Beyond Varices: Complications of Cirrhotic Portal Hypertension in Pediatrics

 

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Abstract

Complications of cirrhotic portal hypertension (PHTN) in children are broad and include clinical manifestations ranging from variceal hemorrhage, hepatic encephalopathy (HE), ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS) to less common conditions such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy. The approaches to the diagnosis and management of these complications have become standard of practice in adults with cirrhosis with many guidance statements available. However, there is limited literature on the diagnosis and management of these complications of PHTN in children with much of the current guidance available focused on variceal hemorrhage. The aim of this review is to summarize the current literature in adults who experience these complications of cirrhotic PHTN beyond variceal hemorrhage and present the available literature in children, with a focus on diagnosis, management, and liver transplant decision making in children with cirrhosis who develop ascites, SBP, HRS, HE, and cardiopulmonary complications.

Lay Summary

Children who develop worsening of liver disease and cirrhosis can experience other complications including the development of fluid and/or infection of this fluid in the abdomen, abnormalities in kidney function, and changes in the lungs and heart. There are many recommendations in adults for physicians to help treat these conditions; however, there is very limited information in children. The goal of this article is to provide an overview of how physicians diagnose and manage these complications in adults and provide the current data available in children who experience these complications.

Publication History

Article published online:
26 December 2022

© 2022. Thieme. All rights reserved.

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