Liver Cirrhosis and Portal Hypertension

How are liver cirrhosis and portal hypertension treated?

Patients with liver cirrhosis will benefit from the following treatment which include:

Treatment of the underlying cause of liver cirrhosis

• Patients with alcoholic liver cirrhosis must stop all intake of alcohol
• Patients with chronic hepatitis B and C should be started on antiviral treatment if there are no contraindications
• Patients with autoimmune hepatitis may require treatment with steroids

Treatment of portal hypertension to reduce risk of variceal bleeding by:

• Non-selective beta blocker medication (e.g. propranolol) for lowering of portal pressure to reduce risk of variceal bleeding
• Endoscopic ligation (banding) of esophageal varices to treat acute bleeding or prevent future variceal bleeding
• Endoscopic sclerotherapy (histoacryl injection) of gastric varices to treat acute bleeding

Treatment and prevention of ascites include:

• Maintenance of a strict low salt diet
  
• Maintenance diuretic medication (e.g. spironolactone or furosemide) to remove excess fluid from the body
• Patients who have persistent ascites that do not respond to medications may require paracentesis, Transjugular Intrahepatic Portosystemic Shunt (TIPS) or liver transplant.

Treatment and prevention of hepatic encephalopathy include:

• Regular bowel clearance in order to reduce build-up of toxins in the bloodstream that may precipitate encephalopathy
• Avoidance of sedatives that may worsen encephalopathy

Surveillance for liver cancer

• Patients with cirrhosis should undergo regular abdominal ultrasound and alfa-fetoprotein (AFP) blood tests at least once every six months Diseases Gastroenterology

Treatment of cirrhosis-related infections

• Cirrhotics need to be closely monitored for infections (e.g. spontaneous bacterial peritonitis) and should be referred for early treatment with antibiotics

Early assessment for liver transplant

• Cirrhotic patients who develop decompensation events should be referred for liver transplant