dotphrase.org
    • Home
    • About
    • FAQs
      • FAQs
      • Best Practices
    Add a dotphrase
    Sign in or Register
    Add a dotphrase

    Decompensated Cirrhosis

    • Rate/comment
    • Bookmark
    • Dotphrase
    • Reviews 0
    • Discussion
    • prev
    • next
    • Rate/comment
    • Bookmark
    • Share
    • Volunteer to maintain page
    • Report
    • Edit dotphrase
    • prev
    • next
    Assessment & Plan (short)

    # Decompensated Cirrhosis
    Pt with known history of cirrhosis secondary to ***, with decompensation as evidenced by varices, ascites, and/or hepatic encephalopathy. MELD-Na: ***.

    #Hepatic Encephalopathy
    - Lactulose titrate to 4 BM/day, Rifaximin 550 mg BID

    #Variceal Bleeding
    - Last EGD ***
    - Octreotide gtt, PPI, CTX x 5 days

    #Ascites
    - Lasix 20mg, spironolactone 50 mg
    - Dx/Tx paracentesis
    - SBP ppx PRN

    #HCC Screening
    - AFP + US/CT/MRI every 6 months; last ***

    Assessment & Plan (long)

    # Decompensated Cirrhosis
    Pt with known history of cirrhosis secondary to ***, with decompensation as evidenced by varices, ascites, and/or hepatic encephalopathy. Child Pugh Class: ***. MELD-Na: ***. Potential precipitants of decompensation: ***.

    ##Hepatic Encephalopathy
    - Lactulose 25mL q2-3h until BM, then titrate to 3-4 BM/d. (Lactulose + Rifaximin 550 mg BID better than lactulose alone for HE reversal and all-cause mortality)

    ##Variceal bleeding
    - Baseline EGD performed?
    - Management: IV access, transfusions PRN, octreotide gtt, PPI, CTX x 5 days, and EGD; in refractory cases consider TIPS
    - Secondary prophylaxis: Propranolol with goal HR 50-60s AND Serial EVL until obliteration & then re-assessment every 6-12 months

    ##Ascites/volume overload
    - Management: 2g Na restriction, Start with 100mg/day spironolactone + 40mg/day furosemide (titrate every 3-5 days as tolerated, max doses: 400mg spironolactone, 160mg furosemide)
    - Therapeutic Paracentesis PRN, If >4L ascites removed, then transfuse 6-8g albumin for every 1L ascites removed
    - D/C Beta-Blocker as no longer beneficial once in decompensated state

    ##Spontaneous bacterial peritonitis (SBP)
    Must rule out SBP in ALL inpatients with cirrhotic ascites
    - Workup: Diagnostic Paracentesis with fluid sent for Cell count with Diff, Gram Stain, Culture, Glucose, Protein,
    - Diagnosis: >250 PMNs, regardless of GS/Cx
    - Treatment: Ceftriaxone x 5 days; 25% Albumin (1.5 g/kg day 1 & 1.0 g/kg day 3, max 100 g); d/c Beta-Blocker
    - Prophylaxis: Cipro 500mg qday

    ##HCC Screening: AFP + US/CT/MRI every 6 months; last ***

    ##Transplant candidacy: ***

    ##Healthcare maintenance:
    - Vaccinations: Pneumovax, Influenza, HAV, HBV
    - Alcohol abstinence
    - Avoid NSAIDs, limit APAP <2g/daily, avoid raw oysters/shellfish

    Description

    Modified from UCSF/SFGH v1

    Organ systems
    • Gastrointestinal
    Medical field
    • Internal medicine
    Setting
    • Inpatient
    Author
    Eric Lee
    Page info

    Originally created: March 3, 2020 by Eric Lee

    [xyz-ips snippet="lastupdated"] [xyz-ips snippet="sectioneditor"] [post-views]

    Number of revisions: [xyz-ips snippet="numrevisions"]

    References
    [xyz-ips snippet="easyfootnote"]
  • No comments yet.
  • Add a review

    Leave a Reply · Cancel reply

    Your email address will not be published. Required fields are marked *

    Overall Rating

    Evidence base

    Usefulness

    Forum

    Work in progress, do not use

    [bbp-single-forum id=5150]

    Cart

      • Facebook
      • Twitter
      • WhatsApp
      • Telegram
      • LinkedIn
      • Tumblr
      • VKontakte
      • Mail
      • Copy link