Cirrhosis and Hepatitis
Complications of liver disease and the hepatitis viruses
Cirrhosis
Causes: alcohol, MASLD (metabolic dysfunction-associated steatotic liver disease, the 2023 name for NAFLD) Updated, hepatitis B and C.
| Portal hypertension → varices | Can bleed massively. Beta blocker (propranolol, carvedilol) to prevent; banding; avoid straining |
| Ascites | Sodium limit (~2 g/day), spironolactone + furosemide, paracentesis (void first; watch BP; albumin after large volumes); measure girth and weight |
| Hepatic encephalopathy | ↑ ammonia: confusion, asterixis (flapping tremor), sleepiness. Lactulose (2–3 soft stools/day) + rifaximin. Don't restrict protein |
| Bleeding | Low clotting factors and platelets: bleeding precautions |
| Others | Jaundice, itching, spontaneous bacterial peritonitis, kidney failure (hepatorenal) |
Cirrhosis: drugs and diet
- Acetaminophen up to 2 g/day is the preferred pain reliever. Avoid NSAIDs (bleeding, kidney failure).
- Avoid or minimize sedatives (benzodiazepines, opioids): they trigger encephalopathy.
- No alcohol.
- Adequate protein (1.2–1.5 g/kg/day), small frequent meals and a late-evening snack.
- Vaccinate against hepatitis A and B if not immune.
PriorityVomiting blood in a patient with cirrhosis: variceal bleed. Airway, two large IVs, call for help, prepare for octreotide, transfusion and endoscopy.
Viral hepatitis
| Virus | Spread | Key points |
|---|---|---|
| A | Fecal-oral (food, water) | Short illness, no chronic form. Vaccine. Hand hygiene; contact precautions if incontinent |
| B | Blood, sex, birth | Can become chronic (liver cancer, cirrhosis). Vaccine. Antivirals (tenofovir, entecavir) for chronic infection |
| C | Blood (injection drug use, past transfusions) | Often silent and chronic. No vaccine, but curable (>95%) with 8–12 weeks of direct-acting antiviral pills. Updated Screen all adults at least once |
| D | Blood | Only with hepatitis B |
| E | Fecal-oral | Dangerous in pregnancy |
Signs of acute hepatitis: fatigue, nausea, RUQ discomfort, dark urine, clay-colored stools, jaundice. Rest; avoid alcohol and liver-toxic drugs.
Memory hook
Hepatitis A and E come from the bowel (vowels → bowels). B, C and D come from blood and body fluids.