In cirrhosis, portal hypertension and hepatic dysfunction contribute to perioperative bleeding risk primarily through what mechanism?

• A. Coagulopathy and bleeding tendency
• B. Immune suppression
• C. Hypertension
• D. Hypercoagulability

Answer: (A)

The main concept is that liver failure from cirrhosis disrupts the body's ability to form stable clots. The diseased liver can’t produce enough clotting factors (such as II, VII, IX, X, and fibrinogen) and its reduced synthetic function raises the prothrombin time, reflecting a coagulopathy. At the same time portal hypertension causes splenomegaly with sequestration and destruction of platelets, leading to thrombocytopenia and impaired primary hemostasis. Taken together, these changes create a bleeding tendency, which is why perioperative bleeding risk is heightened in cirrhosis.

While there can be a complex balance of pro- and anticoagulant factors in chronic liver disease, the net effect during surgery is an increased bleeding risk from impaired coagulation and low platelets rather than immune suppression, hypertension, or a primary hypercoagulable state.