Materiały źródłowe

• #1 Cirrhosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

  Lower the risk of cirrhosis by taking these steps to care for your liver: […] Do not drink alcohol if you have cirrhosis. If you have liver disease, you should not drink alcohol. […] Eat a healthy diet. Choose a diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Cut down on the amount of fatty and fried foods you eat. […] Maintain a healthy weight. Too much body fat can damage the liver. Talk to a healthcare professional about a weight-loss plan if you are obese or overweight. […] Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase the risk of hepatitis B and C. Ask a care professional about hepatitis vaccinations. […] If you’re concerned about your risk of liver cirrhosis, talk to a health professional about ways to reduce your risk.

• #1 Liver Cirrhosis – Symptoms, Causes, Complications and Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact

  https://www.pacehospital.com/liver-cirrhosis-symptoms-causes-and-prevention

  Preventative care can be taken by the patients themselves to avoid cirrhosis of the liver altogether. Preventative care can be divided into three steps: Healthy lifestyle adoption, Regular screenings for liver disease, Care optimisation, especially in risk populations. […] A healthy lifestyle allows the efficient liver functioning, potentially reducing the risk of liver disease. Healthy weight maintenance and having a healthy balanced diet with regular exercise can ensure a healthy lifestyle. Also, alcohol abstinence is another important factor. […] Screenings are necessary, especially in specific risk populations with greater possibility for signs of disease. The screenings could include a liver function test – a group of blood tests to check how well the liver is working. […] It’s crucial that patients with liver disease or any other medical condition adhere to their doctor’s orders and contact either their primary care physician for any questions or concerns. If the care is optimised, the likelihood of developing chronic liver cirrhosis is decreased. […] The risk population includes: Diabetics, Patients suffering from Hepatitis B and Hepatitis C virus, Patients suffering from non-alcoholic steatohepatitis (NASH) (fatty build-up in the liver linked with alcoholism) etc.

• #1 Back to Basics: Outpatient Management of Cirrhosis | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/back-basics/back-basics-outpatient-management-cirrhosis

  The 2023 AASLD guidelines state that NSBBs should be considered in patients with compensated cirrhosis and CSPH to prevent decompensation. […] Patients with cirrhosis should undergo endoscopic variceal surveillance if they are not a candidate for empiric NSBB. […] The 2023 AASLD guidelines recommend that patients with cirrhosis and subset populations of patients with chronic hepatitis B undergo HCC screening every 6 months with abdominal ultrasound and alpha-fetoprotein (AFP) testing. […] Recent AASLD guidelines recommend screening patients with cirrhosis for micronutrient deficiencies annually. […] AASLD guidelines recommend a goal daily protein intake of 1.2-1.5 g/kg ideal body weight. […] Sodium restriction will prevent fluid retention but may decrease the palatability of food, creating a barrier to adequate oral intake. […] Non-selective beta blockers are beneficial in patients with portal hypertension and can prevent/delay complications of variceal bleeding and ascites. […] Patients with cirrhosis should be screened for HCC every 6 months and malnutrition at least every 12 months.

• #1 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Hepatic fibrosis can be prevented by interventions that decrease the levels of proinflammatory cytokines in both experimental models and human subjects. […] The AASLD supports screening for clinically significant fibrosis (ie, F2) in a number of patient cohorts such as those with Type 2 diabetes, medically complicated obesity, MASLD in the setting of moderate alcohol use, first-degree relatives of patients with cirrhosis due MASLD, and fatty liver identified incidentally on imaging. […] The FIB-4 score is the primary screening tool recommended to assess patients with MASLD risk factors. […] The AASLD recommends every-6-month performance of an abdominal ultrasound and an AFP blood test in patients with both compensated and decompensated cirrhosis. […] Patients with compensated cirrhosis should undergo routine follow-up monitoring of their complete blood cell (CBC) count, renal and liver chemistries, and INR.

