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Relationship Between Portal HTN and Cirrhosis as a Cause for Diabetes
1Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Insights
Liver cirrhosis (LC) and portal hypertension (PH) significantly impact patient health, often co-occurring with diabetes mellitus (DM). LC and PH are primary drivers of mortality, more so than diabetes complications in cirrhotic patients.
Area of Science:
- Hepatology
- Endocrinology
- Internal Medicine
Background:
- Liver cirrhosis (LC) is associated with hemodynamic alterations, including hypertension and hyperdynamic circulation.
- Portal hypertension (PH) commonly leads to splenomegaly and ascites, complicating patient management.
- The interplay between LC, PH, and diabetes mellitus (DM) requires comprehensive understanding for accurate prognosis.
Purpose of the Study:
- To investigate the relationship between liver cirrhosis, portal hypertension, and diabetes mellitus.
- To evaluate how these conditions influence patient prognosis and disease severity.
- To analyze the impact of obesity and ascites on body mass index (BMI) assessment in cirrhotic patients.
Main Methods:
- Analysis of laboratory data including liver enzymes (AST, ALT), albumin, bilirubin, blood counts (WBC, erythrocytes, platelets), coagulation parameters (INR, PT), and glucose levels.
- Assessment of clinical signs of hypertension, hyperdynamic circulation, splenomegaly, and ascites.
- Correlation of BMI with obesity, ascites, and disease severity.
Main Results:
- Alcoholic cirrhosis patients exhibited abnormal laboratory values indicative of PH, ascites, DM, infection, and coagulopathy.
- Hepatocellular failure, driven by LC, was a more significant factor in mortality than diabetes and its complications.
- Elevated BMI in cirrhotic patients was often exacerbated by ascites, leading to inaccurate weight assessment.
Conclusions:
- Liver cirrhosis and portal hypertension are critical determinants of prognosis in affected patients.
- Diabetes mellitus appears to have a lesser impact on mortality compared to the severity of liver cirrhosis itself.
- Accurate assessment of PH stage, through laboratory markers like WBC and platelet counts, is crucial for evaluating disease severity.
Abstract:
Our aim was to explore the relationship between liver cirrhosis (LC), portal hypertension (PH), and diabetes mellitus (DM). LC displayed hemodynamic alterations reflected by signs and symptoms of hypertension and hyperdynamic circulation. Portal hypertension also caused splenomegaly because of the blood flow into the spleen from the portal vessels and portal flow. The alcoholic cirrhosis displayed abnormal values (AST, ALT, AST/ALT, albumin, ammonia, bilirubin, blood platelet, erythrocytes, glucose, Hb, international normalized ratio (INR), PT, prothrombin index (PI), thymol test, white blood cell (WBC) count), which demonstrated the presence of portal hypertension, ascites, DM, infection, and coagulopathy. The evaluation of liver enzymes and other laboratories data helped to determine the severity of the condition and prognosis. Diabetes appeared to be less affecting the prognosis of patients with cirrhosis than LC itself, showing that hepatocellular failure was largely responsible for patients' mortality rather than diabetes and its complications. Patients displayed a BMI correlating obesity, although affected by concomitant diseases that commonly cause a severe weight loss. The elevated BMI in this case was accentuated by the presence of ascitic fluid, which is responsible for the increase in weight and the inaccurate BMI evaluation. Ascites affect patients' recovery from liver diseases. Obese patients with cirrhosis can be related to have a large amount of ascites and that physicians should be expecting to notice changes in their BMI pre- and postoperatively, subsequently making a prior classification as obese inappropriate. Disease severity could be assessed through the evaluation of PH stage, which was characterized by a significant depletion of WBC and as well as platelet counts.
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