Which liver condition increases the risk of bleeding and postoperative ascites?

• A. Cirrhosis
• B. Fatty liver without cirrhosis
• C. Hepatitis A
• D. Alcoholic hepatitis

Answer: (A)

Cirrhosis best explains why both bleeding risk and postoperative ascites are heightened. In cirrhosis, scar tissue and nodular regeneration disrupt normal liver function and create portal hypertension. The elevated pressure in the portal system increases the likelihood of bleeding, especially during or after surgery, and it promotes the development of varices and a fragile coagulation system. The diseased liver also has impaired synthesis of clotting factors and platelets often become reduced from splenomegaly, further tipping toward bleeding.

At the same time, cirrhosis lowers the liver’s ability to produce albumin, which decreases oncotic pressure and allows fluid to accumulate in the abdomen. Portal hypertension adds hydrostatic pressure that pushes fluid into the peritoneal cavity, leading to ascites. In contrast, fatty liver without cirrhosis, acute hepatitis A, or alcoholic hepatitis without established portal hypertension and significant synthetic dysfunction carry a lower or more variable bleeding and ascites risk.