Complications of Cirrhosis

Portal Hypertension—Obstruction of blood flow in liver—causes increase pressure on

portal vein; develop collateral channels.
Problems: Splenomegaly—Backflow of blood into spleen
Enlarged spleen destroys platelets
Thombocytopenia—may be first sign of liver dysfunction
Esophageal varicies
Dilated abdominal veins—Caput Medusae
Hemorrhoids
Ascites

Ascites—Collection of fluid in abdomen; have increased hydrostatic pressure due to

Portal HTN; leakage of plasma proteins into peritoneal fluid and decreased synthesis of
protein by liver due to dysfunction; increased leaking of fluid from vasculature into
peritoneum

Problems: Hypovolemia—Tachycardic, Hypotensive

Enlarged abdomen—increased pressure on diaphragm—dyspnea,
orthopnea
Renal vasoconstriction—with severe ascites; pressure applied to
renal arteries decreasing blood flow to kidneys; activation of
Renin-Angiotensin-Aldosterone System (RAAS); increased
sodium and water retention; increased vascular volume; increased
ascites

Esophageal Varicies—Increased pressure in the portal system increases pressure on

esophageal veins which become dilated; may rupture due to increased force on
esophagus, i.e. food, straining.

Problems: Bleeding—may be slow bleed or massive rupture; due to

malabsoption of vitamin K and inability of liver to produce
adequate amounts of prothrombin, bleeding can be life-threatening.
Pt may be tachycardic, tachypneic, hypotensive, pale/cyanotic,
cool/clammy, weak pulses, hemataemesis, melena (with slow
bleed).
Portal-systemic Encephalopathy (PSE)—Also known as hepatic encephalopathy; liver
cannot breakdown or detoxify substances; seen in later stages of liver failure.
Neurological symptoms from alterations in LOC, alterations in sleep, asterixis, mood
disturbances. Four stages from Stage 1 Prodromal to Stage 4 Comatose.

Causes: High protein diet—increases ammonia since ammonia is formed

by breakdown of protein by bacteria—liver cannot convert
ammonia.
Infections
Hypovolemia
Hypokalemia
Constipation
GI bleed
Drugs

Hepatorenal Syndrome—Caused by constriction of renal arteries and decreased renal

blood flow; can also be caused by decreased circulating volume (hypovolemia). Pt will
have a sudden decrease in urine output, increase BUN and Creatinine