Ascites, hyponatremia, and variceal bleeding are complications associated with advanced chronic liver disease and portal hypertension.

Ascites should be managed with dietary sodium intake restriction and diuretics (spironolactone alone or in combination with furosemide). In patients with refractory ascites, transjugular intrahepatic portosystemic shunt (TIPS) should be considered.

Hypovolemic hyponatremia is rare and should be managed by stopping diuretics and expanding the plasma volume with isotonic solutions. Hypervolemic hyponatremia should be managed with fluid and dietary sodium restriction.

Primary prophylaxis of acute gastroesophageal variceal bleeding should be based on non-selective beta blockers (NSBB). Preemptive use of TIPS in patients with variceal bleeding and high risk of failure and rebleeding should be considered. Secondary prophylaxis should be based on NSBB plus endoscopic band ligation.