GIM Question 37 Instructor

List 6 complications of cirrhosis.
Cirrhosis is the result of progressive scarring of the liver, secondary to one or several pathologic processes (commonly: Hepatitis B/C, alcohol, non-alcoholic fatty liver disease).

Six possible complications of cirrhosis are:

  • Ascites
  • Spontaneous bacterial peritonitis
  • Hepatic encephalopathy (caused by metabolic abnormalities – can present with confusion and neuromuscular dysfunction (i.e. asterixes))
  • Hepatorenal syndrome
  • Esophageal varices/bleeding
  • Coagulopathy

The Childs-Pugh score is a useful tool to determine the severity of a patient’s cirrhosis. The following factors are used to determine this score:

  • Encephalopathy grade
  • Ascites
  • Total bilirubin level
  • Serum albumin level
  • PT/INR

How do you treat hepatic encephalopathy?
Treatment of hepatic encephalopathy involves:

  • Lactulose – decrease levels of serum ammonia
  • Rifaximin (can be used if hepatic encephalopathy is refractory to lactulose)
  • Potassium (if hypokalemic – hypokalemia increases renal production of ammonia)

Diagnosis and management of hepatic encephalopathy should be rapid to prevent coma and death.


  1. Heidelbaugh JJ and Bruderly M. Cirrhosis and Chronic Liver Failure: Part 1. Diagnosis and Evaluation. Am Fam Physician. 2006;74:756-762.
  2. Heidelbaugh JJ and Sherbondy M. Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment. Am Fam Physician. 2006;74:767-776.
  3. Vilstrup H et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715-735.

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