Management options in decompensated cirrhosis

Abstract

Chronic injury to the liver from a variety of different sources can result in irreversible scarring of the liver, known as cirrhosis. Cirrhosis is a major cause of morbidity and mortality in the USA, and according to the Centers for Disease Control and Prevention was responsible for 31,903 deaths in 2010 alone. It is thus of the utmost importance to appropriately manage these patients in the inpatient and outpatient setting to improve morbidity and mortality. In this review, we address four major areas of cirrhosis management: outpatient management of portal hypertension with decompensation, hepatic encephalopathy, hepatorenal syndrome, and bleeding/coagulation issues. Outpatient management covers recommendations for health care maintenance and screening. Hepatic encephalopathy encompasses a brief review of pathophysiology, treatment in the acute setting, and long-term prevention. Hepatorenal syndrome is discussed in regards to pathophysiology and treatment in the hospital setting. Finally, a discussion of the assessment of coagulation profiles in cirrhosis and recommendations for bleeding and thrombosis complications is included. These topics are not all encompassing with regard to this complicated population, but rather an overview of a few medical problems that are commonly encountered in their care.

Cost‐effectiveness analysis of antiviral therapy in patients with advanced hepatitis B virus‐related hepatocellular carcinoma treated with sorafenib

“…A large part of patients with hepatitis B will develop cirrhosis and complications of end‐stage liver disease . Previous studies have shown the marked decrease in survival among patients with decompensated cirrhosis . In our study, we have demonstrated that antiviral therapy may decrease the progression of cirrhosis, hepatic decompensation, and prolong the survival of patients with advanced HBV‐related HCC.…”

The Pharmabiotic Approach to Treat Hyperammonemia

“…The lower CDR indicates a less diverse gut microbial composition and is associated with increased scores in the model for end-stage liver disease (MELD) and with increased intestinal permeability [ 118 ]. Decompensated cirrhotic patients with hepatic encephalopathy had a more reduced gut microbial diversity compared to cirrhotic patients [ 119 ].…”

Hepatorenal syndrome

“…45 Improvement in renal failure is associated with a better prognosis and higher survival rates after liver transplant. 46 The medication is intravenously administered 1 mg/4-6 h and doses are increased based on creatinine in addition to 1 mg/kg albumin. 42 If no response is seen in creatinine level after 3 days, the dose of terilepssin is doubled.…”

“…47 Midodrine is administered orally, 7.5 mg three times daily and octreotide 100-200 μg is administered as subcutaneous injections three times daily. 25,46 Norepinephrine Norepinephrine is a catecholamine with alpha-adrenergic activity. In the United States, it is an alternative to terlipressin that has been studied extensively.…”