Symptom Management in Patients with Cirrhosis: a Practical Guide

Abstract

Purpose of the review Though it is well known that cirrhosis is associated with significant morbidity and mortality, management of symptoms in cirrhosis can be difficult. This review serves to offer practical guidance in the management of liver-specific symptoms of cirrhosis as well as other symptoms with special hepatic considerations. Recent findings We discuss liver-specific symptoms and management, including ascites and refractory ascites, hepatic encephalopathy, pruritus, and muscle cramping. We also discuss the challenges of treating more generalized symptoms in cirrhosis, including pain, depression/anxiety, appetite, and fatigue. Medication management is, especially complex in this population given the altered metabolism of drugs, and we consider some strategies to approach this. Summary With the right tools, provided throughout this review, hepatologists should be well equipped to manage the nuanced liver-specific and generalized symptoms in patients with cirrhosis.

Quality of death in patients in advanced chronic liver disease and cancer patients managed by gastroenterologists in Portugal: are we doing it right?

“…On the other hand, impaired liver metabolism can lead to analgesia-related adverse events such as hepatic encephalopathy, kidney injury and gastrointestinal bleeding. Although they should be avoided for chronic pain management, they might be necessary in the context of EOL to prioritize patient comfort over cognition [30,35,36].…”

The relationship between patient-reported health-related quality of life and malnutrition risk in cirrhosis: an observational cohort study

“…The pain symptom can occur outside of underpinning liver disease or be disease-specific such as ascites-associated abdominal pain (25) . Given the altered bioavailability and metabolism of pain medications in the context of cirrhosis, it is often difficult to treat (26) . Our results adding the knowledge that it may be practical to mitigate pain problem as a HRQoL deficit via nutritional support.…”

Neutrophil-to-Lymphocyte Ratio Can Distinguish Patients with Liver Cirrhosis from Healthy People but Cannot Distinguish Patients with Cirrhotic Hepatocellular Carcinoma from Patients with Liver Cirrhosis

“… 5 Growing numbers of people are being diagnosed with LC and correct treatment can help improve the quality of life. 6 Patients with LC are at high risk of developing HCC and approximately 70%-90% of HCC patients have underlying LC, 7 , 8 which means the majority of HCC patients also have LC. HCC patients with non-cirrhotic livers represent a relatively small proportion (10–30%) of HCC cases.…”