Pay attention to the course of liver cirrhosis, don't wait for these 5 major complications to know the danger!

One

• Includes ascites, pleural effusion, and pericardial effusion
  .
  

• Chyloastic ascites: milky in appearance, with triglyceride levels in ascites greater than 200 mg/dl (11.
  11 mmol/L) support the diagnosis, and < 50 mg/dl excludes the diagnosis<b20>.
  

• Can occur in all stages of cirrhosis, and should exclude obstruction or destruction
  of abdominal or thoracic lymphatic vessels caused by malignancy, abdominal surgery, sclerotherapy-related thoracic duct injury, infection (especially tuberculosis, filariasis), and congenital anomalies.
  

• Bloody ascites: defined as ascites with a red blood cell count > 50,000/mm3
  .
  

• Bloody ascites should be excluded, and other causes such as severe infection (including tuberculous peritonitis), coagulopathy, and variceal rupture may also present with bloody ascites, ranging in appearance from washed to venous blood
  .
  

• Pleural effusion: other causes
  such as tuberculosis need to be excluded.
  Patients with cirrhosis with pleural effusion are more common on the right side, and ascites enters the chest cavity through a diaphragmatic defect due to inhalation
  .
  In severe cases, bilateral pleural effusions may occur, and a small number of patients have left pleural effusions alone, and chest ultrasound or x-ray can confirm the diagnosis
  .
  

• If pleural effusion is combined with spontaneous bacterial infection, the prognosis is not good, and the median survival is 8~12 months
  .
  

Two

• Ruptured esophageal and gastric varices are the most common cause
  of gastrointestinal bleeding in cirrhosis.
  

• Portal hypertensive gastropathy (PHG) is caused by excessive pressure in the portal vein and its affiliated blood vessels, according to the definition of the 1992 Milan Conference: gastric mucosal and submucosal vasodilation can be seen on gastroscopy, showing "snakeskin changes" and "mosaic"
  .
  

• PHG is the second leading cause of gastrointestinal bleeding in cirrhosis, after esophageal and gastric variceal bleeding, and multiple studies have shown that PHG is also a high risk factor
  for predicting the first bleeding of gastric varices.
  

• 64% of patients with antral telangiectasia (GAVE) are cirrhosis of the liver, the average BMI is also higher in GAVE patients, and diabetes and nonalcoholic fatty cirrhosis are more common
  in GAVE patients.
  

• Portal hypertension enteropathy (PHE) is a lesion characterized by intestinal vasodilation of portal hypertension, which is divided into portal hypertension colopathy and portal hypertension small enteropathy (including duodenal disease, jejunal disease, ileal disease), etc
  .
  Most patients have no obvious symptoms, some patients show gastrointestinal bleeding, abdominal distention, abdominal pain, most of them are lower gastrointestinal bleeding, mostly black stool, fecal occult blood positive, individual patients may have gastrointestinal bleeding
  .
  

• Internal hemorrhoids are one of the common manifestations of cirrhosis and are often overlooked
  .
  

• Internal hemorrhoids and PHE are important causes
  of lower gastrointestinal bleeding in patients with cirrhosis.
  

• Portal hypertension cholangiosis (PHB) refers to the abnormality of the bile duct tree (including duodenal cystic duct and gallbladder) associated with cirrhosis of the liver cirrhosis, abnormal or thickened bile duct wall, bile duct stenosis, bile duct/gallbladder wall varices, chronic cholecystitis, and loss of bile ducts
  .
  Most patients have no obvious discomfort, and a few patients may have fever, epigastric pain, jaundice, skin itching and other symptoms
  .
  Magnetic resonance cholangiopancreatography (MRCP) is the preferred modality, and endoscopic retrograde cholangiopancreatography (ERCP) can assist in diagnosis and treatment
  .
  

Three

• SBP is a peritonitis that occurs on the basis of cirrhosis of the liver, and occurs without a clear source of intra-abdominal lesions (e.
  g.
  , intestinal perforation, intestinal abscess), and pathogenic microorganisms invade the abdominal cavity, which is a common complication
  in patients with end-stage liver disease such as cirrhosis.
  

• In addition to SBP, common infections in patients with cirrhosis include urinary tract, biliary system, gastrointestinal tract, respiratory tract, skin and soft tissue infections, and sepsis
  .
  The clinical manifestations are diverse, and the symptoms are often atypical, or even insidious in onset, which is easy to miss the diagnosis
  .
  Patients with secondary peritonitis, endocarditis, pneumonia, and sepsis have a poor
  prognosis.
  

• Infection is considered a common precipitating factor
  for liver failure in cirrhosis.
  

• Patients with cirrhosis have liver microcirculation disorders, local and systemic inflammation of the liver, immune disorders, and intestinal microecological imbalances, which are all risk factors
  for infection.
  Conversely, infection is also a high-risk factor
  for complications and death in patients with cirrhosis.
  

Four