ABSTRACT
In Greek mythology, Prometheus defied the gods by stealing fire for all of humanity. Managing the diverse complications related to cirrhosis may require expertise from several Hercules-like specialists. Gastroesophageal varices develop in more than one-third of patients with cirrhosis and lead to significant morbidity. Cirrhotic patients with spontaneous bacterial peritonitis who received early as compared to delayed paracentesis had lower mortality and each hour delay in paracentesis was associated with a 3.3% increase in mortality. The annual incidence of hepatocellular carcinoma is 5% for those in the United States who have cirrhosis. For cirrhotic patients who require elective non-hepatic surgery, operative repair has traditionally been considered high risk. Cirrhotic patients with ascites have a high rate of umbilical hernias due to the increased intra-abdominal pressure from ascites, weakness of the abdominal fascia and muscle wasting, and/or an umbilical vein dilating the fascial opening due to portal hypertension.
