Lectures
Cirrhosis.pptx (sharepoint.com)
Management of Decompensated Cirrhosis - teachIM
Podcasts
#100: Cirrhosis: Initial Evaluation and Management - The Curbsiders
#101: Cirrhosis: Medications, decompensation, complications - The Curbsiders
#466 Cirrhosis Update with Scott Matherly - The Curbsiders
Articles
Cirrhosis: Diagnosis and Management | AAFP
Back to Basics: Outpatient Management of Cirrhosis | AASLD
See table 3 for nonselective beta-blockers and their dosing strategies
Carvedilol is recommended as the preferred NSBB as studies have shown improvement in lowering portal pressures compared to propranolol due to carvedilol’s anti-alpha-adrenergic activity
PREDESCI trial showed decreased frequency of decompensation with use of carvedilol
Coffee Consumption Decreases Risks for Hepatic Fibrosis and Cirrhosis: A Meta-Analysis - PMC
The pooled results of the meta-analysis indicated that coffee consumers were less likely to develop cirrhosis compared with those who do not consume coffee, with a summary OR of 0.61 (95%CI: 0.45–0.84)
Retrospective cohort study of 303 patients with cirrhosis presenting with upper GI bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of antibiotic administration for prophylaxis: 1-3 days of antibiotics, 4-6 days of antibiotics and 7 days or more of antibiotics
Rates of infection were not statistically different between the three antibiotic groups (p = 0.78). There was no difference in time to infection (Kruskall Wallace test p = 0.75), early re-bleeding (p = 0.81), late re-bleeding (p = 0.37) and in-hospital mortality (p = 0.94) in the three groups.
Bottom-line: Short course of antibiotics for prophylaxis (3 days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if there is no active infection.
References
Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021;56(7):593-619. doi:10.1007/s00535-021-01788-x
Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884
Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases [published correction appears in Hepatology. 2017 Jul;66(1):304]. Hepatology. 2017;65(1):310-335. doi:10.1002/hep.28906
Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013;108(9):1458-1463. doi:10.1038/ajg.2013.219
Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362(12):1071-1081. doi:10.1056/NEJMoa0907893