4. Natural History of the Cirrhotic Patient

  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)2,3,4,5
  1. Jordan J. Feld MD, MPH1,3

Published Online: 4 SEP 2012

DOI: 10.1002/9781118314968.ch4

Hepatology: Diagnosis and Clinical Management

Hepatology: Diagnosis and Clinical Management

How to Cite

Feld, J. J. (2012) Natural History of the Cirrhotic Patient, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch4

Editor Information

  1. 2

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

  3. 4

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  4. 5

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Author Information

  1. 1

    Liver Centre, Division of Gastroenterology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

Publication History

  1. Published Online: 4 SEP 2012
  2. Published Print: 12 OCT 2012

ISBN Information

Print ISBN: 9780470656174

Online ISBN: 9781118314968

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Keywords:

  • non-invasive test;
  • thrombocytopenia;
  • decompensation;
  • MELD;
  • varices;
  • hepatoma;
  • regression

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.