Decompensated Cirrhosis

Decompensated Cirrhosis: What Is It?

The term “decompensated cirrhosis” (or simply “cir”) refers to any condition where there are no or little functional liver cells left in the body. These cells have been destroyed by some other cause such as a virus, toxins, radiation, chemotherapy drugs, etc.

In general, these types of conditions are not fatal but they do require specialized care and support from doctors. For example, patients with advanced cancer may need surgery to remove their liver. Patients with hepatitis C may need medication to prevent its spread through the blood stream.

People suffering from AIDS may need treatment to suppress their immune system so it doesn’t attack healthy liver cells.

Cirrhosis is a medical condition that affects the liver, which is one of the major organs involved in detoxifying our bodies. The liver helps us metabolize food and eliminate waste products. Without enough liver cells to work properly, we would suffer from many health problems including high cholesterol levels, heart disease, diabetes mellitus and even death.

How Common Is It?

According to the United States Department of Health and Human Services, there are over 1 million people with irreversible liver damage in the country. Over 600,000 of these people have been diagnosed with some form of liver disease, while the rest suffer from undiagnosed conditions. About a half million people in the US will die from liver disease each year.

As with any condition, some people are more likely to get it than others. Men are twice as likely to get it as women. People of African, Asian or Hispanic descent are also more likely to contract liver disease.

It is also more common in people who smoke, drink a lot, have a family history of the condition, or suffer from obesity. Certain blood transfusions can also lead to liver damage.

Most of these conditions cause a slow, gradual destruction of liver tissue over many years. When the body is suddenly hit with a toxin or other agent, the liver has only a limited number of cells that can be permanently damaged before they are lost forever. When this happens, the condition is known as “decompensated cirrhosis”.

How Does Decompensated Cirrhosis Happen?

Decompensated cirrhosis is similar to liver failure, except it occurs when the patient is hit with a toxin or other agent. When the liver starts to fail because it has been damaged beyond repair, certain types of cells known as sinusoidal endothelial cells start to break down and die. These cells are vital for the maintenance and repair of the bile ducts, which are responsible for draining bile from the liver, gall bladder and small intestine.

When these cells start to degenerate and die, bile backs up into the liver. This back up of bile can cause two major problems: jaundice and it can cause a severe inflammatory response in the liver. Jaundice is the medical term for when bile pigments build up in the skin and eyes, causing them to turn a distinct yellow color.

The condition is often accompanied by itching, pale stools and severe tiredness. If it isn’t treated, the patient could suffer brain damage and even death.

If bile backs up into the small intestine, it can cause intense pain, vomiting and diarrhea. This condition is known as “biliary colic.” If the bile backs up into the gall bladder, the patient may experience severe pain in the upper right side of the abdomen.

The condition is known as “Gallstone pancreatitis.”

Ultimately, if treatment is not given to drain the bile out of the liver and gallbladder, the patient may die.

How Is Decompensated Cirrhosis Treated?

There are three methods that medical professionals use to treat this condition:

Liver Transplant: By far the most common method for treating this condition is a liver transplant. A surgeon will remove the patient’s diseased liver and replace it with a healthy one from a donor. This is often an effective treatment, however it comes with its own serious risks and the patient will need to take immunosuppressant drugs for the rest of their life to prevent their body from rejecting the new organ.

Portal Vein Filter: In some cases, patients may be advised to have a filter placed in their portal vein. This small device is designed to catch any toxins or other harmful materials that may be passing through the blood and sending them to the liver. The filter is secured in place by weaving it into the patient’s superior mesenteric vein, and the device can either be removed later, or it will eventually break down and pass through the system naturally.

Lifestyle Changes: In many cases, making a few simple lifestyle changes can help to prevent decompensated cirrhosis from ever occurring. The most important thing the patient can do is stop drinking alcohol as it can cause severe inflammation in the liver. In some cases, medications may be needed to help prevent the condition from occurring.

If the patient doesn’t have any other major health problems, and they are able to address the issue before permanent liver damage occurs, they could potentially reverse some of the damage done to their liver.

What Are The Long-Term Complications?

Patients who suffer from decompensated cirrhosis are at a much higher risk of developing liver cancer or experiencing a major hemorrhage within the liver (which can be fatal).

What Is The Average Life Expectancy Of A Decompensated Cirrhosis Patient?

The average life expectancy for someone suffering from decompensated cirrhosis is three to five years.

Sources & references used in this article:

Survival and prognostic indicators in compensated and decompensated cirrhosis by G D’amico, A Morabito, L Pagliaro, E Marubini – Digestive diseases and …, 1986 – Springer

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis by European Association for the Study of the Liver – Journal of hepatology, 2018 – Elsevier

Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B by JP Villeneuve, LD Condreay, B Willems… – …, 2000 – Wiley Online Library

Sofosbuvir and velpatasvir for HCV in patients with decompensated cirrhosis by MP Curry, JG O’Leary, N Bzowej, AJ Muir… – … England Journal of …, 2015 – Mass Medical Soc

Hospital re-admissions among patients with decompensated cirrhosis by ML Volk, RS Tocco, J Bazick, MO Rakoski… – The American journal of …, 2012 – ncbi.nlm.nih.gov

Compensated cirrhosis: natural history and prognostic factors by P Ginés, E Quintero, V Arroyo, J Terés… – …, 1987 – Wiley Online Library

Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients by R Planas, B Ballesté, MA Álvarez, M Rivera… – Journal of …, 2004 – Elsevier

Prognostic indicators of survival in patients with compensated and decompensated cirrhosis by A Zipprich, G Garcia‐Tsao, S Rogowski… – Liver …, 2012 – Wiley Online Library

Lamivudine treatment in patients with severely decompensated cirrhosis due to replicating hepatitis B infection by FY Yao, NM Bass – Journal of hepatology, 2000 – Elsevier