Complicaciones agudas del paciente cirrótico. Ascitis, encefalopatía hepática y síndrome hepatorrenal

  1. Conthe, A. 1
  2. Baines, A. 2
  3. Poncela, M. 2
  4. Bañares Cañizares, R. 3
  1. 1 Servicio de Medicina de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd)
  2. 2 Servicio de Medicina de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
  3. 3 Servicio de Medicina de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd) Facultad de Medicina, Universidad Complutense, Madrid, España
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Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2023

Título del ejemplar: Urgencias (III) Urgencias abdominales y digestivas

Serie: 13

Número: 89

Páginas: 5269-5277

Tipo: Artículo

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Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

La cirrosis hepática es una enfermedad de curso inicialmente silente (cirrosis compensada), hasta que en etapas avanzadas el paciente presenta un evento sintomático conocido como descompensación, el cual es consecuencia del deterioro progresivo de la función hepática y del incremento de la presión portal. La ascitis, la encefalopatía hepática y la hemorragia digestiva por varices conforman las descompensaciones clásicas de la cirrosis, y su aparición condiciona un marcado empeoramiento del pronóstico. El tratamiento de la encefalopatía hepática y de la ascitis basado en medidas higiénico-dietéticas y en un arsenal terapéutico amplio permite una mejoría sustancial en la calidad de vida, si bien estos pacientes deben ser valorados para trasplante hepático, el cual es el único tratamiento curativo de la cirrosis descompensada. Del mismo modo, los pacientes con cirrosis e hipertensión portal pueden presentar, habitualmente en el contexto de una infección u otro evento desencadenante, un deterioro agudo de la función renal conocido como síndrome hepatorrenal (SHR) que aparece como consecuencia de la vasoconstricción local compensadora por la pérdida de volumen efectivo. El tratamiento del SHR se basa en evitar nefrotóxicos, infusión de albúmina e inicio de vasoconstrictores esplácnicos, si bien nuevamente el trasplante hepático conforma el único tratamiento curativo.

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