ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-based Learning (Day Two) | March 2025-Cirrhosis and Complications Liver Disease

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The document provides an extensive overview of cirrhosis and portal hypertension, authored by Dr. Sumeet K. Tewani. Cirrhosis is characterized by fibrotic replacement of liver tissue due to chronic liver diseases, resulting in irreversible scarring that disrupts liver functions, impedes portal blood flow, and interferes with hepatocyte perfusion. The document details various etiologies of cirrhosis, including alcohol consumption, viral hepatitis, and autoimmune conditions.<br /><br />Epidemiological data indicates that cirrhosis affects approximately 2.2 million adults in the U.S., predominantly male, with rising incidence among younger populations. The clinical features of cirrhosis include symptoms like muscle cramps, and poor-quality sleep, accompanied by lab findings such as thrombocytopenia and coagulopathy.<br /><br />The document highlights complications arising from cirrhosis such as ascites, variceal hemorrhage, hepatic encephalopathy, and hepatocellular carcinoma (HCC), and provides management strategies for these complications. Treatment involves complete alcohol abstinence, vaccinations, periodic screenings, and avoiding certain medications.<br /><br />Ascites management includes dietary adjustments and medications like diuretics and paracentesis. For varices, screening and treatment protocols involve endoscopy and use of beta-blockers. Hepatic encephalopathy treatment emphasizes dietary protein management, along with medications like lactulose and rifaximin.<br /><br />Liver transplant is mentioned as a treatment for end-stage liver disease, with patient prioritization based on scoring systems like the Child-Turcotte-Pugh Score and the MELD 3.0 Score, which evaluate liver functionality and prioritize organ allocation.<br /><br />The document underscores the importance of early detection and continuous management of cirrhosis-related complications to improve patient outcomes and survival rates. The overall content is rich in medical guidelines and current research data, supporting both clinical practices and patient care strategies related to cirrhosis and portal hypertension.

Asset Subtitle

Sumeet K. Tewani, MD, FASGE

Keywords

cirrhosis

portal hypertension

liver disease

fibrotic replacement

complications

management strategies

liver transplant

hepatocellular carcinoma

epidemiology

treatment protocols