There are several musculoskeletal complications that can arise in the setting of cirrhosis 1:
- stigmata of portal hypertension, mainly abdominal wall varices
- hemorrhagic complications due to coagulopathy:
- spontaneous rectus hematoma
- postparacentesis abdominal wall bleeding
- infective complications as patients have immune function derangement and metabolic impairment:
- osseous non-infective complications:
- hepatic osteodystrophy
- fractures particular osteopenic femoral neck and vertebral fractures
- non-traumatic osteonecrosis (AVN) particular of the femoral head, due to alcohol intake (alcoholic cirrhosis) and steroids (e.g. primary biliary cholangitis)
- hepatocellular carcinoma osseous metastases which are most commonly multiple, lytic, expansile, hypervascular and within the thoracolumbar vertebrae
- miscellaneous:
- sarcopenia due to malnutrition which is secondary to a combination of impaired hepatic metabolic function, limited inadequate oral intake due to ascites-induced early satiety and malabsorption
- abdominal wall herniae due to the presence of high-volume ascites which increases abdominal pressure
- body fat edema (anasarca) due to portal hypertension secondary to increased mesenteric hydrostatic pressure, hypoalbuminemia and impaired aldosterone catabolism
- post-FNA needle track seeding which is rare
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