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