Describe the general principles.
Treat the underlying condition
Screen for, recognize, and treat complications and decompensations
Describe the supportive care concerning “avoid hepatotoxic substances”.
Alcohol
Complete abstinence is recommended for patients with cirrhosis.
Initiate treatment for alcohol disorder if present.
Typical drugs to avoid include:
NSAIDs
Opiates
Benzodiazepines in hepatic encephalopathy
Stop nonessential medications.
Describe the prophylaxis.
Nonselective beta blockers (e.g., propranolol) may be indicated for prophylaxis of esophageal varices and to prevent variceal bleeding
Routine vaccinations: pneumococcal (PPSV23), hepatitis A, hepatitis B, influenza, SARS-CoV-2, and tetanus
Avoidance of raw seafood and unpasteurized dairy
Prophylactic antibiotics (e.g., after previous spontaneous bacterial peritonitis or GI bleeding)
Describe the liver transplantion.
A liver transplant is the only curative option in patients with cirrhosis.
Indications for liver transplant evaluation include:
Occurrence of an index complication: i.e., ascites, hepatic encephalopathy, variceal hemorrhage
Hepatocellular dysfunction resulting in a MELD score of ≥ 15
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