From the Guidelines
Cirrhosis management should prioritize treating the underlying cause, preventing further damage, and addressing complications, with a focus on improving morbidity, mortality, and quality of life, as recommended by the most recent guidelines 1. The most common causes of cirrhosis include chronic alcohol abuse, viral hepatitis (particularly hepatitis B and C), and non-alcoholic fatty liver disease.
- For alcoholic cirrhosis, complete abstinence from alcohol is essential.
- Patients with viral hepatitis may require antiviral medications like entecavir or tenofovir for hepatitis B, or direct-acting antivirals for hepatitis C. Complications of cirrhosis include:
- Portal hypertension
- Ascites (treated with sodium restriction and diuretics like spironolactone 100mg daily with furosemide 40mg daily) 1
- Hepatic encephalopathy (treated with lactulose 25mL 2-3 times daily)
- Variceal bleeding (managed with beta-blockers like propranolol 20-40mg twice daily) Regular screening for hepatocellular carcinoma with ultrasound every 6 months is recommended 1. Advanced cirrhosis may ultimately require liver transplantation, and the use of vasoactive drugs and intravenous albumin can be beneficial in managing certain complications, such as variceal hemorrhage and hepatorenal syndrome 1. The disease progresses silently, often diagnosed only after complications develop, highlighting the importance of early detection in high-risk individuals through regular medical evaluation. The management of cirrhosis should be guided by the most recent and highest-quality evidence, with a focus on improving patient outcomes and quality of life 1.
From the Research
Definition and Causes of Cirrhosis
- Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol 2.
- Liver fibrosis and nodule formation result in significant complications due to portal system hypertension 2.
Complications of Cirrhosis
- Complications include variceal hemorrhage, ascites, increased risk of bacterial infection, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, umbilical hernia, and hepatic hydrothorax 2.
- Variceal hemorrhage is a life-threatening event in patients with liver cirrhosis, with a high recurrence rate of 40% to 80% within one year 3.
Management and Treatment of Cirrhosis
- Beta-blockers, mainly propranolol, can significantly reduce the incidence of first variceal bleeding, but the effect on mortality is marginal 3.
- Endoscopic therapy (sclerotherapy or ligation of the varices) is effective in significantly lowering the rate of re-bleeding, and may be more effective than medical prophylaxis with beta-blockers 3.
- A combined approach of beta-blockers and endoscopic therapy may be beneficial in patients with a high risk of re-bleeding 3.
- Symptom management in patients with cirrhosis can be difficult, and requires a practical approach to managing liver-specific symptoms such as ascites, hepatic encephalopathy, and pruritus, as well as generalized symptoms like pain, depression, and fatigue 4.
Predictors of Esophageal Varices in Cirrhosis
- Predicting the presence of esophageal varices through non-invasive means may reduce the number of unnecessary endoscopies 5.
- Spleen width and portal vein diameter are independent risk factors for the presence of esophageal varices in patients with Hepatitis B virus-related cirrhosis 5.
- A predictive model using spleen width and portal vein diameter may help identify patients who would most likely benefit from screenings for esophageal varices 5.