Introduction to cirrhosis and its complications

Chronic liver disease of any aetiology can progress to cirrhosis and portal hypertension, and can be associated with complications that require therapeutic intervention. Treatment of the underlying disease is a priority (eg abstinence from alcohol, antiviral treatment for hepatitis B or C, weight loss for nonalcoholic fatty liver disease, immunosuppressive therapy for autoimmune hepatitis)—this may significantly improve liver function and portal hypertension, and reduce the risk of developing hepatocellular carcinoma.

In patients with compensated cirrhosis, the primary goal of management is to prevent decompensation de Franchis 2021 [Baveno VII] and therefore improve survival—see Prevention of decompensation in patients with compensated cirrhosis.

Patients with decompensated cirrhosis presenting to hospital have an in-hospital mortality of up to 10 to 20%. Early intervention is critical to improving survival. Care bundles to optimise care in the first 24 hours of hospitalisation have been shown to improve mortality and quality of care in patients with decompensated cirrhosisDyson 2016. An Australian cirrhosis care bundle, designed to be filled out within 6 hours of hospitalisation, is available from the Gastroenterological Society of Australia website.

Information about the complications of cirrhosis is available in these topics:

• Ascites
• Coagulopathy in patients with cirrhosis
• Gastro-oesophageal varices
• Hepatic encephalopathy
• Hepatocellular carcinoma
• Kidney impairment in patients with cirrhosis
• Liver transplant referral
• Nutrition, exercise and bone health in patients with cirrhosis
• Spontaneous bacterial peritonitis
• Symptom management in patients with cirrhosis.

For information about palliative care in patients with end-stage liver disease, see Principles of palliative care for patients with chronic liver disease. For general information about palliative care, see the Palliative Care guidelines.