• #1 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Cirrhosis is the 12th leading cause of death in the United States. […] Treatment goals are preventing cirrhosis, decompensation, and death. […] Varices are monitored with endoscopy and often require prophylaxis with nonselective beta blockers. […] Oral antibiotic prophylaxis against spontaneous bacterial peritonitis should be initiated in patients with a history of spontaneous bacterial peritonitis or ascitic fluid protein 1.5 g per dL (15 g per L) and advanced liver disease (Child-Pugh score 9 or bilirubin 3 mg per dL) or kidney disease (serum creatinine 1.2 mg per dL, serum sodium 130 per mmol per L). […] Patients with cirrhosis who have medium, large, or high-risk varices (red wale markings) should be treated with nonselective beta blockers and/or endoscopic band ligation for primary prevention of variceal bleeds.

• #1 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  Primary prevention of bleeding from esophageal varices in patients with cirrhosis […] Thus, strategies to prevent the first episode of variceal bleeding are important for patients with cirrhosis and portal hypertension. […] The rationale for screening for esophageal varices is to identify patients at risk for bleeding from esophageal varices so as to prevent bleeding and improve survival in such patients. […] General measures to prevent the first episode of variceal bleeding include: Manage underlying liver disease – Patients with cirrhosis are evaluated for interventions that will slow or reverse the progression of liver disease (ie, avoiding alcohol, weight loss) and prevent additional insults to the liver (eg, adjusting medications, immunizing against hepatitis A virus and hepatitis B virus).

• #1 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  We refer patients with decompensated cirrhosis for liver transplantation evaluation because transplantation is effective long-term therapy for preventing variceal bleeding and other complications of portal hypertension. […] The goals of prevention for patients with esophageal varices at risk for bleeding include: Prevent variceal bleeding, Improve survival, Prevent other complications of portal hypertension (eg, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy). […] Our preferred strategy is pharmacologic prophylaxis with a nonselective beta blocker for patients without contraindications to beta blockers. […] Primary prophylaxis with a nonselective beta blocker or with EVL is supported by randomized trials demonstrating similar survival benefits with each strategy. […] Nonselective beta blockers are the cornerstone of pharmacologic prophylaxis for patients with cirrhosis and esophageal varices who do not have a contraindication or intolerance to beta blockers.

• #1 Varices – Cirrhosis Care

  https://cirrhosiscare.ca/treatment-provider/varices-hcp/

  Patients with compensated cirrhosis and fibroscan based liver stiffness 20 kPa AND platelet count 150,000 OR those who are already on carvedilol or a non-selective beta blocker, do not need endoscopy to screen for varices […] All patients with a suspected variceal bleed should receive antibiotic prophylaxis (ceftriaxone, 1 g i.v. daily for 7 days or until discharge whichever occurs sooner) […] After a variceal bleed, prevention of re-bleeding includes a combination of variceal ligation and non-selective beta-blockers (in the absence of contraindications) […] Choosing between Beta-blockers versus Endoscopic variceal ligation for primary prophylaxis against variceal bleeding […] Intolerance to one NSBB may sometimes be overcome by switching to another NSBB.

• #1 Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8422913/

  Patients with cirrhosis show an increased susceptibility to infection due to disease-related immune-dysfunction. […] Among pharmacological strategies to prevent infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute variceal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. […] Short-term antibiotic prophylaxis is applied in many other settings during hospitalization, such as before interventional or surgical procedures, but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial stewardship. […] Antibiotic prophylaxis represents a cornerstone for the management of several complications of decompensated cirrhosis, as spontaneous bacterial peritonitis and variceal bleeding.

• #1 Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8422913/

  Current guidelines recommend secondary prophylaxis with norfloxacin (400 mg/d) until death or LT after the first episode of SBP. […] The beneficial role of antibiotic prophylaxis has been widely demonstrated in patients with decompensated cirrhosis and AVB. […] Current guidelines recommend the use of intravenous (i.v.) cephalosporins (i.e. ceftriaxone 1 gr/d) as the best prophylactic therapy in AVB. […] Therefore, current guidelines advocate prospective studies to assess properly the effectiveness of antibiotic prophylaxis in compensated patients. […] In summary, antibiotic prophylaxis remains a cornerstone for decompensated cirrhosis with AVB. […] Antibiotic prophylaxis may be considered at least for expected technically difficult procedures or in patients with previous biliary interventions.

