Chronic Liver Disease, Cirrhosis, and Complications: Part 1 (Portal Hypertension, Ascites, Spontaneous Bacterial Peritonitis (SBP), and Hepatorenal Syndrome (HRS))

Abstract

Portal hypertension due to cirrhosis or pre- or posthepatic vascular events is a major cause of morbidity and mortality at all ages. Signs and symptoms of portal hypertension are primarily the result of decompression of elevated portal blood pressure through portosystemic collaterals. The major problems in children are bleeding varices, ascites and its complications (spontaneous bacterial peritonitis and hepatorenal syndrome), and malnutrition. Encephalopathy and portopulmonary hypertension, while important when they do occur, are seen less frequently in children. Splenomegaly with or without hypersplenism are common presenting features but rarely require specific intervention. Children with these conditions provide special challenges in understanding and management because of a predominance of congenital etiologies, combined with growth and developmental considerations.