J Clin Outcomes Manage
Management of the cirrhotic patient prior to liver transplantation
Kallwitz ER, Cotler SJ
Abstract Objective: To review common manifestations in patients with end-stage liver disease and highlight effective clinical management strategies. Methods: Review of the literature. Results: The major complications of cirrhosis include variceal bleeding, ascites, hepatic encephalopathy, and hepatorenal syndrome. Management of varices includes primary prophylaxis for prevention of a first bleeding episode, management of active bleeding, and secondary prophylaxis. Management of variceal bleeding includes volume resuscitation, correction of coagulopathy, and achieving hemostasis. Sodium restriction and the use of diuretics is a mainstay of treatment of ascites. Patients with cirrhosis also are at increased risk for hepatocellular carcinoma and require surveillance. Conclusion: Liver transplantation offers good long-term survival in patients with cirrhosis; however, long waiting times and lack of organ availability necessitate meticulous management of patients with complications of liver disease.
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