Key Concepts

© Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease: ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE). Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality.

O1 Chronic excessive ingestion of ethanol causes progressive liver damage because both ethanol and its metabolic products are direct hepatotoxins.

Cirrhosis is irreversible; treatments are directed at limiting disease progression and minimizing complications.

Nonselective P-blockers are first-line treatment for preventing variceal bleeding; they vasoconstrict the splanchnic bed through multiple mechanisms.

® The goals of treating ascites are to minimize acute discomfort, reequilibrate ascitic fluid, and prevent SBP. Treatment should modify the underlying disease pathology; without directed therapy, fluid will rapidly reaccumulate.

Cirrhosis is a high aldosterone state; spironolactone is a direct aldosterone antagonist and a primary treatment for ascites.

'©' During acute variceal hemorrhage, it is crucial to control bleeding, prevent rebleeding, and avoid acute complications such as SBP.

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