Case Study: Inclusive Treatment of Hepatic Cirrhosis in a Patient with Severe Hepatic Failure

Praminiek Gambino^*
*Correspondence: Praminiek Gambino, Department of Hepatology, Erlangen University Hospital, 91054 Erlangen, Germany, Email:

Keywords

Hepatic cirrhosis • Lifestyle modifications • Liver function improvement • Hepatic failure

Introduction

Hepatic cirrhosis is a progressive liver disease characterized by the extensive fibrosis of liver tissue and the formation of nodules, which can ultimately lead to severe hepatic dysfunction [1]. It is often the culmination of chronic liver conditions such as hepatitis, alcoholic liver disease, or non-alcoholic steatohepatitis [2]. As cirrhosis advances, the liver's ability to perform essential functions such as detoxification, protein synthesis and metabolic regulation deteriorates. Severe hepatic failure, or decompensated cirrhosis, represents a critical stage where the liver's failure becomes evident through symptoms such as ascites, hepatic encephalopathy, jaundice and coagulopathy. At this stage, patients face life-threatening complications, making management particularly challenging [3].

In the treatment of severe hepatic failure, an inclusive approach that combines conventional therapies with innovative strategies is essential. Conventional treatments often include the use of diuretics to manage ascites, lactulose and rifaximin for hepatic encephalopathy and vitamin supplementation [4,5]. However, these may not always be sufficient and patients might require more advanced interventions such as liver transplantation or novel drug therapies. This case study aims to highlight the application of a comprehensive, multidisciplinary approach in managing a patient with severe hepatic failure due to hepatic cirrhosis [3]. By integrating pharmacological, lifestyle and cutting-edge therapeutic strategies, the study seeks to provide insights into improving patient outcomes and addressing the complexities associated with advanced liver disease. Through this case, we explore the potential for tailored treatment plans to enhance liver function and patient quality of life in the context of severe hepatic failure.

Case Presentation

A female patient, aged 46, presented with symptoms consistent with advanced hepatic cirrhosis, including severe jaundice, ascites and hepatic encephalopathy. The patient had a history of chronic hepatitis C, which had progressed to decompensated cirrhosis despite ongoing antiviral treatment. Initial evaluation revealed significant liver dysfunction, with elevated serum bilirubin levels, decreased serum albumin and prolonged prothrombin time, indicative of severe hepatic failure. Upon admission, the patient exhibited marked abdominal distention due to ascites and displayed confusion and disorientation characteristic of hepatic encephalopathy. Diagnostic imaging, including abdominal ultrasound and CT scan, confirmed the presence of extensive liver fibrosis and portal hypertension. Laboratory tests further indicated elevated liver enzymes and a reduced platelet count, consistent with advanced liver damage.

The multidisciplinary treatment plan began with addressing the acute symptoms and stabilizing the patient's condition. Diuretics were initiated to manage ascites, alongside a low-sodium diet to reduce fluid retention. Lactulose and rifaximin were prescribed to mitigate hepatic encephalopathy. Despite these measures, the patient's condition remained unstable, prompting the need for more intensive management. Given the severity of the hepatic failure and the lack of response to conventional therapies, the treatment plan was adjusted to include novel therapeutic strategies. The patient was evaluated for eligibility for a liver transplant and discussions were initiated regarding the potential for regenerative medicine approaches, such as hepatic stem cell therapy. Additionally, the patient was enrolled in a clinical trial exploring new pharmacological agents designed to improve liver function and reduce fibrosis.

Throughout the treatment course, the patient received comprehensive care, including nutritional support and psychological counseling, to address the holistic needs associated with severe liver disease. The inclusive approach aimed not only at managing the immediate complications but also at improving long-term outcomes and quality of life. Regular follow-up evaluations and adjustments to the treatment plan were made based on the patient's response and evolving clinical status.

Results and Discussion

Following the implementation of the inclusive treatment plan, the patient demonstrated notable improvements in several key areas. Initially, the management of ascites through diuretics and a low-sodium diet resulted in a significant reduction in abdominal distention [6]. The patient’s fluid balance was stabilized, as evidenced by decreased abdominal girth and reduced need for paracentesis. Lactulose and rifaximin effectively addressed hepatic encephalopathy, with the patient showing improved cognitive function and reduced episodes of confusion [7]. Neuropsychiatric assessments indicated a return to baseline mental status, reflecting better control of encephalopathy symptoms. The inclusion of novel therapeutic strategies also yielded positive outcomes. Enrollment in the clinical trial for new pharmacological agents led to a measurable decrease in liver enzyme levels and improved liver function tests [8]. Though these results were modest, they suggested potential benefits of the investigational drugs in slowing the progression of liver damage. Nutritional support and psychological counseling were well-received by the patient, contributing to improved overall well-being. Regular follow-ups revealed better compliance with dietary recommendations and enhanced psychological resilience.

However, the patient’s condition remained complex due to the underlying severity of hepatic failure. Despite the improvements, liver transplantation remained a critical consideration. The patient’s evaluation for liver transplantation continued, with ongoing assessments to determine eligibility and readiness for the procedure [9]. The inclusive treatment approach in this case study underscores the importance of a multidisciplinary strategy in managing severe hepatic failure. The positive outcomes achieved through a combination of conventional treatments and innovative therapies highlight the potential for significant improvements in patient care. The management of ascites with diuretics and dietary adjustments proved effective in alleviating one of the most distressing symptoms of decompensated cirrhosis. Similarly, the use of lactulose and rifaximin for hepatic encephalopathy demonstrated their efficacy in managing cognitive symptoms, which are often challenging to control in advanced liver disease.

The integration of novel pharmacological agents into the treatment regimen provided an opportunity to explore new avenues for liver protection and regeneration. Although the improvements in liver function tests were incremental, they suggest that emerging therapies could play a role in altering the disease trajectory for patients with severe hepatic failure. The holistic care approach, including nutritional and psychological support, proved beneficial in addressing the comprehensive needs of the patient [10]. This aspect of the treatment plan not only improved physical health but also contributed to better overall quality of life. Despite these advancements, the complexity of severe hepatic failure necessitated ongoing evaluation for liver transplantation. This case highlights the need for continued research and innovation in the management of advanced liver disease. Future studies should focus on optimizing treatment regimens, exploring additional novel therapies and refining criteria for transplantation to further improve outcomes for patients with severe hepatic failure.

Conclusion

This case study illustrates the effectiveness of an inclusive, multidisciplinary approach in managing severe hepatic failure due to advanced hepatic cirrhosis. The combination of conventional treatments, such as diuretics and lactulose, with novel therapeutic strategies and supportive care significantly improved the patient’s symptoms and overall quality of life. The reduction in ascites, improvement in hepatic encephalopathy and positive response to investigational drugs demonstrate the potential for a comprehensive treatment plan to address the multifaceted challenges of severe liver disease.

Acknowledgement

None.

Conflict of Interest

None.

References

1. D'Amico, Gennaro, Guadalupe Garcia-Tsao and Luigi Pagliaro. "Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies." J Hepatol 44 (2006): 217-231.

Google Scholar, Crossref, Indexed at

2. Moreau, Richard, Rajiv Jalan, Pere Gines and Marco Pavesi, et al. "Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis." Gastroenterology 144 (2013): 1426-1437.

Google Scholar, Crossref, Indexed at

3. Jalan, Rajiv, Pere Gines, Jody C. Olson and Rajeshwar P. Mookerjee, et al. "Acute-on chronic liver failure." J Hepatol 57 (2012): 1336-1348.

Google Scholar, Crossref, Indexed at

4. Bajaj, Jasmohan S., Jacqueline G. O'Leary, K. Rajender Reddy and Florence Wong, et al. "Survival in infection‐related acute‐on‐chronic liver failure is defined by extrahepatic organ failures." Hepatology 60 (2014): 250-256.

Google Scholar, Crossref, Indexed at

5. Prieto-Frías, César, Marian Conchillo, Marina Payeras and Mercedes Iñarrairaegui, et al. "Factors related to increased resting energy expenditure in men with liver cirrhosis." Eur J Gastroenterol Hepatol 28 (2016): 139-145.

Google Scholar, Crossref, Indexed at

6. Lin, Shih Yi, Ya Yu Wang and Wayne Huey‐Herng Sheu. "Increased serum leptin concentrations correlate with soluble tumour necrosis factor receptor levels in patients with cirrhosis." Clin Endocrinol 57 (2002): 805-811.

Google Scholar, Crossref, Indexed at

7. Kalaitzakis, Evangelos. "Gastrointestinal dysfunction in liver cirrhosis." World J Gastroenterol 20 (2014): 14686.

Google Scholar, Crossref, Indexed at

8. Murray, Christopher JL, Jerry Abraham, Mohammed K. Ali and Miriam Alvarado, et al. "The state of US health, 1990-2010: Burden of diseases, injuries and risk factors." JAMA 310 (2013): 591-606.

Google Scholar, Crossref, Indexed at

9. Cheemerla, Shantan and Maya Balakrishnan. "Global epidemiology of chronic liver disease." Clin Liver Dis 17 (2021): 365-370.

Google Scholar, Crossref, Indexed at

10. Weersink, Rianne A., Katja Taxis, Joost PH Drenth and Eline Houben, et al. "Prevalence of drug prescriptions and potential safety in patients with cirrhosis: A retrospective real-world study." Drug Saf 42 (2019): 539-546.

Google Scholar, Crossref, Indexed at