Management of decompensated liver cirrhosis I

Abstract

The natural history of liver cirrhosis begins with an asymptomatic phase of compensation. This is followed by a rapidly progressive phase of decompensation marked by clinical evidence of the complications of portal hypertension and/or impairment of liver function. The clinical prognosis of this decompensated phase is poor with reduced survival time. As a result, liver cirrhosis remains a leading cause of disability and mortality globally. To this end, the management of decompensated liver cirrhosis has evolved with the rationale of improving care and survival of the patient by managing individually the complications as they arise. This review discusses the stages of liver cirrhosis and details on interventions and improved therapeutic options for the complications of the decompensation phase —ascites, varices and variceal haemorrhage, hepatic encephalopathy, hyponatremia, hepato-renal syndrome, and infections in cirrhosis  while briefly discussing the pathogenesis of these complications and highlighting the pieces of evidence and rationale behind management options. However, the discussion at hand is an extensive one, and we have taken the liberty of splitting it into two parts for the sake of brevity without compromising on relevant information. In this first part, we discuss the importance of therapeutic albumin, the management of hepatic encephalopathy and varices/variceal haemorrhage. The second part of this review will focus on the management of ascites, hyponatraemia, hepatorenal syndrome and infections in the cirrhotic patient. This review also recognizes the gap in the prevention of these complications.