What is the difference between compensated and decompensated cirrhosis

Biopsies are rarely required in these cases. Liver biopsy should be considered in patients with liver lesions that do not have the typical features for HCC or in patients with typical features for HCC in a noncirrhotic liver. Management Patients with confirmed HCC should be staged for tumor burden, metastatic disease, liver disease severity, and functional status.

While multiple staging systems have been proposed in the literature to assess patients, guidelines suggest using the Barcelona Clinic Liver Cancer staging system.

The Milan criteria are defined as a single lesion less than 5 cm in size, or up to 3 separate lesions with none larger than 3 cm in size. Malnutrition is a common finding in patients with cirrhosis and is an independent predictor of mortality.

Patients with cirrhosis should be screened for malnutrition and frailty, and, if at risk, they should undergo a detailed nutritional assessment by a registered dietitian or nutrition expert. Patients who are at the highest risk of malnutrition are those who have decompensated cirrhosis. Management strategies should focus on improving the nutritional status of these patients with appropriate daily caloric and protein intake along with taking nutrition supplementation at bedtime, avoiding immobility, and encouraging exercise as tolerated.

Nutritional counseling should ideally be conducted by a multidisciplinary team to achieve goals of ideal daily energy and protein intake, as this approach has been demonstrated to improve survival and quality of life. Exercise, particularly aerobic, is essential to improving aerobic capacity and cardiovascular fitness, leading to better outcomes in patients awaiting liver transplantation.

As such, a multidisciplinary approach with a registered dietitian and an exercise therapist to tailor an individual plan for each patient based on his or her comorbidities would be ideal. Alcohol Use Data are limited regarding a safe threshold of alcohol use for patients with cirrhosis. Given the hepatotoxic effects of alcohol, all patients with cirrhosis, regardless of the etiology of liver disease, should refrain from alcohol use.

Even modest alcohol consumption is associated with worsening outcomes in patients with chronic liver disease and is related to an increased risk of developing HCC.

Prescription and Over-the-Counter Medications Patients should avoid unnecessary over-the-counter health supplements due to the potential risk of drug-induced liver injury.

Polypharmacy should also be avoided, and a thorough medical reconciliation should be performed at each clinic visit, including a review of nonprescribed medication intake. Acid-suppressive medications, in particular proton pump inhibitors PPIs , are commonly prescribed to patients with cirrhosis and should be discontinued when their use is unnecessary, as PPIs are associated with an increased risk of infections such as spontaneous bacterial peritonitis and Clostridium difficile colitis.

Cirrhosis is often associated with several vitamin deficiencies, such as folic acid, cobalamin vitamin B12 , thiamine vitamin B1 , and vitamin D. Given the low cost and low risk associated with multivitamin supplementation, daily consumption of a multivitamin should be encouraged in patients with cirrhosis. Vitamin D deficiency is associated with poor clinical outcomes; therefore, patients with cirrhosis should be screened and treated.

Infections are a common trigger for decompensations and can lead to acute-on-chronic liver failure. Infections and their subsequent deleterious effects can be prevented by early vaccination. Influenza and Streptococcus pneumoniae carry significant morbidity and mortality in patients with cirrhosis and are potentially preventable with an annual vaccination influenza and valent pneumococcal conjugate vaccine or valent pneumococcal polysaccharide vaccine, respectively. All patients with etiologies of cirrhosis, particularly cholestatic liver disease, are at risk of osteoporosis and should be screened with bone mass density measurements every 2 to 3 years.

Patients should also undergo age-appropriate screening for breast cancer, cervical cancer, and prostate cancer. Compared to the general population, patients with cirrhosis often ignore dental hygiene. Patients with cirrhosis should be encouraged to undergo dental examinations every 6 to 12 months, and may need to undergo a bleeding risk assessment with viscoelastic testing.

In patients with cirrhosis, survival without liver transplantation is dependent on the timing of diagnosis and decompensation. Early diagnosis offers the opportunity to treat underlying causes, preventing progression of liver disease. Physicians should screen all patients with liver disease for advanced fibrosis and cirrhosis using noninvasive modalities. Serologic-based scores can be easily incorporated into the electronic medical record as a screening tool for primary care physicians, gastroenterologists, and hepatologists.

By implementing early screening strategies, improving patient education, and offering preventive care, the economic burden of decompensated cirrhosis can be decreased, and survival and quality of life among patients with cirrhosis can be improved. Liver transplantation referral should be considered in patients with a MELD score of 15 or greater, in patients with HCC, or in patients with decompensated cirrhosis.

There is a rising demand for liver transplantation despite an ongoing scarcity of donor grafts. The use of prospective medicine could decrease this demand. Time trends in the health care burden and mortality of acute on chronic liver failure in the United States.

Mortality due to cirrhosis and liver cancer in the United States, observational study. Nat Rev Gastroenterol Hepatol. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease.

Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: validating the European Liver Fibrosis Panel and exploring simple markers. J Hepatol. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol. Compensated cirrhosis: natural history and prognostic factors. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of studies. Competing risks and prognostic stages of cirrhosis: a year inception cohort study of patients.

