1) Portal hypertension, which leads to:

• Ascites
• Esophageal varices (d.t. left gastric vein engorgement) and bleeding from it

P.S. Ascites here is caused by increased blood hydrostatic pressure.

2) Decreased serum Albumin, which leads to:

• Ascites
• Edema (usually in the lower limb)

P.S. Liver is the main ‘albumin factory’. When albumin is low, blood oncotic pressure drops. Thus, the fluid leaks into the tissues easily (transudation), manifesting as ascites and edema.

3) Elevated Partial Thromboplastin Time (PTT)
Bleeding (purpura, echymosis,…)

P.S. Liver synthesizes ALL clotting factors except factor VIII and vWF.

4) Jaundice (variable)

5) Hepatic encephalopathy (variable), which leads to:

• Personality changes
• Mental changes
• Sleep disturbances
• Flabbing tremors (asterixis)
• Coma and death

6) Clubbing of fingers/toes (d.t. portopulmonary shunts leading to hypoxia)