Editorial

Outpatient Management of Cirrhosis

Authors: Adeel B. Shibli, MD, Allan Tachauer, MD, Smruti R. Mohanty, MD, MS

Abstract

Cirrhosis is an advanced stage of liver disease caused by a variety of insults to hepatic parenchyma including infections, autoimmune processes, genetic disorders and toxins. It is characterized by extensive fibrosis with nodule formation and interruption of normal hepatic blood flow. The major complications of cirrhosis are ascites, gastroesophageal varices-related bleeding, hepatic encephalopathy, hepatorenal syndrome and hepatocellular carcinoma (HCC). Therefore, ultimate treatment of decompensated cirrhosis is liver transplantation. Hence, cirrhotics with the above complications should be referred to a hepatologist at a liver transplant center for transplant evaluation and possible listing for liver transplant. Some of the complications such as variceal bleeding and refractory ascites require hospitalization and inpatient treatment, but many of the complications can be managed on an outpatient basis. Proper outpatient care decreases the number of hospitalizations leading to decreased morbidity and mortality until the patient receives liver transplant. Cirrhotics without any complications are usually managed by screening for HCC and periodic measurement of liver tests, including coagulation profiles, until the development of complications. Abstinence from alcohol is imperative even if the cirrhosis is not a result of alcohol. Other hepatotoxins and nonsteroidal anti-inflammatory drugs should also be avoided. Acetaminophen up to 2 g/d may safely be used in most cirrhotics for pain control.

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