Descompensación cirrótica avanzada con hemorragia digestiva alta y fallo multiorgánico: Análisis de un caso clínico complejo
DOI:
https://doi.org/10.62452/2sc79250Keywords:
Liver cirrhosis, gastrointestinal bleeding, multiorgan failure, Child-Pugh C, clinical managementAbstract
Advanced-stage liver cirrhosis presents a significant clinical challenge due to its multiple complications and high morbidity and mortality rates. This paper analyzes a clinical case of a patient with Child-Pugh class C cirrhosis who developed upper gastrointestinal bleeding secondary to esophageal varices, along with hemodynamic decompensation and multiorgan failure. Diagnostic considerations, multidisciplinary therapeutic management, and the patient’s clinical evolution are thoroughly examined. Effective management requires prompt hemodynamic stabilization, timely endoscopic intervention, and comprehensive treatment of associated systemic dysfunctions. The case also underlines the poor prognosis in such settings and emphasizes the importance of early evaluation for liver transplantation as the only curative option. This report illustrates the severity of complications in decompensated cirrhosis and reinforces the relevance of standardized clinical protocols.
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Bernard, B., Grangé, J. D., Khac, E. N., Amiot, X., Opolon, P., & Poynard, T. (1999). Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology (Baltimore, Md.), 29(6), 1655–1661. https://doi.org/10.1002/hep.510290608
Bosch, J., Groszmann, R. J., & Shah, V. H. (2015). Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments. Journal of Hepatology, 62(S1), 121–130. https://www.journal-of-hepatology.eu/action/showFullText?pii=S0168827815000069
Bosch, J., Thabut, D., Albillos, A., Carbonell, N., Spicak, J., Massard, J., D'Amico, G., Lebrec, D., de Franchis, R., Fabricius, S., Cai, Y., Bendtsen, F., & International Study Group on rFVIIa in UGI Hemorrhage (2008). Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial. Hepatology (Baltimore, Md.), 47(5), 1604–1614. https://doi.org/10.1002/hep.22216
Caldwell, S. H., Hoffman, M., Lisman, T., Macik, B. G., Northup, P. G., Reddy, K. R., Tripodi, A., Sanyal, A. J., & Coagulation in Liver Disease Group. (2006). Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology (Baltimore, Md.), 44(4), 1039–1046. https://doi.org/10.1002/hep.21303
Campion, E. W., Kullberg, B. J., & Arendrup, M. C. (2015). Invasive candidiasis. In E. W. Campion (Ed.), New England Journal of Medicine, 373(15), 1445–1456. https://pubmed.ncbi.nlm.nih.gov/26444731/
De Franchis, R., Abraldes, J. G., Bajaj, J., Berzigotti, A., Bosch, J., Burroughs, A. K., D'Amico, G., Dell'Era, A., Garcia-Pagán, J. C., Garcia-Tsao, G., Grace, N., Groszmann, R., Krag, A., Laleman, W., La Mura, V., Lebrec, D., Lo, G. H., Merkel, C., O'Beirne, J., Peck, M., Primignani, M., Salerno, F., Sarin, S. K., Thabut, D., Trebicka, J., Zipprich, A., et al. (2015). Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. Journal of Hepatology, 63(3), 743–752. https://pubmed.ncbi.nlm.nih.gov/26047908/
Fernández, J., Acevedo, J., Wiest, R., Gustot, T., Amoros, A., Deulofeu, C., Reverter, E., Martínez, J., Saliba, F., Jalan, R., Welzel, T., Pavesi, M., Hernández-Tejero, M., Ginès, P., Arroyo, V., & European Foundation for the Study of Chronic Liver Failure. (2018). Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. Gut, 67(10), 1870–1880. https://doi.org/10.1136/gutjnl-2017-314240
García-Pagán, J. C., & Bosch, J. (2005). Endoscopic band ligation in the treatment of portal hypertension. Nature clinical practice. Gastroenterology & hepatology, 2(11), 526–535. https://doi.org/10.1038/ncpgasthep0323
