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

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This document reviews cirrhosis and portal hypertension, focusing on definition, causes, epidemiology, clinical features, diagnosis, complications, and management. Cirrhosis is advanced, largely irreversible liver scarring characterized by fibrotic tissue replacement and regenerative nodules, which impair portal blood flow, hepatocyte perfusion, and hepatic synthetic function. Major etiologies include alcohol-related liver disease, metabolic dysfunction–associated steatotic liver disease (MASLD), chronic hepatitis C and B, and less common genetic/autoimmune cholestatic disorders (e.g., hemochromatosis, autoimmune hepatitis, PBC/PSC, Wilson disease, alpha-1 antitrypsin deficiency). In the U.S., cirrhosis affects ~2.2 million adults; mortality has risen, driven largely by alcohol, with increasing incidence in younger adults.<br /><br />Clinical findings include symptoms (cramps, poor sleep, pruritus, sexual dysfunction), lab abnormalities (thrombocytopenia, coagulopathy, hypoalbuminemia), and imaging findings (nodular liver, ascites, varices, splenomegaly). Diagnosis can involve liver biopsy (percutaneous/transjugular/EUS) but often uses noninvasive fibrosis testing (FIB-4, FibroScan/VCTE, MR elastography, serum panels). Portal hypertension is defined by an elevated portal pressure gradient (clinically significant around ≥10 mmHg) and drives decompensation (ascites, variceal bleeding, encephalopathy, hepatorenal syndrome) and increased hepatocellular carcinoma (HCC) risk.<br /><br />Management emphasizes alcohol abstinence, vaccinations (HAV/HBV), avoiding NSAIDs and limiting acetaminophen, controlling comorbidities, and routine surveillance: HCC screening with ultrasound/AFP every 6 months and variceal screening endoscopy at intervals based on compensation status. Key complication management includes: ascites (sodium restriction, spironolactone ± furosemide, paracentesis with albumin replacement, TIPS), spontaneous bacterial peritonitis (diagnosis via ascitic neutrophils ≥250/µL; ceftriaxone plus albumin; secondary prophylaxis), varices (nonselective beta blockers and/or band ligation; acute bleed treated with vasoactive agents, antibiotics, urgent endoscopy, and TIPS when needed), hepatic encephalopathy (treat triggers; lactulose ± rifaximin), and hepatorenal syndrome (albumin plus vasoconstrictors; transplant consideration). Prognosis and transplant prioritization use Child-Turcotte-Pugh and MELD 3.0 scoring.

Asset Subtitle

Sumeet K. Tewani, MD, FASGE

Keywords

cirrhosis

portal hypertension

decompensated cirrhosis

ascites

esophageal varices

hepatic encephalopathy

hepatorenal syndrome

hepatocellular carcinoma (HCC) surveillance

noninvasive fibrosis assessment (FIB-4, FibroScan)

MELD 3.0 and Child-Turcotte-Pugh scoring