Chart — Med-Surg
Cirrhosis Complications Chart
Every complication of cirrhosis traces to one of two root failures — portal hypertension (blocked blood flow) or lost liver function (failed chemistry). Group them that way and the disease stops being a list to memorize.
Educational use only. Treatment of each complication follows provider orders and protocol; this chart maps cause to nursing response, not prescriptions. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Complications by Root Cause
| Complication | Root Cause | What You See | Nursing Response |
|---|---|---|---|
| Esophageal / gastric varices | Portal hypertension | Painless massive hematemesis or melena; the fragile collateral veins rupture | Emergency: large-bore IV, type & cross, volume; anticipate endoscopic banding; non-selective beta-blockers as prophylaxis |
| Ascites | Portal hypertension + low albumin | Abdominal distension, shifting dullness, weight gain, dyspnea from pressure on the diaphragm | Sodium restriction, diuretics (spironolactone-based), daily weight & girth; paracentesis for tense ascites (albumin after large taps) |
| Spontaneous bacterial peritonitis (SBP) | Infected ascitic fluid | Fever, abdominal pain, and worsening encephalopathy in an ascitic patient — sometimes subtle | Diagnostic paracentesis (cell count/culture), antibiotics; a high-suspicion, escalate-early complication |
| Hepatic encephalopathy | Lost ammonia detoxification | Confusion, altered LOC, asterixis (flapping tremor), elevated ammonia; GI bleeding worsens it | Lactulose titrated to 2–3 soft stools/day; rifaximin per orders; identify and treat triggers (bleeding, infection, constipation) |
| Coagulopathy & bleeding | Lost clotting-factor synthesis + low platelets | Prolonged PT/INR, easy bruising, mucosal bleeding | Bleeding precautions; vitamin K / FFP / platelets per orders; avoid IM injections and trauma |
| Jaundice & pruritus | Lost bilirubin processing | Yellow skin/sclera, dark urine, clay stools, intense itching | Skin care, cool environment, antipruritics per orders; protect skin from scratching breakdown |
| Hepatorenal syndrome | Advanced liver failure → renal hypoperfusion | Rising creatinine, falling urine output without primary kidney disease — a late, ominous sign | Monitor renal function and I&O; avoid nephrotoxins; escalate — it signals advanced decompensation |
Exam Traps
- ✦Hematemesis in cirrhosis = variceal bleed (emergency) — and it also drives up ammonia, worsening encephalopathy.
- ✦Fever + abdominal pain + new confusion in an ascitic patient = spontaneous bacterial peritonitis.
- ✦Lactulose titrates to 2–3 soft stools/day; improving mental status confirms it's working.
- ✦Rising creatinine with falling output and no kidney disease = hepatorenal syndrome, a late sign.
- ✦Bleeding precautions throughout — the cirrhotic liver can't make clotting factors.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →