Cirrhosis — complications to watch
Portal hypertension: esophageal varices that bleed massively, ascites, splenomegaly. Hepatic encephalopathy: confusion, altered sleep-wake cycle, asterixis (flapping tremor), rising ammonia. Lactulose is titrated to two or three soft stools per day. Coagulopathy: the liver makes clotting factors, so bleeding risk rises. Hypoalbuminemia: edema and ascites. Jaundice and pruritus. Watch for a change in mental status: it is often the first sign of decompensation, and it is easy to attribute to something else.