Complications of cirrhosis. A 50 years flashback

Abstract

In patients with cirrhosis and portal hypertension, it is largely the frequency and severity of complications relating to the diseased liver, degree of portal hypertension and hemodynamic derangement that determine the prognosis. It can be considered as a multiple organ failure that apart from the liver involves the heart, lungs, kidneys, the immune systems and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. With the progression of the disease development of portal hypertension leads to formation of esophageal varices and ascites. The circulation becomes hyperdynamic with cardiac, pulmonary as well as renal consequences for dysfunction and reduced survival. Infections and a changed cardiac function known as cirrhotic cardiomyopathy may be involved in further aggravation of other complications such as renal failure precipitating the hepatorenal syndrome. Patients with end-stage liver disease and related complications as for example the hepatopulmonary syndrome can only radically be treated by liver transplantation.

Key Words:

• arterial vasodilatation
• ascites
• cirrhosis
• cirrhotic cardiomyopathy
• hemodynamics
• hepatic encephalopathy
• hepatopulmonary syndrome
• hepatorenal syndrome
• esophageal varices
• portal hypertension
• portopulmonary hypertension
• vasoactive substances

Acknowledgements

Professor Søren Møller is supported by grants from the NovoNordisk Foundation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.