hepatic and biliary disorders
Cirrhosis
Treatment of Cirrhosis
Supportive care In general, treatment is supportive and includes stopping injurious medications, providing nutrition (including supplemental vitamins), and treating the underlying disorders and complications. Doses of medications metabolized in the liver should be reduced. All alcohol and hepatotoxic substances must be avoided. Withdrawal symptoms during hospitalization should be anticipated in patients who have cirrhosis and have continued their chronic use of alcohol. Patients should be vaccinated against Overview of Acute Viral Hepatitis unless they are already immune. Patients with varices need therapy to prevent bleeding (see Treatment ). Patients with compensated cirrhosis who have clinically significant portal hypertension (according to the Baveno VII criteria) should be started on a nonselective beta-blocker to prevent decompensation ( Treatment (TIPS) should be considered if patients have complications of portal hypertension that are refractory to standard treatments, including ascites and recurrent variceal bleeding. TIPS is relatively contraindicated in patients with heart failure, moderate or severe pulmonary hypertension, or hepatic encephalopathy. Patients with high MELD scores ( Liver Transplantation is indicated for patients with end-stage liver disease or HCC. Risk of death without liver transplantation begins to exceed risks of transplantation (eg, perioperative complications, chronic immunosuppression) when the MELD score is more than about 15. Thus, if the score is 1.de Franchis R, Bosch J, Garcia-Tsao G, Baveno VII Faculty.: Baveno VII - Renewing consensus in portal hypertension.J Hepatol76(4):959-974, 2022. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in:J Hepatol. 2022 Apr 14. 