7 Complications of Liver Dysfunction
Understand how cirrhosis can alter hemostasis, cause jaundice through impaired bile flow, and contribute to acute kidney injury and hepatorenal syndrome.
How cirrhosis causes complications
Cirrhosis can impair bilirubin processing, alter hemostasis, and disrupt kidney perfusion. These complications require attention to the underlying process and to the clinical context rather than reliance on a single laboratory result.
and procedures
Cirrhosis reduces both procoagulant and anticoagulant factors, producing a fragile rebalanced hemostatic state. As a result, bleeding and thrombosis are both possible; cirrhosis does not protect against clotting complications.
measures only part of this system and does not reliably predict bleeding risk on its own. For a patient without active bleeding who is undergoing low-risk diagnostic paracentesis, routine plasma or platelet correction is generally not recommended. Clinical context matters, including infection, kidney injury, active bleeding, and the procedure itself.
Jaundice and impaired bile flow
Yellow eyes are a sign of jaundice, but jaundice can reflect worsening hepatocellular dysfunction, , infection, or biliary obstruction. The cause should be assessed rather than inferred from jaundice alone.
is water-soluble and can appear in urine, causing dark urine. Pale stools and an alkaline phosphatase level disproportionately elevated compared with aminotransferases raise concern for impaired bile flow. Unconjugated bilirubin is not excreted in urine.
When jaundice worsens
Rapidly worsening jaundice accompanied by fever and right-upper-quadrant pain calls for urgent assessment for infection and biliary obstruction. Evaluation can include fractionated bilirubin and liver chemistries, with imaging selected according to the presentation.
Assessment should consider intrahepatic and extrahepatic obstruction as appropriate. Jaundice alone does not establish hemolysis or exclude significant hepatobiliary disease.
Evaluating
A rising creatinine in a patient with cirrhosis and ascites should prompt assessment before attributing the problem to HRS. can result from volume depletion, infection, medications, structural kidney injury, or HRS.
Assess volume status, review medications, look for infection or other triggers, and evaluate alternative causes. Address precipitating factors promptly. Diuretics and nephrotoxic drugs such as NSAIDs may need to be withheld. HRS should be considered when kidney dysfunction does not improve after appropriate assessment and management and there is no stronger alternative explanation.
Recognizing
is associated with advanced cirrhosis and ascites, but a creatinine rise alone does not establish the diagnosis. Consensus criteria include a creatinine increase of at least mg/dL within hours, or at least from baseline within days, with no improvement after adequate volume resuscitation when clinically indicated and no strong alternative cause.
The assessment must consider other causes of kidney dysfunction. In particular, the absence of shock or clear urinary obstruction and failure to improve after appropriate volume resuscitation can support considering , but the full evaluation remains necessary.
Managing
Treatment generally combines vasoconstrictor therapy with albumin and close monitoring for complications such as ischemia or pulmonary edema. Terlipressin is a recommended option for suitable patients; norepinephrine may be used in appropriate settings.
Liver transplantation is the definitive treatment for in cirrhosis, so assessment for transplant candidacy is important.