Chronic liver disease, cirrhosis and complications: Part 2: Hepatic encephalopathy and other systemic effects

Abstract

The liver is a metabolically active organ where there is continuous synthesis and detoxification of several biologically active substances such as albumin, clotting factors, neurotransmitters and vasoactive amines. In end-stage chronic liver disease (CLD), there is an imbalance between the production and degradation of these biologically active substances. This leads to a disturbance of end-organ homeostasis particularly in the brain, kidney and lungs. The severity of end-organ dysfunction might not be proportional to the degree of liver synthetic functional impairment, and progressive complexity of dysfunction should be expected. It is important that these complications are anticipated and treatment is initiated in a timely manner. This chapter focuses on cerebral, renal, pulmonary, skeletal and cardiac complications associated with chronic liver disease. Complications related to portal hypertension, ascites, SBP and hepatorenal syndrome are discussed in the preceding chapter.