Garcia-Tsao, G., Bosch, J., & Groszmann, R. J. (2008). Portal hypertension and variceal bleeding—unresolved issues. Summary of an American Association for the Study of Liver Diseases and European Association for the Study of the Liver single-topic conference. Hepatology, 47(5), 1764–1772. https://pubmed.ncbi.nlm.nih.gov/18435460/
Jalan, R., Fernandez, J., Wiest, R., Schnabl, B., Moreau, R., Angeli, P., Stadlbauer, V., Gustot, T., Bernardi, M., Canton, R., Albillos, A., Lammert, F., Wilmer, A., Mookerjee, R., Vila, J., Garcia-Martinez, R., Wendon, J., Such, J., Cordoba, J., Sanyal, A., … Ginès, P. (2014). Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. Journal of hepatology, 60(6), 1310–1324. https://doi.org/10.1016/j.jhep.2014.01.024
Jalan, R., Pavesi, M., Saliba, F., Amorós, A., Fernandez, J., Holland-Fischer, P., Sawhney, R., Mookerjee, R., Caraceni, P., Moreau, R., Ginès, P., Durand, F., Angeli, P., Alessandria, C., Laleman, W., Trebicka, J., Samuel, D., Zeuzem, S., Gustot, T., Gerbes, A. L., Wendon, J., Bernardi, M., & Arroyo, V.; CANONIC Study Investigators; EASL-CLIF Consortium. (2015). The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. Journal of Hepatology, 62(4), 831–840. https://pubmed.ncbi.nlm.nih.gov/25463539/
Jalan, R., Pavesi, M., Saliba, F., Amorós, A., Fernandez, J., Holland-Fischer, P., et al. (2015). The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. Journal of Hepatology, 62(4), 831–840. https://pubmed.ncbi.nlm.nih.gov/25463539/
Lageju, N., Uprety, P., Neupane, D., Bastola, S., Lama, S., Panthi, S., & Gnawali, A. (2022). Gastric antral vascular ectasia (Watermelon stomach); an unusual cause of upper gastrointestinal bleeding in elderly: A case report. Annals of medicine and surgery (2012), 82, 104733. https://doi.org/10.1016/j.amsu.2022.104733
Lee, T. H. (2010). Recent advances in diagnosis of portal hypertension. The Korean Journal of Gastroenterology, 56(3), 135–143. https://synapse.koreamed.org/articles/1006705
Lee, Y. R., Park, S. Y., & Tak, W. Y. (2020). Treatment Outcomes and Prognostic Factors of Acute Variceal Bleeding in Patients with Hepatocellular Carcinoma. Gut and liver, 14(4), 500–508. https://doi.org/10.5009/gnl19155
Thabut, D., Pauwels, A., Carbonell, N., Remy, A. J., Nahon, P., Causse, X., et al. Thabut, D., Pauwels, A., Carbonell, N., Remy, A. J., Nahon, P., Causse, X., Cervoni, J.-P., Cadranel, J.-F., Archambeaud, I., Bramli, S., Ehrhard, F., Ah-Soune, P., Rostain, F., Pariente, A., Vergniol, J., Dupuychaffray, J.-P., Pelletier, A.-L., Skinazi, F., Guillygomarc'h, A., Vitte, R.-L., Henrion, J., Combet, S., Rudler, M., & Bureau, C. (2017). Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: A large multicentre audit with real-life results. Journal of Hepatology, 68(1), 73–81. https://pubmed.ncbi.nlm.nih.gov/28918131/
Tripodi, A., & Mannucci, P. M. (2011). The coagulopathy of chronic liver disease. New England Journal of Medicine, 365(2), 147–156. https://pubmed.ncbi.nlm.nih.gov/21751907/
Villanueva, C., Colomo, A., Bosch, A., Concepción, M., Hernández-Gea, V., Aracil, C., Graupera, I., Poca, M., Álvarez-Urturi, C., Gordillo, J., Guarner-Argente, C., Santaló, M., Muñiz, E., & Guarner, C. (2013). Transfusion strategies for acute upper gastrointestinal bleeding. New England Journal of Medicine, 368(1), 11–21. https://doi.org/10.1056/NEJMoa1211801
Zanetto, A., & Garcia-Tsao, G. (2019). Management of acute variceal hemorrhage. F1000Research, 8, F1000 Faculty Rev-966. https://pmc.ncbi.nlm.nih.gov/articles/PMC6593327/
Zuckerman, M. J., Elhanafi, S., & Mendoza Ladd, A. (2022). Endoscopic treatment of esophageal varices. Clinical Liver Disease, 26(1), 21–37. https://pubmed.ncbi.nlm.nih.gov/34802661/
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