Cirrhosis With Ascites and Gastrointestinal Bleeding: A Sign of Advanced Stage Liver Disease?

The presence of ascites and gastrointestinal bleeding in patients with cirrhosis typically indicates the final, decompensated stage of liver disease. At this point, the liver is no longer able to perform its essential functions, and complications such as portal hypertension and hepatic failure become prominent.

Recurrent Gastrointestinal Bleeding

One of the most dangerous complications of advanced cirrhosis is variceal bleeding, which occurs due to portal hypertension causing enlarged veins in the esophagus and stomach. Patients often have impaired coagulation function, marked by a reduced prothrombin activity—usually below 40%—and low platelet counts, making bleeding episodes more severe and harder to control.

Development of Ascites

Ascites, or fluid accumulation in the abdominal cavity, is another hallmark of end-stage liver disease. It primarily results from increased pressure within the portal venous system, which forces fluid out of blood vessels and into the abdominal space.

Hypoalbuminemia in Cirrhosis

As liver function deteriorates, its ability to synthesize proteins like albumin diminishes. Albumin plays a critical role in maintaining oncotic pressure in the bloodstream. When serum albumin levels fall below 32g/L, the risk of ascites significantly increases.

Other Signs of End-Stage Liver Disease

Additional complications such as hepatic encephalopathy and hepatorenal syndrome may also appear. These conditions reflect widespread organ dysfunction and signal a poor prognosis, with significantly reduced life expectancy. Patients at this stage often require evaluation for liver transplantation as a potential treatment option.