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Internal Medicine
• Varices
• Splenomegaly causing thrombocytopenia and leucopenia.
• Hepatic encephalopathy
Major causes of Cirrhosis
1) Alcohol and HCV are major causes in western world
2) HBV is the commonest cause in developing countries
3) Other causes include:
o Biliary obstruction (Intrahepatic and extrahepatic) leading to Biliary cirrhosis
o Autoimmune hepatitis.
Major complications of cirrhosis
1) Portal Hypertension (HPN)
Normal portal pressure gradient 10 -15cm of saline
Portal hypertension is said to exist when the portal pressure gradient is over 30 cm of
Portal hypertension leads to the formation of venous collateral vessels between the
portal and systemic circulation. Collateral vessels may form at several sites, the most
important clinically being those connecting the portal vein to the azygous vein that form
dilated, tortuous veins (varices) in the submucosa of the gastric fundus and
Types of portal hypertension
Presinusoidal portal HPN – increased resistance to portal blood flow into the liver
E.g. Schistosomiasis causes periportal fibrosis and presinusoidal portal HPN
Sinusoidal portal HPN – is the commonest and found in cirrhosis. The resistance is
in the sinusoids of the liver.
Post sinusoidal portal HPN – increased resistance to hepatic venous outflow from
the liver and causes include hepatic vein thrombosis and congestive heart failure.
2) Variceal hemorrhage
Esophageal varices – has a mortality of 30-60% if it bleeds
May present with hematemesis, melena, hematochezia
Treatment of Variceal hemorrhage depends on the speed and volume of bleeding.
Acutely bleeding patients should be referred to hospitals for intensive care.