhosis," enough healthy liver tissue remains to carry out the important functions of the liver (UMMC 2013; BLT 2011). As the disease progresses to the point where there is not enough functional liver tissue remaining to support metabolic demands, "decompensated cirrhosis" emerges. A cirrhotic patient is deemed "decompensated" upon the emergence of symptoms such as ascites (fluid accumulation in the abdominal cavity), variceal bleeding (hemorrhage of dilated blood vessels, usually in the esophagus or stomach), hepatic encephalopathy (altered mental state due to the diseased liver's inability to remove toxins from the blood), or jaundice (yellowing of the whites of the eyes and skin) (MedicineNet 2014; Garcia-Tsao 2012).

Worldwide, cirrhosis prevalence is increasing in tandem with rising incidence of its primary risk factors: hepatitis virus infection, alcoholism, and non-alcoholic fatty liver disease (NAFLD) (Sirli 2012; Schuppan 2013). As of 2014, cirrhosis was the 12th most common cause of death in the United States (National Center for Health Statistics 2013; Fox 2014; Garcia-Tsao 2012).

Owing to its myriad and diverse responsibilities within the body, functional liver loss leads to repercussions in several areas, including digestion, detoxification, circulation, energy production, and immune function, which can ultimately lead to the potentially life-threatening complications seen in decompensated cirrhosis: cardiovascular and pulmonary compromise; kidney failure; serious infection; gastrointestinal hemorrhage; and neurological, endocrine, and skeletal disorders (Liou 2014; Schuppan 2008).

Currently, the only definitive cure for cirrhosis is liver transplant (Manns 2013). However, awareness of modifiable risks such as alcohol consumption and obesity may help prevent the disease; early detection and treatment of underlying conditions may help slow its progression; and dietary and lifestyle changes may further improve quality of life in patients with cirrhosis (Liou 2014; Schwartz 2012; Plauth 2006; Amodio 2013; Purnak 2013).

This protocol will discuss the nature, causes, and outcomes of cirrhosis; outline current and emerging methods of diagnosis and treatment; and summarize state of the art nutritional support for the cirrhotic patient.