Skip to Main Content

Source: Sease JM. Portal Hypertension and Cirrhosis. In: DiPiro JT, Talbert RL, Yee GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. Accessed April 27, 2012.

  • Diffuse injury to liver characterized by destruction of hepatocytes and their replacement by fibrous tissue.

  • Most common causes are excessive alcohol intake and chronic viral hepatitis (types B and C, Table 1).

Table 1. Etiology of Cirrhosis

  • Elevation of portal blood pressure because of fibrotic changes within hepatic sinusoids, changes in levels of vasodilatory and vasoconstrictor mediators, and increase in blood flow to splanchnic vasculature.
  • Resistance to blood flow contributes to portal hypertension and the development of varices, ascites, hepatic encephalopathy (HE), and coagulopathy.
  • Portal hypertension characterized by:
    • Hypervolemia
    • Increased cardiac index
    • Hypotension
    • Decreased systemic vascular resistance

  • Ranges from asymptomatic, with abnormal laboratory or radiographic tests, to decompensated with ascites, spontaneous bacterial peritonitis, HE, or variceal bleeding.

Signs and Symptoms

  • Anorexia
  • Malaise
  • Weight loss
  • Pruritus
  • Jaundice
  • Palmar erythema
  • Spider angiomata
  • Hyperpigmentation
  • Hepatomegaly
  • Splenomegaly
  • Ascites
  • Edema
  • Pleural effusion
  • Respiratory difficulties
  • Coagulopathy
  • Mental status changes

Means of Confirmation and Diagnosis

Laboratory Tests

  • No laboratory or radiographic tests of hepatic function can accurately diagnose cirrhosis.
  • Routine liver function tests include alkaline phosphatase, bilirubin, aspartate transaminase (AST), alanine aminotransferase (ALT), and γ-glutamyl transpeptidase (GGT).
  • Albumin and prothrombin time (PT)
  • Complete blood count (CBC): Thrombocytopenia relatively common feature in chronic liver disease; found in 15–70% of cirrhotic patients.

  • Clinical improvement or resolution of acute complications
    • Resolution of hemodynamic instability
  • Prevention of complications
    • Adequate lowering of portal pressure with medical therapy
    • Support of abstinence from alcohol

  • Identify and eliminate causes of cirrhosis (e.g., alcohol abuse).
  • Assess risk for variceal bleeding and begin pharmacologic prophylaxis where indicated, reserving endoscopic therapy for high-risk patients or acute bleeding episodes.
  • Evaluate for clinical signs of ascites and manage with pharmacologic treatment (e.g., diuretics) and paracentesis. Careful monitoring for spontaneous bacterial peritonitis (SBP) in patients with ascites who undergo acute deterioration.
  • HE is common complication of cirrhosis and requires clinical vigilance and treatment with ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.