Management of the complications of chronic liver disease

The complications of severe chronic liver disease result from hepatocellular failure, portal hypertension, or a combination of both. Acute variceal haemorrhage can be effectively managed by drugs, endoscopic techniques, balloon tamponade, and surgery. The advent of the transjugular intrahepatic portosystemic stent-shunt has offered a new therapeutic option. Prevention of re-bleeding also depends on endoscopic therapy or surgery. Beta-blockers have been shown to be useful, not only in preventing re-bleeding, but also in primary prophylaxis. Spontaneous bacterial peritonitis has proved to be preventable by antibiotic prophylaxis. Massive ascites can be satisfactorily treated by repeated large-volume paracentesis and albumin infusion. Hepatic encephalopathy responds to protein restriction and reduction of bowel ammonia production by classical and novel agents. Liver transplantation may be used for those with hepatorenal and hepatopulmonary syndromes and it is the ideal treatment of choice for all suitable patients with terminal chronic liver disease.