Ascites, Hepatorenal Syndrome, and Encephalopathy

Abstract The portal hypertension and hepatic synthetic dysfunction of cirrhosis cause three main complications as liver disease progresses: variceal bleeding, ascites, and hepatic encephalopathy. Ascites is the most common major complication of cirrhosis and occurs in about 50% of patients with compensated cirrhosis in 10 years. The development of ascites denotes the transition from compensated to decompensated cirrhosis. Hepatic encephalopathy is a debilitating complication of cirrhosis for which therapies are still very limited and nonspecific. Furthermore, no weight is given for this complication in the MELD system for organ allocation, resulting in considerable morbidity for patients and a burden for families and the health care system. In chronic liver disease, noxious substances, presumed nitrogenous compounds from protein breakdown, are ineffectively detoxified or bypassed (or both) by the diseased liver and affect the brain, causing a neuropsychiatric syndrome called hepatic encephalopathy.