Rapid Clinical Updates: Inpatient Management of Cirrhosis-Slides

Pdf Summary

This document is a hospital medicine/hepatology presentation on inpatient management of cirrhosis. It emphasizes practical steps for common decompensations and complications.

Key points include:
- <strong>Ascites:</strong> New-onset or hospitalized ascites should prompt <strong>diagnostic paracentesis</strong>. Fluid studies should include cell count, culture, albumin, protein, and Gram stain. SAAG ≥ 1.1 suggests portal hypertension; PMN ≥ 250/mm³ indicates <strong>spontaneous bacterial peritonitis (SBP)</strong>. Ascites management includes sodium restriction, spironolactone-based diuresis, furosemide as needed, and albumin after large-volume paracentesis.
- <strong>SBP:</strong> Treat promptly with <strong>ceftriaxone or broader antibiotics</strong> plus IV albumin in appropriate patients, and repeat paracentesis at 48 hours if needed.
- <strong>Hepatic encephalopathy:</strong> <strong>Ammonia levels are not useful</strong> for diagnosis or management. First-line therapy is <strong>lactulose</strong>, with rifaximin used to reduce recurrence/readmissions.
- <strong>HRS-AKI:</strong> In cirrhotics with acute kidney injury, stop diuretics, give an <strong>albumin challenge</strong>, and consider vasoconstrictors (e.g., norepinephrine or terlipressin) if true hepatorenal syndrome is suspected. Watch for pulmonary edema.
- <strong>Variceal bleeding:</strong> Management includes <strong>octreotide</strong>, <strong>ceftriaxone prophylaxis</strong>, GI consultation, endoscopy/banding, and restrictive transfusion (Hgb 7–9).
- <strong>Coagulopathy:</strong> Routine <strong>FFP is discouraged</strong> before low-risk procedures like paracentesis because it does not meaningfully improve hemostasis and can worsen portal pressure and cause complications.
- <strong>Advanced care:</strong> MELD/CTP scores help estimate surgical risk, and early palliative care, advance care planning, and transplant referral are encouraged.
- <strong>Alcohol use disorder:</strong> Important treatment options include <strong>naltrexone</strong> and <strong>gabapentin</strong>, along with linkage to care.

Overall, the presentation stresses early recognition, targeted treatment, and avoiding low-value or harmful interventions.

Meta Tag

Concept Cirrhotic Ascites

Concept Cirrhosis

Concept Diagnostic Paracentesis

Concept Serum-Ascites Albumin Gradient

Concept Portal Hypertension

Concept Spontaneous Bacterial Peritonitis

Concept Hepatic Encephalopathy

Concept Hepatorenal Syndrome

Concept Variceal Upper Gastrointestinal Bleeding

Keywords

cirrhosis

ascites

diagnostic paracentesis

spontaneous bacterial peritonitis

hepatic encephalopathy

lactulose

hepatorenal syndrome

variceal bleeding

octreotide

albumin challenge

Cirrhotic Ascites

Cirrhosis

Diagnostic Paracentesis

Serum-Ascites Albumin Gradient

Portal Hypertension

Spontaneous Bacterial Peritonitis

Hepatic Encephalopathy

Hepatorenal Syndrome

Variceal Upper Gastrointestinal Bleeding