Cirrhosis and Digestive Complications: Portal Hypertension, Varices, Ascites

Cirrhosis: Digestive System Impact

Cirrhosis—irreversible hepatic fibrosis—disrupts liver architecture, causing portal hypertension and synthetic dysfunction, leading to multisystem digestive complications.

1. Portal Hypertension

Increased resistance in hepatic sinusoids → portal pressure >10 mmHg. Drives most complications.

2. Gastroesophageal Varices

• Portosystemic collaterals at gastroesophageal junction.
• Risk of rupture: 5-15%/year; mortality 15-20% per bleed.
• Screening endoscopy at diagnosis; NSBB or band ligation for prophylaxis.

3. Ascites

• Transudative fluid from sinusoidal hypertension + hypoalbuminemia + sodium retention.
• Management: salt restriction, diuretics (spironolactone ± furosemide), large-volume paracentesis + albumin, TIPS for refractory.

4. Splenomegaly & Hypersplenism

Congestive splenomegaly → thrombocytopenia, leukopenia, anemia.

5. Hepatic Encephalopathy

• Gut-derived toxins (ammonia) bypass liver → cerebral dysfunction.
• Precipitants: GI bleed, infection, constipation, sedatives, electrolyte imbalance.
• Treatment: lactulose, rifaximin, treat precipitant.

6. Malabsorption & Malnutrition

• Bile salt deficiency → fat malabsorption, steatorrhea, fat-soluble vitamin deficiency (A, D, E, K).
• Anorexia, altered metabolism → sarcopenia.

7. Other Manifestations

• Gastropathy (congestive), peptic ulcers, gallstones (pigment), pancreatitis.
• Hepatorenal syndrome (functional renal failure).
• Hepatopulmonary syndrome (intrapulmonary shunting).

Management Principles

• Etiologic treatment (antivirals, abstinence, weight loss).
• Surveillance: HCC screening (US ± AFP q6mo), variceal screening.
• Nutrition: high-protein, frequent meals, branched-chain amino acids.
• Transplant evaluation for decompensated cirrhosis (Child-Pugh B/C, MELD ≥15).