Adapted from a powerpoint presentation by Yilin Zhang, MD; Neha Deshpande, MD and Eric Lamotte, MD.
Edits, updates and graphics by Yilin Zhang, MD.
- Compensated vs. decompensated cirrhosis
- Significance of MELD-Na score
- Evaluation of acute decompensation
- Management of common complications of cirrhosis
Part 1: Overview of Cirrhosis
Part 2: Complications of Cirrhosis
Acute decompensation occurs when the there is an ↑ in MELD score or developement of one of the complications of cirrhosis. Click on each tab for additional details on each complication.
TAKE HOME POINTS:
- MELD-Na score predicts 3 month mortality and is used for liver transplant allocation.
- Acute decompensation of cirrhosis occurs when patients have an increase in their MELD-Na score or develop new complications of cirrhosis.
- The precipitants of many of the complications of cirrhosis overlap and include infection/ SBP, GI bleeding or portal vein thrombosis and initial work-up should include diagnostic paracentesis, evaluation for clinical signs of bleeding and potentially a RUQ US with duplex.
- Essentially everyone admitted to the hospital with cirrhosis and ascites should receive a diagnostic paracentesis.
- Ge, PS & Runyon, BA. Treatment of Patients with Cirrhosis. NEJM. 2016;375:767-77
- Liou, IW. Management of end-stage liver disease. Med Clin North Am. 2014 Jan;98(1):119-52.
- Sharma, BG, et al. A Randomnized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy. The American Journal of Gastroenterology. 2013; 108: 1458-1463.
- Rahimi, RS, et al. Lactulose vs polyethylene glycol 3350 –electrolyte solution for treatment of overt hepatic encephalopathy: the HELP randomized clinical trial. JAMA Internal Medicine. 2014; 174(11): 1727-33.
- Rahimi, RS & Rockey, DC. Novel Ammonia-Lowering Agents for Hepatic Encephalopathy. Clin Liver Dis. 2015; 19(3): 539-49.
- Sachar, H, Vaidya, K & Laine, L. Intermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers. JAMA Internal Mediicne. 2014; 174(11): 1755-1762.
- Villaneuva, C, et al. Transfusion Strategies for Acute Upper Gastrointestinal Bleeding. NEJM. 2013; 368: 11-2