Leberzirrhose – Wie lassen sich Komplikationen verhindern?

Für den Verlauf der Leberzirrhose bedeutet das Auftreten von Komplikationen einen entscheidenden Wendepunkt – Morbidität und Mortalität nehmen drastisch zu. Klinisch bedeutet das Auftreten einer Komplikation den Übergang von der kompensierten zur dekompensierten Leberzirrhose.

Wird bei einem Patienten eine Leberzirrhose diagnostiziert, müssen alle Anstrengungen dem Verhindern von Komplikationen dienen. Im besten Fall wird durch ein erfolgreiches Behandeln der Grunderkrankung eine Regression der Vernarbung erreicht und damit langfristig Zirrhose-assoziierte Komplikationen verhindert. Dies kann bei Patienten mit chronisch viraler Hepatitis gelingen oder durch vollständige Abstinenz eines Alkoholkranken dank Suchtbehandlung erreicht werden.

Der folgende Artikel fokussiert auf die Maßnahmen, die ein Fortschreiten vom kompensierten Status zur Dekompensation verhindern bzw. ein erneutes Auftreten unwahrscheinlicher machen. Während das Bewahren des kompensierten Status in erster Linie auf einer ambulanten Betreuung fußt, werden dekompensierte Patienten häufig stationär behandelt und die Einleitung einer geeigneten Sekundärprophylaxe erfolgt deshalb im Krankenhaus.

Cirrhosis is the end-stage of every chronic liver disease. Its natural history is characterized by an asymptomatic phase, termed 'compensated' cirrhosis followed by a rapidly progressive phase marked by the development of complications of portal hypertension and liver dysfunction, coined 'decompensated cirrhosis'. Taking care of cirrhotic patients asks for an anticipatory attitude to introduce prophylactic measures in order to avoid or at least to delay the occurrence of complications. While primary prophylactic interventions, such non-selective beta blocker therapy to prevent variceal bleeding, fall into the field of outpatient care, the introduction of secondary prophylaxis upon initial decompensation, such as lactulose and rifaximin for prevention of relapse of hepatic encephalopathy should be initiated immediately in the inpatient setting.

Key words

Complications of liver cirrhosis - prophylaxis - ascites - spontaneous bacterial peritonitis - esophageal variceal bleeding - hepatocellular carcinoma - encephalopathy

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