Cirrhosis (musculoskeletal manifestations)

There are several musculoskeletal complications that can arise in the setting of cirrhosis :

• 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:
  • cellulitis
  • necrotizing fasciitis
  • septic arthritis
  • spondylodiskitis
  • osteomyelitis
• 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