Feature Article

Cirrhosis: a management guide

Gokulan Pavendranathan, Simone Strasser

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Abstract

Treating the aetiology, managing the clinical manifestations and screening patients for life-threatening complications are key principles in the management of patients with cirrhosis.

Key Points

  • Every patient with newly diagnosed cirrhosis warrants a thorough assessment for the aetiology.
  • Recent deterioration in a patient or new onset ascites, jaundice or encephalopathy should prompt a thorough search for a precipitant of decompensation.
  • A low platelet count is a very useful clue to the presence of cirrhosis and portal hypertension.
  • Withdrawal or treatment of the aetiological factor may lead to reversal of decompensation and sometimes reversal of the histological changes of cirrhosis.
  • Patients with cirrhosis, particularly those with ascites, are often severely malnourished.
  • Protein intake should not be restricted in patients with severe liver disease and chronic hepatic encephalopathy.
  • All patients with cirrhosis should be screened regularly for hepatocellular carcinoma and have an endoscopy to screen for varices.
  • Patients aged less than 65 years with decompensated cirrhosis or early hepatocellular carcinoma should be considered for liver transplantation, unless contraindications apply

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