Management of Decompensated Cirrhosis
An asymptomatic compensated phase followed by a decompensated phase characterizes the natural history of cirrhosis . It is also marked by the development of overt clinical signs. The most frequent of which are ascites, bleeding, encephalopathy, and jaundice. The following Clinical Practice Guidelines represent the first Guidelines on the Management of Decompensated Cirrhosis.
EASL Guideline for the Management of Decompensated Cirrhosis
When the panel of experts nominated by the European Association for the Study of the Liver (EASL) governing board began work to update the Clinical Practice Guidelines (CPGs) on ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS), it became obvious that they should cover all other complications of decompensated cirrhosis. Within this framework, a formal definition of decompensated cirrhosis was sought. A silent, asymptomatic course characterizes the natural history of cirrhosis. This until increasing portal pressure and worsening liver function produce a clinical phenotype. In the asymptomatic phase of the disease, usually referred to as compensated cirrhosis, patients may have a good quality of life. Also the disease may progress undetected for several years. The development of overt clinical signs marks the decompensation. The most frequent of which are ascites, bleeding, encephalopathy, and jaundice.
More on Decompensated Cirrhosis
Following the first appearance of any of these signs, the disease usually progresses more rapidly towards death or liver transplantation (LT). This phase of the
disease has been designated ‘‘decompensated cirrhosis”. Hence the name of the EASL Guideline: Management of Decompensated Cirrhosis. Progression of the decompensated disease may be further accelerated by the development of other complications. Among them rebleeding, acute kidney injury (AKI), with or without the features of HRS, hepato-pulmonary syndrome (HPS), portopulmonary hypertension (PPHT), cirrhotic cardiomyopathy (CCM), and bacterial infections.
Download the EASL Guideline for Management of Decompensated Cirrhosis as PDF or PPT Slide Deck from the right of your screen.