Complications of Cirrhosis
Many of the severe complications of cirrhosis are secondary to portal hypertension, since it leads to the development of collateral flow from the portal venous system to the systemic circulation. Portal hypertension is associated with splenomegaly and hence hypersplenism and the development of collateral vessels lining the esophagus and stomach, producing varices. Esophageal varices and, less often, gastric varices are particularly prone to bleeding, which is often massive. Another complication is hypoxemia with reduced arterial O2 saturation, secondary to intrapulmonary shunting, ventilation-perfusion mismatch, and a reduction in O2 diffusing capacity. In addition, jaundice, ascites, renal failure, and hepatic encephalopathy may develop because of portal hypertension, portal-systemic shunting, other circulatory disturbances, and impaired hepatic metabolic function. Lastly, hepatocellular carcinoma frequently complicates the cirrhosis associated with chronic Hepatitis B (and perhaps Hepatitis C virus), hemochromatosis, and long-standing glycogen storage disease.