COMPLICATIONS OF CHRONIC LIVER-DISEASE

Important emergencies in the patient with chronic liver disease include bleeding gastroesophageal varices, massive ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition to careful hemodynamic management and appropriate antibiotic treatment, care of the patient should be directed toward specific pharmacologic and endoscopic interventions to decrease portal hypertension and its sequelae. Recently introduced approaches include endoscopic sclerotherapy and variceal band ligation, a growing array of portal antihypertensive drugs, and transjugular intrahepatic portosystemic shunt placement under radiologic guidance. In carefully selected patients, liver transplantation may be appropriate and life saving.