Summary of the Management of Compensated and Decompensated Cirrhosis - Flowchart
Summary of the Management of Compensated and Decompensated Cirrhosis - Flowchart Cirrhosis Cirrhosis
«Flowchart»

Cirrhosis

Cirrhosis

Cirrhosis

Cirrhosis

Compensated

Compensated

Compensated Compensated

Decompensated

Decompensated

Decompensated Decompensated

End

End

End

HCC surveillance
US, AFP q6mos

HCC surveillance
US, AFP q6mos

HCC surveillance
HCC surveillance

Varices surveillance

Varices surveillance

Varices surveillance Varices surveillance

Monitor INR, albumin, bilirubin

Monitor INR, albumin, bilirubin

Monitor INR, albumin, bilirubin Monitor INR, albumin, bilirubin

No varices
Repeat EGD in 3 yr

No varices
Repeat EGD in 3 yr

No varices
No varices

Small varices
Repeat EGD in 2 yr

Small varices
Repeat EGD in 2 yr

Small varices
Small varices

Large varices


Nonselective β-blockers
Ligation in those intolerant

Large varices

Large varices


Nonselective β-blockers
Ligation in those intolerant


Nonselective β-blockers β
Ligation in those intolerant Large varices

Monitor INR, albumin, bilirubin

Monitor INR, albumin, bilirubin

Monitor INR, albumin, bilirubin Monitor INR, albumin, bilirubin

Monitor creatinine

Monitor creatinine

Monitor creatinine Monitor creatinine

Variceal hemorrhage


Early vasoconstrictors + endoscopic therapy (ligation)
Do not overtransfuse
Short-term antibiotic prophylaxis
Prevent rebleeding with propranolol + ligation

Variceal hemorrhage

Variceal hemorrhage


Early vasoconstrictors + endoscopic therapy (ligation)
Do not overtransfuse
Short-term antibiotic prophylaxis
Prevent rebleeding with propranolol + ligation


Early vasoconstrictors + endoscopic therapy (ligation)
Do not overtransfuse
Short-term antibiotic prophylaxis
Prevent rebleeding with propranolol + ligation Variceal hemorrhage

Ascites


Salt restriction
Diuretics (spironolactone-based)
Avoid NSAIDs
No water restriction unless serum Na <130
Low threshold to perform diagnostic paracentesis to r/o SBP
If renal dysfunction occurs, d/c diuretics, expand volume with albumin, and identify and treat conditions: Sepsis, hemorrhage, diarrhea, nephrotoxic agents, etc.

Ascites

Ascites


Salt restriction
Diuretics (spironolactone-based)
Avoid NSAIDs
No water restriction unless serum Na <130
Low threshold to perform diagnostic paracentesis to r/o SBP
If renal dysfunction occurs, d/c diuretics, expand volume with albumin, and identify and treat conditions: Sepsis, hemorrhage, diarrhea, nephrotoxic agents, etc.


Salt restriction
Diuretics (spironolactone-based)
Avoid NSAIDs
No water restriction unless serum Na <130
Low threshold to perform diagnostic paracentesis to r/o SBP
If renal dysfunction occurs, d/c diuretics, expand volume with albumin, and identify and treat conditions: Sepsis, hemorrhage, diarrhea, nephrotoxic agents, etc. Ascites

Hepatic encephalopathy


Identify and treat precipitating factor (GI hemorrhage, infection, prerenal azotemia, constipation)
Lactulose to obtain 2-3 BM/day
Rifaximin in patients intolerant to lactulose and added to lactulose in those with recurrent encephalopathy
No long-term protein restriction

Hepatic encephalopathy

Hepatic encephalopathy


Identify and treat precipitating factor (GI hemorrhage, infection, prerenal azotemia, constipation)
Lactulose to obtain 2-3 BM/day
Rifaximin in patients intolerant to lactulose and added to lactulose in those with recurrent encephalopathy
No long-term protein restriction


Identify and treat precipitating factor (GI hemorrhage, infection, prerenal azotemia, constipation)
Lactulose to obtain 2-3 BM/day
Rifaximin in patients intolerant to lactulose and added to lactulose in those with recurrent encephalopathy
No long-term protein restriction Hepatic encephalopathy