ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Cirrhosis and Complications of Liver Disease

Video Transcription

Video Summary

The talk reviews cirrhosis and portal hypertension, focusing on liver functions, causes, clinical recognition, diagnosis, complications, and management. Cirrhosis is irreversible fibrotic scarring with regenerative nodules that obstruct portal blood flow, impair hepatocyte perfusion, and reduce synthetic function, leading to portal hypertension. Major etiologies include alcohol, metabolic dysfunction–associated steatotic liver disease (formerly NAFLD/NASH), and chronic hepatitis C/B, with other autoimmune and genetic causes.<br /><br />Cirrhosis affects ~2.2 million U.S. adults and mortality is rising, especially in younger patients due largely to alcohol-related disease. Early symptoms are nonspecific; clues include thrombocytopenia, elevated INR, low albumin, and imaging signs such as nodular liver, splenomegaly, ascites, and varices.<br /><br />Diagnosis is gold-standard by biopsy (percutaneous, transjugular, or EUS-guided), but noninvasive tests and elastography are increasingly used. Decompensation (5–10%/year) includes ascites, variceal bleeding, encephalopathy, SBP, and hepatorenal syndrome (HRS).<br /><br />Core management: alcohol abstinence, HAV/HBV vaccination, NSAID avoidance, HCC screening (US + AFP q6 months), and endoscopic variceal screening. Ascites: sodium restriction, spironolactone/furosemide, paracentesis with albumin for large-volume removal, and TIPS for refractory cases. SBP: ceftriaxone plus albumin and secondary prophylaxis. Varices: nonselective beta blockers or band ligation; acute bleeding requires resuscitation, octreotide, antibiotics, urgent endoscopy, and sometimes early TIPS. Encephalopathy: treat triggers, lactulose ± rifaximin; ammonia levels are not reliable. Prognosis uses Child-Pugh and MELD 3.0; transplant referral generally when MELD ≥15.

Asset Subtitle

Sumeet K. Tewani, MD, FASGE

Keywords

cirrhosis

portal hypertension

decompensated cirrhosis

ascites management

esophageal varices

hepatic encephalopathy

spontaneous bacterial peritonitis (SBP)

MELD 3.0 and liver transplant referral