Cirrhosis: Clinical sciences

Cirrhosis refers to chronic progressive fibrotic changes of the liver parenchyma that occur in response to chronic injury and inflammation. A variety of conditions can cause this injury, including viral hepatitis, chronic alcohol use, autoimmune disease, and hereditary conditions like hemochromatosis or alpha-1 antitrypsin deficiency, and the ensuing fibrotic changes eventually impair liver function.

Early in the disease process, cirrhotic patients remain relatively asymptomatic and are considered to have compensated cirrhosis, while those who present with symptoms are considered to have decompensated cirrhosis. Complications due to cirrhosis include spontaneous bacterial peritonitis, ascites, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome, which can be life-threatening, therefore it’s important to quickly identify these patients who may suddenly decompensate.

Now, if you suspect cirrhosis, first perform an ABCDE assessment to determine if your patient is unstable. Keep in mind that cirrhosis is never unstable unless it's decompensated and the patient develops complications. If this is the case, you may need to secure the airway, breathing, and circulation, which might require intubating the patient, and starting mechanical ventilation. Next, obtain IV access and, if your patient is hypotensive, start IV fluids for volume resuscitation. If there are signs of blood loss, they might even need a transfusion of blood products, such as packed red blood cells, platelets, and even fresh frozen plasma. You should also continuously monitor vital signs.