Cirrhosis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Overview

Cirrhosis is the final stage of chronic liver disease, characterized by replacement of normal liver architecture with fibrosis (scar tissue) and regenerative nodules.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Chronic right side heart failure

Common Causes

• Alcoholic liver disease
• Autoimmune hepatitis
• Chronic hepatitis B
• Chronic hepatitis C
• Drug induced liver disease
• Hemochromatosis
• Non alcoholic steatohepatitis
• Primary billiary cirrhosis
• Secondary billiary cirrhosis
• Wilson disease

Management

Shown below is an algorithm summarizing the approach to [[Cirrhosis]].

Initial Work Up for Cirhosis

History of jaundice, pruritis, weakness, abdominal distention, confusion, upper GI bleed

Signs of liver failure on examination

Send ivestigations, CBC, LFTs, serum chemistry, abdominal USG

Liver biopsy for definitive diagnosis (not required if clinical, laboratory and radiology data suggest cirrhosis)

Further Management of Cirrhosis after Diagnosis

Patient diagnosed with cirrhosis

MELD score

>15

<15

Consider referring patient to a transplant center

De-compensated cirrhosis (with complications)

Compensated cirrhosis (complications)

Slower disease progression

Alcohol abstinence, antiviral treatment for hepatitis related cirrhosis, avoidance of hepatotoxic agents, vaccination against Hep A and Hep B

Varices

Ascites

Hepatorenal Syndrome

Hepatic encelopathy

References

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