| 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.
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