Complications of Cirrhosis

Complications of Cirrhosis

1. Malnutrition & Muscle wasting

   • Regular meals (every 2-3 hrs)
   • Low sodium
   • High protein & high calorie
   • Avoid alcohol

2. Portal HTN & Varices

   • Treatment of stable varices
     • Propranolol
     • Elastic band ligation
     • TIPS
     • Injection of Sclerosant
   • Bleeding Oesophageal Varices
     • Resuscitation
       • Terlipressin
       • Correct any coagulopathy with vitamin K and fresh frozen plasma
       • Broad spectrum Abx
       • Consider intubation & ICU
     • Urgent endoscopy
       • Injection of sclerosant
       • Elastic band ligation
     • Sengstaken-Blakemore Tube - into oesophagus - when endoscopy fails

3. Ascites Management

   • Low sodium diet
   • Anti-aldosterone diuretics - spironolactone
   • Paracentesis (ascitic tap or ascitic drain)
   • Prophylactic Abx against SBP (ciprofloxacin or norfloxacin)
   • Consider TIPS or transplant in refractory ascites

4. Spontaneous Bacterial Peritonitis (SBP)

   • Presentation
     • Can be asymptomatic - have low threshold for ascitic fluid culture
     • Fever
     • Abdo pain
     • Deranged bloods (raised WBC, CRP, creatinine or metabolic acidosis)
     • Ileus
     • Hypotension
   • Most common organisms
     • E. coli Klebsiella pnuemoniae
       • Gram positive cocci (Staphylococcus, enterococcus)
   • Management
     • Take ascitic culture before Abx > IV cephalosporin - Cefotaxime

5. Hepatorenal Syndrome

   • Renal vasoconstriction + low circulation volume > starvation of blood to kidney> rapid deteriorating function
   • Fatal within a week unless liver transplant

6. Hepatic Encephalopathy

   • Acutely, presents with reduced consciousness & confusion
     • Chronically > personality, memory, mood changes
   • Precipitating Factors
     • Constipation
     • Electrolyte disturbance
     • Infection
     • GI bleed
     • High protein diet
     • Medications
   • Manangement
     • Laxatives - lactulose - promote ammonia excretion
     • Abx - Rifaximin >reduces intestinal bacteria producing ammonia
     • Nutritional support > may need nasogastric feeding