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Cirrhosis, Emergency Medicine

Ahmed Nadeem and Paul J. Allegretti Reviewed 06/2017
 


Basics

Description

  • Progressive process of inflammation, cellular injury and necrosis, diffuse fibrosis, and formation of regenerative nodules

  • Loss of lobular and vascular architecture

  • Irreversible in adv...

Diagnosis

Signs and Symptoms

  • May be silent

  • Insidious onset with nonspecific findings:

    • Malaise

    • Fatigue

    • Anorexia

    • Nausea and vomiting

    • Weight loss

    • Pruritus

    • Hyperpigmentation

  • Jaundice

  • Abdominal collateral circulation...

Treatment

Pre-Hospital

  • Naloxone, dextrose (or Accu-Chekk), and thiamine for altered mental status

  • Reverse hypotension with IV fluids to prevent acute ischemic hepatic injury.

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • Acute decompensation or complicating conditions

  • 1st presentation with clinically evident cirrhosis, unless close outpatient workup is possible

  • Advanced grades HE, ...

Pearls and Pitfalls

  • Prognosis is highly variable.

  • Patients present with a wide variety of signs and symptoms related to end-stage liver disease.

  • New cases need full workup and GI consultation for manage...

Additional Reading

  • Feldman  M. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: WB Saunders; 2010.

  • Goldberg  E. Diagnostic Approach to the Patient with Cirrhosi...

Codes

ICD9

  • 571.2 Alcoholic cirrhosis of liver

  • 571.5 Cirrhosis of liver without mention of alcohol

  • 571.6 Biliary cirrhosis

ICD10

  • K70.30 Alcoholic cirrhosis of liver without ascites

  • K74.5 Biliary cirrhosis, u...

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