Expansion
Portal hypertension and hepatocellular failure, each with its own complications
Expansion
From portal hypertension
- Varices: oesophageal, gastric, rectal, caput medusae
- Ascites and spontaneous bacterial peritonitis
- Splenomegaly with hypersplenism, causing thrombocytopenia
- Hepatic encephalopathy, from shunted ammonia
- Hepatorenal and hepatopulmonary syndromes
From hepatocellular failure
- Hypoalbuminaemia: oedema
- Coagulopathy: prolonged prothrombin time
- Jaundice
- Failure of hormone metabolism: gynaecomastia, spider naevi, palmar erythema, testicular atrophy
- Impaired drug metabolism
- Hypoglycaemia
Plus: hepatocellular carcinoma, for which cirrhosis of any cause is the main risk factor, warranting surveillance.
Pathology: cirrhosis is defined by diffuse fibrosis with regenerative nodules, which distorts the vascular architecture. It is the distortion, not the fibrosis alone, that causes portal hypertension.
Causes: alcohol, non-alcoholic fatty liver disease, hepatitis B and C, haemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency, primary biliary cholangitis and autoimmune hepatitis.