Cirrhosis

Decompensated cirrhosis has a mortality of about 15%, there are a lot of important complications to cover.  The proforma above has been designed to give a quick overview of possible causes and complications of decompensated cirrhosis.

There is a lot of information to cover in this proforma.  The key points are:

• Although an ascitic tap is required, it has been decided that this will be done in AMU not in the ED
• Because patients often have a low creatinine in liver disease AKIs can frequently be missed as they appear to have a normal eGFR.  Therefore there are modified criteria to check for an AKI in these patients.  The information is at the bottom of the proforma.
• Long acting benzodiazepines should be avoided in cirrhosis due to their delayed breakdown.  Therefore lorazepam is preferred in these patients when they are withdrawing from alcohol.
• Gentamicin should be avoided in these patients due to increased risk of nephrotoxicity and hepatoxicity.