The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists

Abstract

There are many complications of cirrhosis. Management of these complications can be complex and are targeted at stabilizing the patient's clinical condition. Liver transplantation remains the only definitive treatment.

Specific Nursing Care Rendered In Hepatic Encephalopathy: Contemporary Review and New Clinical Insights

“…Special attention should be focused on decubital ulcers which may appear due to prolonged bed lying. The risk of cellulitis also increases because of poor skin integrity and development of peripheral edema [8]. Inadequately treated cellulitis can lead to fasciitis and a potentially lethal phlegmon -Vibrio vulnificus cellulitis.…”

“…Type II HRS appears more frequently and it is characterized by increase in serum concentration of creatinine and urea with chronic to moderate progression which usually takes place in the time period of six or over six weeks from the disease starting point (pathological black point).Care of IV cannulas. Every intravenous route is a potential place of infection entry [8]. Bacterial infections are present in about 15% -47% of patients with cirrhosis of the liver, especially in relation to gram-negative bacteria.…”

“…If positive, hemoculture indicates the presence of pathogenic organisms, and administration of adequate antibiotics is mandatory. Coagulation status points to the presence of coagulopathy and low levels of coagulation factors predominantly factor V (with plasma halflife of 3-6h) and factor VII(also referred to as proaccelerin or labile factor) [8]. The biochemical examination of abdominal fluid, ascites (Rivalta test), bacteriological and cytomorphological examination (presence of malignant hyperchromatic cells) can also help determine the etiologic factor of liver lesion.…”

Comparisons between Portosystemic Shunting Modalities in Patients with Liver Cirrhosis and Portal Hypertension

“…According to different authors, mortality associated with hemorrhagic syndrome ranges from 30% and above, and with the development of a hepatic coma, that rate rises to 80-90%. [4][5][6] The only radical method of treatment for these patients is liver transplantation. However, liver transplantation is not only a potential possibility for radical treatment, but it is always interfaced with needs to resolve a number of difficult questions; among which are medical, social and organizational issues, both from the government point of view (juristic and legislative based), as well as from the practical health care point of view (hospital equipment, human resources, etc.).…”

“…However, liver transplantation is not only a potential possibility for radical treatment, but it is always interfaced with needs to resolve a number of difficult questions; among which are medical, social and organizational issues, both from the government point of view (juristic and legislative based), as well as from the practical health care point of view (hospital equipment, human resources, etc.). 7,8 Thus, even in countries with an advanced transplantation program, liver transplantation requirements are only, on average, 25-50% met. [9][10][11] Among the patients in the waiting list, 10-24% die before transplantation.…”