From the Guidelines
Liver cirrhosis presents with several key signs including jaundice, ascites, edema in the legs, easy bruising or bleeding, fatigue, itchy skin, spider angiomas on the skin, and mental confusion, and management should focus on treating the underlying cause while preventing progression and complications, as recommended by recent guidelines 1. The signs of liver cirrhosis can be categorized into:
- Jaundice (yellowing of skin and eyes)
- Ascites (fluid accumulation in the abdomen)
- Edema in the legs
- Easy bruising or bleeding
- Fatigue
- Itchy skin
- Spider angiomas on the skin
- Mental confusion (hepatic encephalopathy) Management of liver cirrhosis involves:
- Treating the underlying cause, such as alcohol cessation for alcoholic cirrhosis or antiviral medications for viral hepatitis
- Controlling ascites with diuretics like spironolactone and furosemide, and sodium restriction, as recommended by the British Society of Gastroenterology and the British Association for the Study of the Liver 1
- Preventing variceal bleeding with beta-blockers such as propranolol or nadolol, as recommended by the Korean Association for the Study of the Liver 1
- Regular screening for hepatocellular carcinoma with ultrasound every 6 months
- Nutritional support with adequate protein and calories, as recent studies have shown that protein restriction is no longer recommended 1
- Considering liver transplantation evaluation for advanced cirrhosis, as it is the only curative option for untreatable ascites, as stated in the guidelines on the management of ascites in cirrhosis 1 The most recent and highest quality study recommends that patients with liver cirrhosis should be managed with a multidisciplinary approach, focusing on treating the underlying cause, preventing progression and complications, and improving quality of life, as recommended by the AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis 1.
From the FDA Drug Label
- 3 Edema Associated with Hepatic Cirrhosis or Nephrotic Syndrome Spironolactone tablets are indicated for the management of edema in the following settings: Cirrhosis of the liver when edema is not responsive to fluid and sodium restriction
The signs of liver cirrhosis are not directly listed in the drug label, but it mentions edema as a condition associated with hepatic cirrhosis that spironolactone tablets are indicated for.
- Management of liver cirrhosis with edema includes the use of spironolactone tablets when edema is not responsive to fluid and sodium restriction 2.
From the Research
Signs of Liver Cirrhosis
- Muscle cramps (approximately 64% prevalence) 3
- Pruritus (39%) 3
- Poor-quality sleep (63%) 3
- Sexual dysfunction (53%) 3
- Ascites, which is the accumulation of fluid in the peritoneal cavity 4, 5, 6
- Hepatic encephalopathy, which is a brain disorder caused by liver disease 4, 5, 6
- Variceal hemorrhage, which is bleeding from enlarged veins in the esophagus or stomach 7, 5, 6
- Hepatorenal syndrome, which is a type of kidney dysfunction that occurs in people with advanced liver disease 3, 5, 6
Management of Liver Cirrhosis
- Nonselective β-blockers (carvedilol or propranolol) to prevent variceal bleeding and decompensation 3, 7
- Lactulose for hepatic encephalopathy 3, 4, 6
- Combination aldosterone antagonist and loop diuretics for ascites 3
- Terlipressin for hepatorenal syndrome 3
- Transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal hemorrhage 5, 6
- Endoscopic band ligation for variceal bleeding 7, 5, 6
- Liver transplantation when medical therapy has failed 6