4. Natural History of the Cirrhotic Patient

Summary

Cirrhosis is the final common pathway of most chronic liver diseases and indicates the presence of fibrotic nodules in the liver. Prior to hepatic decompensation, patients with cirrhosis may be entirely asymptomatic and therefore the diagnosis requires a high index of suspicion. Keys to diagnosis from history and physical examination, and from basic laboratory tests as well as new non-invasive markers and liver biopsy are discussed. Once cirrhosis is established, prognosis can be determined using the MELD and Child–Pugh scores. Decompensation of cirrhosis is often precipitated by infection, medications, and medical procedures (surgery) and therefore great caution must be taken with patients with cirrhosis. Treatment of the underlying cause of liver disease may lead to regression of fibrosis, even with early cirrhosis; however, patients remain at risk for certain complications and require ongoing follow-up. The diagnosis, evaluation, prognosis, and basic management are reviewed.