• #1 Why do we use antibiotics for SBP prophylaxis? | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-we-use-antibiotics-sbp-prophylaxis

  Individuals with low protein in their ascites and no other risk factors have a risk of developing SBP of less than 20% at 1 year. The risk is much higher with low protein ascites and markers of severe liver failure (Child-Pugh score 9 points with serum bilirubin 3 mg/dL) and/or circulatory dysfunction (serum creatinine 1.2 mg/dL, blood urea nitrogen 25 mg/dL, or serum sodium 130 mEq/L). […] Results from this study helped lead to recommendations from the American Association of Liver Diseases and the European Association for the Study of the Liver to use antibiotic primary prophylaxis in individuals with low-protein ascites less than 1.5 g/dL PLUS impaired liver (Child-Pugh score 9 points with serum bilirubin 3 mg/dL) or renal dysfunction (creatinine 1.2 mg/dL, blood urea nitrogen 25 mg/dL, or serum sodium 130 mEq/L).

• #1 Antimicrobial prophylaxis in decompensated cirrhosis: friend or foe?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10476838/

  Antimicrobial prophylaxis is currently recommended by international guidelines for patients with decompensated cirrhosis in specific clinical scenarios, namely, to prevent infection in acute variceal bleeding, as secondary prophylaxis following an episode of SBP, as primary prophylaxis in only a small subgroup of patients with ascites, and as secondary prophylaxis against recurrent HE. […] However, many clinicians find such rationing of medication challenging and we must work together to ensure our practice is based on evidence.

• #1 Antimicrobial prophylaxis in decompensated cirrhosis: friend or foe?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10476838/

  The single trial that underpins this recommendation, a landmark placebo-controlled RCT in 80 patients reported by Gins et al in 1990, demonstrated the effectiveness at 1 year of norfloxacin 400 mg/d at preventing SBP recurrence following an initial episode. […] Primary antibiotic prophylaxis to prevent a first episode of SBP in patients with cirrhotic ascites is a less well-established practice. […] Guideline-producing bodies are also split on this topic. […] The ASEPTIC trial (Primary Antibiotic prophylaxis using co-trimoxazole to prevent SpontanEous bacterial PeritoniTIs in Cirrhosis) is a multicenter RCT designed to address this question, with results anticipated in 2025. […] The most widely recommended and studied class of antibiotic for prophylaxis against SBP are quinolones. […] US guidance recommends either norfloxacin or co-trimoxazole for primary SBP prophylaxis in those with severe liver failure and/or renal dysfunction.

• #1 Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacteria peritonitis in cirrhosis: a systematic review and meta-analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08557-6

  Rifaximin was a promising and effective alternative to norfloxacin in SBP primary and secondary prevention. […] Overall, our results illuminated comparable incidences of adverse events with other antibiotics and norfloxacin. […] This updated meta-analysis could contribute to developing appropriate antibiotic strategies and provide evidence to support the use of rifaximin in the prevention of SBP.

• #1 Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8422913/

  Current American guidelines recommend the use of piperacillin-tazobactam, or cefotaxime plus ampicillin as routine prophylaxis during LT. […] Prophylaxis should be considered in cases where illness progression is considered likely, as in those with worsening encephalopathy, signs of systemic inflammation, or awaiting LT. […] In summary, current guidelines say that, even the routine use of prophylactic antibiotics does not increase survival in such patients, a strict surveillance for infection should be provided in order to start antibiotic therapy as early as possible.

