Cirrhosis peritonitis Variceal bleeding

O Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease—ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality. 

Cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue. This scarring is accompanied by the loss of viable hepatocytes, which are the functional cells of the liver. Progressive cirrhosis is irreversible and leads to portal hypertension that is in turn responsible for many of the complications of advanced liver disease. These consequences include (but are not limited to) spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and variceal bleeding.1... 

Decompensated liver disease is complicated by jaundice, refractory ascites, bacterial peritonitis, coagulopathy, and variceal bleeding and may require liver transplantation. The number of liver transplants for decompensated cirrhosis doubled from 1990 to 2004, when 5845 cadaveric (orthotopic) liver transplants were performed (65). 

Complications such as variceal bleeding, hepatic encephalopathy, ascites and infections as well as reduced renal function also influence the mortality rate of liver cirrhosis (in Germany some 25,000/year). The main causes of death are hepatic coma or liver failure (25-40%), bleeding (20-30%), infections (about 10%) and HCC (about 5%). Spontaneous bacterial peritonitis is fatal in 50-70%, and with liver dysfunction even in 90% of cases. Occurrence of the hepatorenal syndrome is almost invariably fatal. 

Indications for transplantation include poor synthetic function, refractory ascites, subacute bacterial peritonitis, chronic encephalopathy, recurrent variceal bleeding, unacceptable quality of life, hepa-to-pulmonary syndrome, and a life expectancy of less than 18 months due to liver disease. The most common clinical conditions associated with cirrhosis requiring transplantation are chronic viral... 

Hepatic cirrhosis may be associated with portal hypertension, ascites, encephalopathy, spontaneous bacterial peritonitis, and hepatocellular carcinoma. Portal hypertension is directly responsible for the formation of esophageal varices, which may give rise to massive upper gastrointestinal bleeding. Therapy is aimed at correcting hypovolemic shock and at achieving hemostasis at the bleeding site. 

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