Autonomic dysfunction in cirrhosis and portal hypertension

Liver cirrhosis and portal hypertension are frequently associated with signs of circulatory dysfunction and peripheral polyneuropathy, which includes defects of the autonomic nervous system. Autonomic dysfunction, which is seen in both alcoholic and non-alcoholic liver cirrhosis and increases with severity and duration of the liver disease, is associated with a significant increase in mortality. The lack of total resolution after liver transplantation indicates that the autonomic neuropathy is not exclusively functional. This article highlights some aspects of the autonomic dysfunction in chronic liver disease. A description is given of its aetiology and the typical circulatory dysfunction with characteristic hyperdynamic and hyporeactive circulation and heart failure, and the most important tests of the autonomic nervous system.