• #1

  https://journals.lww.com/hep/fulltext/2016/06000/antibiotic_prophylaxis_in_cirrhosis__good_and_bad.34.aspx

  Antibiotic prophylaxis should therefore be instituted as early as possible, ideally before or immediately after endoscopy according to a recommendation of the Baveno VI consensus conference and the American Association for the Study of Liver Diseases guidelines. […] Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early de-escalation policies are key to achieve this balance; non-antibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis. […] To minimize the increasing development of antibiotic resistance, antibiotic stewardship programs that reduce inappropriate antibiotic use, including restriction of antibiotic prophylaxis to only those patients at the highest risk of infection, should be implemented.

• #1 Why do we use antibiotics for SBP prophylaxis? | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-we-use-antibiotics-sbp-prophylaxis

  Antibiotic prophylaxis is currently recommended to be started as early as possible after upper GI bleeding according to the American Association for the Study of Liver Diseases and to continue for 7 days. […] The current antibiotic regimens recommended for primary and secondary SBP prophylaxis in the United States are ciprofloxacin 500 mg/day PO or TMP/SMX double strength PO daily. […] There are several major concerns associated with long-term antibiotic use: Antibiotic resistance. This can lead to decreased antibiotic effectiveness and cause changes in the microbiologic profile of SBP infections over time by increasing multi-drug resistant organisms. […] All and all, there is still work that needs to be done to better understand the patient groups that most benefit from SBP prophylaxis.

• #1 Antibiotic Prophylaxis in Patients with Cirrhosislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40206/2016/01/19/antibiotic-prophylaxis-patients-with-cirrhosis

  A major cause of morbidity and mortality among patients with cirrhosis, especially decompensated cirrhosis, is the development of bacterial infections. The use of prophylactic antibiotics has led to improved outcomes in select high-risk cirrhotic patients, such as those with poor liver function and associated low protein ascites, upper gastrointestinal bleeding, and a prior episode of spontaneous bacterial peritonitis. […] To balance the drawbacks and benefits of antibiotic prophylaxis, investigators suggest the following strategies, based on a literature review. […] Limit broader spectrum antibiotics to those with more severe liver dysfunction or clinical status. […] Optimize antibiotic use within the first 48 to 72 hours of diagnosis of infection. […] Implement early de-escalation rules for empirical antibiotic treatment.

• #1 Antibiotic Prophylaxis in Patients with Cirrhosislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40206/2016/01/19/antibiotic-prophylaxis-patients-with-cirrhosis

  Limit antibiotic treatment duration to 5 to 7 days. […] Secondary spontaneous bacterial peritonitis prophylaxis may be unnecessary in cirrhotic patients who have resolution of ascites or in Child A patients who present with upper gastrointestinal bleeding. […] Use nonabsorbable antibiotics, such as rifaximin. […] Use emerging selective gut decontamination modalities, including pre- and probiotics and fecal microbiota transplant. […] What can be employed now, and what is highlighted in this review, is antibiotic stewardship. While we wait for more evidence-based strategies, clinicians can work with their hospitals to implement antibiotic stewardship principles for cirrhotic patients.

• #1 Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers | Gut

  https://gut.bmj.com/content/73/6/1015

  The pathophysiology of CSPH in patients with cirrhosis is underpinned by profound peripheral arterial vasodilatation and circulatory dysfunction. […] Gut-derived systemic inflammation and CAID, therefore, become the logical targets for therapies that prevent hepatic decompensation episodes and the progression to ACLF, which is often precipitated by infection and sterile inflammation. […] Therapeutic targets for patients with cirrhosis and CSPH have historically focused on counteracting peripheral arterial vasodilatation, that is, non-selective beta blockers (NSBB), which was shown to be a mainstay therapy that may have benefits beyond the prevention of variceal bleeding. […] The most effective therapy to reduce portal pressure is TIPS. Early or pre-emptive TIPS is recommended in patients at high risk of rebleeding after haemostasis, despite the presence of HE at admission.

