43Įxpert opinion and consensus guidelines with low-quality trials 19, 20Įxpert opinion and consensus guidelines in the absence of clinical trialsĪll patients with cirrhosis should be evaluated for hepatocellular carcinoma with ultrasonography every six months. Hepatocellular carcinoma screening includes ultrasound screening every six months for patients with cirrhosis.įurther evaluation of patients with clinical signs or symptoms of liver disease or abnormal liver function tests should be pursued to determine the potential etiology, regardless of duration of the abnormality. Hepatic encephalopathy is managed with lifestyle and nutritional modifications and, as needed, with lactulose and rifaximin. Ascites treatment includes diuresis, salt restriction, and antibiotic prophylaxis for spontaneous bacterial peritonitis, when indicated. Varices are monitored with endoscopy and often require prophylaxis with nonselective beta blockers. Treatment goals are preventing cirrhosis, decompensation, and death. Chronic liver disease management includes directed counseling, laboratory testing, and ultrasound monitoring. Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis. Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. Additional testing is based on demographics and risk factors. Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. The most common causes of cirrhosis are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. Most patients with cirrhosis remain asymptomatic until the onset of decompensation. Only one in three people with cirrhosis knows they have it. Newer research has established that liver fibrosis is a dynamic process and that early cirrhosis may be reversible. Cirrhosis is the 12th leading cause of death in the United States.
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