Inpatient Management of Decompensated Cirrhosis

In this clinical-pearl-packed session, Dr. Suchita Shah Sata from Duke University Hospital in Durham, N.C., recaps the breadth of knowledge needed by hospitalists to manage this complex patient population. Outlining the objectives of the talk, Dr. Sata describes the pathophysiology of cirrhosis and how this leads to the complications that are seen in the decompensated state, suggests a framework for evaluating the etiologies of decompensated cirrhosis, and applies current evidence to delineate best practices in inpatient management of common complications of cirrhosis. Reviewing the pathophysiology of decompensated cirrhosis, increased intrahepatic resistance results in increased portal pressures and congestion, with splanchnic vasodilation and the development of venous varices. Vasodilator release and low oncotic pressure due to the decline in hepatic albumin production decreases peripheral vascular resistance and results in low systemic blood pressure with decreased effective arterial blood volume experienced by the kidneys. A sodium avid state develops with retention of both sodium and fluid, resulting in ascites and edema. The complications of decompensated cirrhosis are deeply intertwined, with one complication often resulting in a cascade of others. When admitting a patient with new-onset ascites or a worsening decompensated state, Dr. Shah Sata asks the question, “Why is this patient sick today? Why now?” to understand why a patient might be developing ascites, en...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines Liver Disease Source Type: research