Cirrhosis is advanced scarring of the liver after years of injury from alcohol, viral hepatitis or fatty liver disease. The scarred liver cannot work well and raises pressure in the portal vein, causing fluid buildup, bleeding and confusion.
Key symptoms
- Tiredness, weakness and loss of appetite
- Swollen belly and leg swelling
- Yellow skin and eyes, itching
- Easy bruising or bleeding
- Confusion, sleepiness or day-night reversal
What you find on exam
- Jaundice, spider angiomas and red palms
- Ascites: shifting dullness or a fluid wave
- Enlarged spleen and muscle wasting
- Asterixis (flapping tremor) and level of alertness
Tests
- Liver tests, albumin, INR, platelets and sodium
- MELD score to judge severity
- Ultrasound with Doppler of the liver and portal vein
- Diagnostic paracentesis for new or worsening ascites
Treatment basics
- Treat the cause: stop alcohol, treat hepatitis, manage weight
- Ascites: salt restriction with spironolactone and furosemide
- Encephalopathy: lactulose, with rifaximin to prevent repeats
- Varices: endoscopy screening and a nonselective beta blocker such as carvedilol; refer for transplant evaluation
Red flags
- Vomiting blood or black stools
- Fever or belly pain with ascites (spontaneous bacterial peritonitis)
- New confusion or falling urine output
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.