TY - CHAP M1 - Book, Section TI - Management of the Patient with Cirrhosis A1 - Roccaro, Giorgio A1 - Subramanian, Ram M. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. Y1 - 2023 N1 - T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSPortal hypertension, resulting from increased intrahepatic resistance to portal flow and increased portal inflow, underlies the transition from compensated to decompensated cirrhosis.The sequelae of portal hypertension affect each organ system, requiring multidisciplinary management.Grades III and IV hepatic encephalopathy require immediate ICU transfer and elective intubation for airway protection.Pulmonary derangements resulting from portal hypertension may be severe and include hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax.Hepatorenal syndrome is a diagnosis of exclusion and is characterized by functional renal impairment in the setting of advanced liver disease, portal hypertension, circulatory dysfunction, and increased activity of the renin-angiotensin system.Spontaneous bacterial peritonitis is a common known precipitant of HRS, which is associated with increased mortality in cirrhotic patients; therefore empiric antibiotic treatment is warranted in patients in whom the suspicion for SBP is high.Aggressive intravenous resuscitation, airway protection, and early endoscopic management of cirrhotic patients presenting with suspected variceal bleeding is critical. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/10 UR - accesssurgery.mhmedical.com/content.aspx?aid=1201809925 ER -