Lviv clinical bulletin 2017, 2(18)-3(19): 53-72

https://doi.org/10.25040/lkv2017.023.053

Characteristics and Features of the Circulatory System Status in Patients with Liver Cirrhosis as a Disease of Multiple Organ Lesions: Pathogenesis; Diagnostics; Principles of their Treatment (Literature Review and Clinical Case Description)

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M. Farmaha, M. Abrahamovych, M. Ferko

Danylo Halytsky Lviv National Medical University

Introduction. Liver cirrhosis has a significant place among the diseases of internal organs and its comorbid syntropic lesions of the circulatory system are a common cause of disability, and often death of patients, determining the actuality, health, socio-economic importance and need for improvement of the principles of its integrated differential treatment, taking into account the state of the cardiovascular system.

Aim. To analyze the studies on frequency, pathogenesis, clinics, diagnostics and treatment of polymorbid syntropic extrahepatic lesions of the cardiovascular system in patients with liver cirrhosis published until now.

Materials and methods. We have worked on clinical research data for previous years and have analyzed a case of the disease of a particular patient who was under our observation.

Results. Diseases of a liver as a key organ of the interorgan and intersystem relationships, lead to the circulatory system disorders. It appears, first of all, by the hemodynamics disorders with the formation of stable arterial hypotension and, consequently, microcirculatory disorders, functional failure of almost all organs and also myocardial damage resulting into cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the heart’s parameters. The study of this problem started in Cappadocien Aretacus and Claudius Galenus, but there were only isolated reports. Detailed study of this problem began in the twentieth century.

However, despite the lengthy study, today there is no there is no final answer to the questions of pathogenesis of the circulatory system lesions in patients with cirrhosis. At this moment, it is well known that cardiovascular homeostasis in patients with liver cirrhosis is associated with the presence and severity of portal hypertension and hepatocellular insufficiency, and among the molecular mechanisms the leading role is given to endothelial dysfunction with an imbalance in the system of vasoconstrictors (endothelin-1) and vasodilators (nitric oxide, carbon monoxide, hydrogen sulfide, prostacyclin, kanabioids, endogenous opioids and others), disorders in the renin-angiotensin-aldosterone system and in the autonomic nervous system. An imbalance in the mentioned system leads to the systemic vasodilation, which is the most pronounced in splanhnic vessels, causing arterial hypotension and subsequent changes in the bloodstream and in the end, leads to polyorganic failure.

These vasoactive substances are able to make the cardiodepressive effect and potentially participate in the pathogenesis of cardiomyopathy in the cirrhotic patients. Clinical signs of liver cirrhosis with the involvement into the process organs of the cardiovascularsystem is poor and, most importantly, non-specific. Most often there are no complaints or regarded as a manifestation of liver disease and the results of physical, laboratory and instrumental examination are of low information. The most specific is a high heart rate, presence of «chronotropic insufficiency», the level and daily fluctuations of blood pressure. Specific treatment of the cardiovascular system lesions in case of liver cirrhosis have been not developed till now. Treatment of such patients should be individualized, aiming at the support of myocardial function and prevention of circulatory decompensation.

Conclusions. According to a literature review the injury of a liver as a key organ of interorgan and intersystem relationships, leads to the disorders of the circulatory system and manifests with the hemodynamics violation resulting into the formation of stable arterial hypotension and myocardial damage known as cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the parameters of the heart. However, disorders of blood flow in patients with liver cirrhosis require further elucidation of features of the pathogenetical mechanisms of its appearance, which will justify the new principles of the effective treatment of this category of critically ill patients.

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