Complications of Cirrhosis

Organ Failure Complications











* Hepatorenal syndrome (renal failure)* Decreased urine output* Labs show elevated creatinine* Admit to hospital (high mortality)* Hepatic encephalopathy (brain failure)* Introduction* Liver clears ammonia from body* In advanced liver failure, ammonia increases* Symptoms* Altered mental status/confusion* Asterixis* Treatment* Lactulose* Binds ammonia and is excreted* Rifaximin* Eliminates bacteria responsible for producing ammonia











Portal Hypertension Complications











* Gastric/esophageal varices* Symptoms* Altered mental status* Hepatic encephalopathy triggered by reabsorbed GI blood* Melena* Black stools from digested GI blood* Treatment* Proton pump inhibitor (PPI)* Pantoprazole* Octreotide* Antibiotics* Classic procedure* Blakemore tube (balloon tamponade)* Ascites with spontaneous bacterial peritonitis (SBP)* Symptoms* Abdominal pain/tenderness* Ascites* Fever* Testing plan* Diagnostic paracentesis* >250 neutrophils* High protein* Low glucose* Treatment* Antibiotics* Albumin











Liver Failure Complications











* Coagulopathy* Diagnose with abnormal coagulation studies* PT with INR* Patients can be BOTH hyper and hypocoagulable











Additional Reading











* How to Perform Paracentesis (Medscape)