Complications of chronic liver disease

The patient with advanced cirrhosis presents unique challenges to the critical care physician, in great measure because of the protean functions attributable to the liver and the multiplicity of derangements that may occur. Portal hypertension, once it develops, is the source of potentially devastating complications that include life-threatening hemorrhage, infection, renal failure, and coma. Parenchymal disease can result in coagulopathy as well as altered handling of both endogenous (hormones, metabolites) and exogenous (drugs) substances. Cirrhosis also can be complicated by the development of HCC, which may worsen portal hypertension, deplete parenchymal reserves, and result in catastrophic complications. The prospect of cure by liver transplantation in selected cases serves to underscore the importance of prompt and vigilant management of patients with decompensated cirrhosis in the critical care setting.