• #1 Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers | Gut

  https://gut.bmj.com/content/73/6/1015

  Dietary interventions with increased consumption of fruit, vegetables, fibre and fermented food substances, prebiotics (lactulose), probiotics and synbiotics should be evaluated. […] Rifaximin- not only reduces the recurrence of overt HE but may also favourably manipulate the gut microbiome. […] FMT, therefore, could represent a promising non-antimicrobial therapeutic strategy to improve an array of clinical outcomes in cirrhotic patients, ranging from the development of encephalopathy and infection to reducing AMR rates. […] Statins are anti-inflammatory agents, blocking the action of eNOS downregulators, such as oxidised low-density lipoprotein, TNF- and caveolin-1, with antifibrotic effects which may not only reduce portal hypertension but also have a favourable impact on decompensation-free survival.

• #1 Cirrhosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

  No amount of alcohol is considered safe in patients with cirrhosis. They should avoid all alcohol use. […] Vaccinations are an important preventive measure in patients with cirrhosis because when the liver is scarred, patients are at higher risk of complications from certain infections. For patients with cirrhosis, we recommend vaccination against hepatitis A and B. We also recommend the pneumococcal vaccine, which is commonly referred to as the pneumonia vaccine, for all adult patients with cirrhosis. And patients with cirrhosis should also get the annual flu shot. […] If you have cirrhosis, be careful to limit additional liver damage: Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, don’t drink alcohol. Drinking alcohol may cause further liver damage. […] Protect yourself from infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.

• #1 Patient education: Cirrhosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/cirrhosis-beyond-the-basics

  Cirrhosis is a disease in which the liver becomes severely scarred, usually as a result of many years of continuous injury. […] In its earlier stages, cirrhosis may be reversible if the underlying cause can be treated. […] […] The first part of treatment for cirrhosis involves identifying its underlying cause and treating that, if possible. For example, if a person’s cirrhosis is due to heavy alcohol use, it’s imperative to stop using alcohol. […] […] Steps to protect the liver from further damage are described below. […] Vaccines against hepatitis A and B for those who are not already immune can help prevent further damage to the liver. […] It’s also important to get other vaccines, including vaccines to protect against diseases such as the flu (once a year), pneumonia (at least once), diphtheria and tetanus (once every 10 years), and pertussis (once during adulthood).

• #1 What are the management considerations for venous thromboembolic events in patients with cirrhosis? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/2/86

  Patients with cirrhosis are therefore susceptible to bleeding and thrombotic events secondary to this tenuous balance. […] Risk of VTE in patients with cirrhosis increases with prolonged hospitalization, immobilization, surgery, and male sex. Because of perceived increased bleeding risk in patients with cirrhosis, VTE prophylaxis has not been used routinely in this population, and evidence supporting it is limited. […] The American Gastroenterological Association therefore recommends standard anticoagulation prophylaxis in hospitalized patients with cirrhosis as a conditional recommendation with very low certainty of evidence. […] The European Association for the Study of the Liver (EASL) recommends that patients with cirrhosis who are at risk of VTE receive LMWH, noting that the strategy has unclear efficacy but a reasonable safety profile. […] Overall, more prospective investigation of DOAC safety and efficacy in this patient population is needed. […] The choice of anticoagulation for prophylaxis and treatment should be individualized, and prospective studies are needed to refine the decision-making process.

• #1 Coagulopathy in cirrhosis – EMCrit Project

  https://emcrit.org/ibcc/cirrhosis/

  DVT prophylaxis in cirrhosis […] Overall, the current consensus is that in patients with cirrhosis, the hemostasis is shifted towards a procoagulant state. […] A common misconception is that since patients with cirrhosis have an elevated INR, they are auto-anticoagulated and don’t require DVT prophylaxis. This is not true! […] Cirrhosis may actually increase the risk of DVT with an odds ratio of 1.7. […] Of course, not every patient with cirrhosis will be at increased risk of DVT there is a tremendous degree of heterogeneity among these patients. But overall, this patient group is at high risk of DVT/PE and requires DVT prophylaxis. […] Critically ill patients with cirrhosis should generally receive chemical DVT prophylaxis, similar to other critically ill patients. However, DVT prophylaxis may be contraindicated in the following situations: […] Elevated INR doesn’t reveal anything about coagulation and generally shouldn’t be a contraindication to anticoagulation.

• #1 Back to Basics: Outpatient Management of Cirrhosis | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/back-basics/back-basics-outpatient-management-cirrhosis

  Cirrhosis is characterized by compensated and decompensated stages, with hepatic decompensation being defined by the presence of ascites, hepatic encephalopathy (HE), or esophageal variceal bleeding. […] It is important to realize that a hepatology referral is prudent if a patient requires endoscopy, has decompensated cirrhosis, or develops HCC, as these patients may benefit from advanced therapies or transplant evaluation. […] In patients with ascites, dietary sodium restriction to 2 grams/day should be considered. However, this must be balanced against the risk of malnutrition, as discussed below. […] Dietary sodium restriction alone is inadequate in most patients with ascites, necessitating the use of diuretics. […] Patients with compensated cirrhosis are at highest risk of hepatic decompensation once they develop CSPH, which is defined by portal pressure gradients 10 mmHg.

• #1 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Most patients with cirrhosis are well compensated. They have no or minimal symptoms and with the modification of risk factors may have a reasonably good life expectancy. […] Patients should be referred for consideration for liver transplantation after the first signs of hepatic decompensation appear. […] Early initiation of beta-blocker therapy may help to reduce the risk of progressive CSPH and resultant decompensation. […] HCPs also have the opportunity to optimize management of the patients underlying liver disease, which has the potential to induce regression of hepatic fibrosis. […] Abstinence from alcohol has the potential to decrease the likelihood of decompensation in patients with established compensated cirrhosis. […] Avoiding alcohol use and cigarette smoking. […] Maintaining a healthy weight through good nutrition and exercise.

• #1 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  For all patients with liver disease, counseling points should be discussed, including avoidance of alcohol; maintenance of a healthy weight; nutrition; medication and supplement review; prevention of infections (including receiving vaccinations); screening and treatment of causative factors; and avoidance of unnecessary surgical procedures. […] Treatment of alcohol use disorder, chronic hepatitis B or C virus infection, and nonalcoholic fatty liver disease can prevent progression and complications of liver disease and can improve fibrosis levels, even in patients with cirrhosis.

• #2 Liver Cirrhosis – Symptoms, Causes, Complications and Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact

  https://www.pacehospital.com/liver-cirrhosis-symptoms-causes-and-prevention

  Preventative care can be taken by the patients themselves to avoid cirrhosis of the liver altogether. Preventative care can be divided into three steps: Healthy lifestyle adoption, Regular screenings for liver disease, Care optimisation, especially in risk populations. […] A healthy lifestyle allows the efficient liver functioning, potentially reducing the risk of liver disease. Healthy weight maintenance and having a healthy balanced diet with regular exercise can ensure a healthy lifestyle. Also, alcohol abstinence is another important factor. […] Screenings are necessary, especially in specific risk populations with greater possibility for signs of disease. The screenings could include a liver function test – a group of blood tests to check how well the liver is working. […] It’s crucial that patients with liver disease or any other medical condition adhere to their doctor’s orders and contact either their primary care physician for any questions or concerns. If the care is optimised, the likelihood of developing chronic liver cirrhosis is decreased. […] The risk population includes: Diabetics, Patients suffering from Hepatitis B and Hepatitis C virus, Patients suffering from non-alcoholic steatohepatitis (NASH) (fatty build-up in the liver linked with alcoholism) etc.

• #2 Liver Disease Prevention | Stanford Health Care

  https://stanfordhealthcare.org/medical-treatments/l/liver-disease-prevention/procedure.html

  Using a team approach, our liver disease specialists work side by side to deliver comprehensive preventive services. We determine the care that is best for you based on your unique condition and risks for liver disease. […] Liver disease prevention at Stanford includes: Adopting a healthy lifestyle, Liver disease screenings, Optimizing care for conditions that can lead to liver disease, Support for liver disease risk factors. […] Living a healthy lifestyle helps your liver work as efficiently as possible and lowers your risk for liver disease. […] Recommendations for a healthy lifestyle may include: Maintaining a healthy weight, Eating a healthy diet, Exercising regularly, Avoiding alcohol, which makes your liver work harder to do its job, Only taking medications that you need and carefully following dosing recommendations.

