[CME: Outpatient Management of Patients with Liver Cirrhosis].

Abstract

CME: Outpatient Management of Patients with Liver Cirrhosis Abstract: Many causes of cirrhosis are modifiable. Therefore, etiologic clarification is mandatory. After diagnosis, the underlying disease must be treated and patients advised as to alcohol abstinence, smoking cessation, healthy diet, vaccinations and physical exercise. Gastroscopic screening for oesophageal varices is recommended. Patients with cirrhosis should undergo surveillance for hepatocellular carcinoma (biannual sonography and alpha-fetoprotein assessment). Following a first complication (e.g., variceal haemorrhage, ascites, encephalopathy) or deterioration of liver function, listing for liver transplantation should be evaluated. Control intervals should be individualized according to disease severity and previous decompensations. Many complications (e.g., bleeding, spontaneous bacterial peritonitis, acute renal failure due to NSAIDs or diuretics) have insidious onsets but may rapidly lead to multiple organ failure. Rapid diagnostics are recommended if patients show clinical, mental or lab deterioration.