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Gastroenterology
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Cirrhosis Management
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Surveillance for HCC and varices; treat each decompensation.
Decision
Outcome
Decision
Compensated cirrhosis. Surveillance?
✓
Ultrasound + AFP every 6 months for HCC, EGD for varices
✗
MRI every month
Decision
Decompensation type?
✓
Variceal hemorrhage → non-selective β-blocker + repeat EGD yearly
✓
Ascites → sodium restriction + diuretics (spironolactone + furosemide) + paracentesis
✓
Hepatic encephalopathy → ID precipitant, lactulose, rifaximin
Outcome
β-blocker + endoscopic ligation surveillance
Outcome
Diet, diuretics, paracentesis; SBP prophylaxis if prior SBP or low ascites protein
SBP if ascitic PMN >250; ceftriaxone empirically.
Outcome
Identify infection, GI bleeding, electrolyte imbalance; lactulose 3–4 BMs/day; rifaximin to prevent recurrence