Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Develops in 15% of alcoholics• Alcoholism most common cause• Other causes include:-Idiopathic-Viral hepatitis-Hemochromatosis-Wilson disease-Primary biliary cirrhosis-Primary sclerosing cholangitis-Budd-Chiari syndrome-Tricuspid regurgitation or stenosis• Chronic allograft rejection in patients with liver transplant +++ Epidemiology + • Increasing incidence in United States• Males affected more than females• Third leading cause of death among men during the fifth decade• 10-30% of patients with chronic hepatitis B and C have cirrhosis• 30% mortality rate at 1 year after diagnosis• Variceal bleeding, 50%• Variceal bleed mortality, 50%• Viral hepatitis most common worldwide +++ Symptoms and Signs + • Jaundice• Ascites• Bleeding varices• Edema• Spider angiomas• Dark urine• Light-colored stools• Encephalopathy• Splenomegaly• Hepatomegaly (early)• Palmar erythema• Gynecomastia• Dupuytren contractures• Dyspnea +++ Laboratory Findings + • Hyperbilirubinemia• Hypoalbuminemia• Prolonged prothrombin time• Elevated creatinine• Occasional elevated transaminases +++ Imaging Findings + • Ascites on CT or US• Hepatic fibrosis and nodularity on CT or US• Hepatofugal portal vein flow on duplex or thrombosis• Splenomegaly on CT• Dilated venous collaterals on CT + • Etiology (alcohol, viral, hemochromatosis, Wilson disease)• Liver biopsy• Hepatoma• GI bleeding• Infection• Model for End-Stage Liver Disease (MELD) criteria: -Bilirubin-International normalized ratio (INR)-Creatinine (Cr)-Etiology• MELD change over timeChild-Pugh classification of functional status in liver diseases. ++Table Graphic Jump Location|Download (.pdf)|PrintClass: ABCRisk: LowModerateHighAscitesAbsentSlight to moderateTenseEncephalopathyNoneGrades I-IIGrades III-IVSerum albumin (g/dL)≥ 3.53.0-3.5< 3.0Serum bilirubin (g/dL)< 2.02.0-3.0> 3.0Prothrombin time (seconds above control)< 4.04.0-6.0> 6.0 +++ Rule Out + • GI bleeding, hepatoma, and infection all could cause cirrhotic decompensation or first presentation of cirrhosis + • History and physical exam• Liver function tests• Renal function tests• Hepatitis serologies• Liver biopsy (for unclear cases)• Esophagoscopy with or without sclerotherapy for varices +++ When to Admit + • Decompensated cirrhosis +++ Surgery + • Liver transplantation• Resection for selected hepatomas• Radiofrequency ablation for selected hepatomas• Transjugular intrahepatic portasystemic shunt (TIPS) vs surgical shunt for portal hypertension +++ Indications + • Relative MELD score for liver transplantaion• Residual liver function for resection vs radiofrequency ablation for hepatoma• Bleeding varices for shunt +++ Contraindications + • To liver transplantation-Continued alcoholism-Medical comorbidities +++ Medications + • Aldactone• Lactulose• β-Blockers• Low protein, low salt diet• Change ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth