SHM's Clinical Quick Talks-Cirrhosis

Pdf Summary
The document titled "Cirrhosis" by Dustin T. Smith focuses on recognizing, evaluating, and managing decompensated cirrhosis. Cirrhosis involves irreversible nodular scarring of the liver due to hepatocellular injury, impairing liver function. It affects approximately 1 in 400 adults in the U.S., with many cases being undiagnosed.<br /><br />**Etiologies:** Key causes include alcohol, non-alcoholic fatty liver disease (MASLD), viral hepatitis, chronic biliary disease, autoimmune hepatitis, cardiovascular conditions (e.g., Budd-Chiari syndrome), certain medications, and storage diseases (like hemochromatosis and Wilson disease).<br /><br />**Presentation of Decompensated Cirrhosis:** Clinically, patients may exhibit jaundice, gastrointestinal bleeding, ascites, and encephalopathy. Physical examination can reveal signs such as asterixis, firm liver, splenomegaly, and cutaneous manifestations (e.g., gynecomastia, spider angiomata). Laboratory abnormalities typically include elevated bilirubin, AST, and ALT, along with changes in PT/INR and albumin levels.<br /><br />**Workup and Diagnostic Procedures:** Initial evaluation often includes an abdominal ultrasound with Doppler. Additional labs based on patient history may include viral hepatitis panels, autoimmune markers, and iron studies. Diagnostic paracentesis is recommended for new onset or worsening ascites and involves analyzing ascitic fluid to guide treatment. Ascites is categorized by serum ascites albumin gradient (SAAG) into high or low protein content, indicating different underlying causes.<br /><br />**Management of Complications (V-I-B-E-S):** <br /><br />- **Volume/Ascites:** Managed through therapeutic paracentesis, diuretics, sodium/fluid restriction, and sometimes albumin infusion.<br />- **Infection (e.g., Spontaneous Bacterial Peritonitis - SBP):** Treated with antibiotics and prophylactic measures.<br />- **Bleeding:** Variceal bleeding requires hemostasis, endoscopic intervention, and medications.<br />- **Encephalopathy:** Treated with lactulose and rifaximin.<br />- **Syndromes:** Hepatorenal syndrome is managed with IV albumin, vasopressors, and supportive care.<br /><br />**Clinical Pearls:**<br />1. Effective management of cirrhosis and associated complications can improve survival and necessitates a systematic approach emphasizing both treatment and prevention.<br />2. Diagnostic paracentesis should be routine for new or hospitalized patients with ascites.<br />3. Albumin use is critical in specific scenarios to prevent complications like circulatory dysfunction and hepatorenal syndrome.<br /><br />**When to Use This Knowledge:** For patients with a new diagnosis or acute decompensation of liver disease.<br /><br />**Resources:** The document references several high-value resources for further reading, including articles and guidelines related to the diagnosis and management of cirrhosis.
Asset Subtitle
Dustin Thomas Smith
Keywords
Cirrhosis
Decompensated cirrhosis
Liver scarring
Hepatocellular injury
Ascites
Encephalopathy
Spontaneous Bacterial Peritonitis
Hepatorenal syndrome
Paracentesis
Liver disease management