Aliment Pharmacol Ther. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: practice guidance by the American Association for the Study of Liver Diseases. Portal hypertension in cirrhosis: natural history. Portal Hypertension: Pathophysiology and Treatment. This not only acts as a laxative but also helps the body remove the toxins that build up in the body when the liver is failing. People are given enough lactulose so that they have one or two loose bowel movements each day.

Most periods of encephalopathy are triggered by problems such as an infection, constipation, dehydration, a medicine or a bleed. It is important that patients seek medical advice so the cause of an episode can be identified and treated.

The liver makes products to help blood clot including clotting factors and platelets and when the liver stops working effectively, patients can be at risk of severe bleeding. Treatments include administering vitamin K and plasma in medical emergencies. People should seek specialist advice before having medical procedures, including any dental work, and ensure that they treat any cuts that bleed with pressure and bandages and seek medical help. People with decompensated cirrhosis who are already very ill with problems such as encephalopathy, jaundice and bleeding problems, are at risk of a serious complication called hepatorenal syndrome, which is kidney failure in liver disease.

For most patients, a liver transplant is needed, for some urgently. Some people with cirrhosis develop liver cancer, most commonly hepatocellular carcinoma HCC. The aim is to detect and treat liver cancer as early as possible. Treatment can involve cutting out the part of the liver affected by cancer. There are a variety of other treatments aimed at controlling the cancer, including injections of chemotherapy, radio frequency ablation and oral medicines.

A liver transplant may be an option for some patients. If your liver is very badly damaged, a liver transplant may be needed. This is a procedure where a diseased liver is removed during a lengthy operation and replaced with a healthy donor liver. A liver transplant is usually only recommended if other treatments are no longer helpful and your life is threatened by end stage liver disease. It is a major operation and you will need to plan it carefully with your medical team, family and friends.

Liver transplantation is usually very successful although in some cases it is possible for liver diseases to return and affect your new liver. Discuss any worries you have about your suitability for treatment with your specialist nurse or doctor and those nearest to you. Anything that leads to the long-term, continuous damage of the liver can cause cirrhosis. These include:. Day-to-day coping strategies In general, it is best to aim for as near to a normal life as possible. However, there are some points that you should keep in mind to help you feel as healthy as you can.

If you find yourself becoming depressed, talk this over with your doctor who can discuss ways of overcoming this. If appropriate, certain medications can be helpful in helping you cope. Remember that liver function can improve if you take care of yourself and receive early treatment. However, you must ensure that health professionals know you have cirrhosis before giving or prescribing any treatment or medication for you.

Diet It is important to eat well and to include a good balance of foods in your diet including vitamins, minerals and calcium. It is likely you will need extra energy and protein. Cirrhosis affects your ability to store glycogen, a carbohydrate that gives you short-term energy.

This means that your body has to use its own muscle tissue to provide energy between meals and this can lead to muscle wasting and weakness. If you are affected in this way, snacking between meals is a way you can top up on calories and protein. Another good method is to eat three or four small meals in a day rather than one large protein or carbohydrate-heavy meal. You may find having nourishing drinks a help. These can include homemade milkshakes or commercially-made products such as Build Up, Complan, Recovery and Nourishment.

These are available at most chemists. It is a good idea to check with your doctor or dietician first to make sure they are suitable for you. Try to avoid salty foods or adding salt to what you eat, to help control fluid retention. Alcohol and cirrhosis Almost everyone who drinks too much alcohol will suffer some liver damage, but this does not necessarily turn into cirrhosis.

As many as nine out of ten people who drink to excess will develop a fatty liver, with one in ten progressing to cirrhosis. In general, the more you drink, the greater your chance of developing alcohol related hepatitis or cirrhosis. A poor diet may make the problem worse.

All types of alcoholic drinks can lead to liver disease. If you have cirrhosis — whether it is caused by alcohol or not — you should not drink alcohol at all. This guideline covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. It aims to improve how cirrhosis is identified and diagnosed. It recommends tools to assess the severity of cirrhosis and gives advice on monitoring people with cirrhosis to detect and manage complications early, and referral criteria for tertiary care.

Click here to view the guidance. Click here to view the information for the public. They are groups of general practices, which come together in each area to commission the best services for their patients and population.

ICS Integrated Care Systems are new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

Devolved nations — health is primarily a devolved matter across the four nations which make up the UK. Cirrhosis of the liver Cirrhosis is the result of long-term, continuous damage to the liver and may be due to many different causes.

Decompensated liver disease is a very serious condition that can lead to death. This is called alcoholic liver…. Cirrhosis is the severe scarring and poor function of the liver caused by long-term exposure to toxins such as alcohol or viral infections.

In the U. Learn about the link between HCV and cirrhosis as well as…. Hepatic failure, also known as liver failure, can be a silent killer. If you have ascites, you have fluid in the space between the abdominal lining and the organs.

An alkaline phosphatase level test can help identify health concerns in your liver, gallbladder, and more. The liver is a powerhouse organ, performing a variety of tasks that are essential to maintaining good health. Eat these 11 foods for optimal liver…. Lifestyle changes can help reduce your risk for fatty liver disease and damage. Learn what 10 foods you should eat and what 6 foods to avoid. Fatty liver disease is best managed with lifestyle changes.

Some of the best methods include weight loss, limiting sugar, and drinking coffee.