Sudden Death From Cirrhosis Of The Liver

In this article, we will take a close look at liver cirrhosis, a condition characterized by the formation of scar tissue in the liver due to injury or long-term disease. We will discuss the different types of cirrhosis, how it can lead to sudden death, and the various treatment options available.
Nithishwer Mouroug Anand

Nithishwer Mouroug Anand

Nithish is a computational biochemist at the University of Oxford working on alchemical methods for protein-drug interactions.

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What is liver cirrhosis?

Liver cirrhosis is a condition characterised by the formation of scar tissue in the liver due to injury or long-term disease. This process of scarring, known as fibrosis, replaces healthy liver tissue and blocks blood flow through the liver. As a result, the liver's ability to perform its functions - such as making protein, fighting infections, cleaning the blood, helping digest food, and storing energy - is compromised [1, 2].

Types of liver cirrhosis

Liver cirrhosis can be classified into two main groups: common and specific types. The common types include postnecrotic, post-hepatitic, alcoholic, and mixed types of cirrhosis. The particular types include congestive, biliary, parasitic cirrhosis, and Wilson's disease [3].

Cirrhosis can also be divided into two categories based on the presence of symptoms: compensated and decompensated.

In compensated cirrhosis, you don't have any symptoms. Decompensated cirrhosis is when your cirrhosis has progressed to the point that the liver is having trouble functioning, and you start having symptoms of the disease [2].

Sudden death caused by liver cirrhosis

Liver cirrhosis, regardless of its type, can potentially lead to sudden death. The likelihood and manner of sudden death are influenced by the specific circumstances and complications associated with each type of cirrhosis.

Micronodular cirrhosis, macronodular cirrhosis, mixed cirrhosis, primary biliary cirrhosis, hemochromatosis, and Wilson-Konovalov disease are all types of liver cirrhosis that have been associated with patient deaths [4]. However, the study does not specify whether these deaths were sudden.

Alcoholic cirrhosis, a common type of cirrhosis, can cause sudden death in certain circumstances. For instance, sudden death can occur due to complications such as ruptured oesophagal varices, which can cause hemorrhagic shock [5]. Alcoholic cirrhosis can also lead to cirrhotic cardiomyopathy, a condition characterised by cardiac dysfunction in cirrhotic patients, which can result in sudden death due to arrhythmia [6].

Fatty liver disease, which can progress to cirrhosis if left untreated, is generally not considered a direct cause of sudden death. However, it can contribute to death indirectly, often due to an underlying condition such as cardiovascular disease [7].

Treatment of liver cirrhosis

The treatment for liver cirrhosis varies based on its cause, the symptoms experienced, and the progression of the disorder. The primary goal is to halt the progression of the disease and manage any complications that arise.

Medications:Various medications are used in the treatment of cirrhosis. Depending on the cause, doctors may recommend certain medications, such as beta-blockers or nitrates for portal hypertension or antibiotics to treat hepatitis [8]. For cirrhosis caused by chronic hepatitis C infection, direct-acting antiviral drugs (DAA) have revolutionised antiviral therapy, with combinations of different DAAs showing high rates of sustained virologic response [9].

Lifestyle changes: Adopting good practices and quitting existing bad habits in your lifestyle is also crucial. For instance, If cirrhosis is a result of alcohol consumption, stopping drinking is advised. Weight loss may be recommended if medically necessary, and a low-sodium diet may be suggested for those with ascites [8].

Etiological treatments: In cases where specific conditions have caused cirrhosis, etiological treatments are used. These include abstinence for alcoholic cirrhosis, alpha-interferon for viral cirrhosis, corticosteroids for autoimmune cirrhosis, and ursodeoxycholic acid for primary biliary cirrhosis [10].

Innovative treatments: new types of treatment are also being explored. For example, Hepatoprotectors with antioxidant, anti-inflammatory, and hepatocytic membrane stabilising properties are being used. Examples include the ethanolic extract of Curcuma longa, the extract of Sophora flavescens, and silymarin (extracted from Silybum marianum) [11]. Cell therapy, including mesenchymal stem cells and macrophages, is another promising approach [12].

Liver transplant in critical cases: In advanced cases where other treatments are not enough, liver transplantation is considered as a last resort [8]. A multidisciplinary team approach involving various treatment measures has been shown to improve the prognosis of patients with cirrhosis [13].

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Nithishwer Mouroug Anand

Nithishwer Mouroug Anand

Nithish is a Doctoral Researcher in Computational Biochemistry at the University of Oxford. A physicist by training, he applies principles of thermodynamics and computational methods to investigate the interactions between drugs, proteins, and cell membranes. His expertise ranges from single-cell RNA sequencing and cancer genomics to utilizing free energy methods to understand protein biophysics.