• #2 Cirrhosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

  No amount of alcohol is considered safe in patients with cirrhosis. They should avoid all alcohol use. […] Vaccinations are an important preventive measure in patients with cirrhosis because when the liver is scarred, patients are at higher risk of complications from certain infections. For patients with cirrhosis, we recommend vaccination against hepatitis A and B. We also recommend the pneumococcal vaccine, which is commonly referred to as the pneumonia vaccine, for all adult patients with cirrhosis. And patients with cirrhosis should also get the annual flu shot. […] If you have cirrhosis, be careful to limit additional liver damage: Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, don’t drink alcohol. Drinking alcohol may cause further liver damage. […] Protect yourself from infections. Cirrhosis makes it more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.

• #2 What Is Cirrhosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/liver-disease/cirrhosis/

  There are many ways to keep your liver healthy and prevent cirrhosis, including the following: […] Don’t drink alcohol to excess. If you consume alcohol, do it in moderation, which is up to one drink a day for women and up to two drinks a day for men, according to the Centers for Disease Control and Prevention (CDC). […] Get vaccinated for hepatitis A and B. […] Follow a healthy diet. […] Have regular medical checkups, and follow your doctor’s recommendations to control your weight, blood pressure, blood cholesterol, and blood sugar if you have diabetes.

• #2 Cirrhosis: Causes, Symptoms, Treatment

  https://www.healthline.com/health/cirrhosis

  Practicing sex with a barrier method can reduce the risk of getting hepatitis B or C. […] The Centers for Disease Control and Prevention (CDC) recommends that all infants and adults with a higher risk, such as healthcare professionals and rescue personnel, be vaccinated against hepatitis B. […] Limiting alcohol intake or avoiding alcohol, eating a balanced diet, and getting adequate exercise can help prevent or slow cirrhosis. Other prevention methods include: avoiding recreational drugs, talking with your doctor about any medications you take and always taking the appropriate amount, getting screened for hepatitis if you believe you may be at risk for it. […] While not every case of cirrhosis can be avoided, there are ways to prevent it. […] Pursuing a lifestyle that includes a nutritious diet, physical activity, moderate to limited alcohol intake, and regular appointments with a doctor are all ways to keep your liver in great shape.

• #2 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Hepatic fibrosis can be prevented by interventions that decrease the levels of proinflammatory cytokines in both experimental models and human subjects. […] The AASLD supports screening for clinically significant fibrosis (ie, F2) in a number of patient cohorts such as those with Type 2 diabetes, medically complicated obesity, MASLD in the setting of moderate alcohol use, first-degree relatives of patients with cirrhosis due MASLD, and fatty liver identified incidentally on imaging. […] The FIB-4 score is the primary screening tool recommended to assess patients with MASLD risk factors. […] The AASLD recommends every-6-month performance of an abdominal ultrasound and an AFP blood test in patients with both compensated and decompensated cirrhosis. […] Patients with compensated cirrhosis should undergo routine follow-up monitoring of their complete blood cell (CBC) count, renal and liver chemistries, and INR.

• #2 Protect your liver: Learn about the prevention and treatment of hepatic cirrhosis

  https://www.linkedin.com/pulse/protect-your-liver-learn-prevention-treatment-hepatic-9lwqc

  Prevention: […] Primary Prevention: […] Treat various potential chronic liver diseases to prevent progression to cirrhosis. […] Regularly screen patients with risk factors for liver disease using non-invasive markers of liver fibrosis to identify liver diseases before they progress to cirrhosis. […] Reduce alcohol consumption or abstain from alcohol completely to prevent alcoholic liver disease. […] Adopt a balanced diet, control weight, and exercise regularly to prevent non-alcoholic fatty liver disease. […] Get vaccinated, avoid intravenous drug use, and practice safe sex to prevent chronic viral hepatitis. […] […] […] Preventing further liver damage in cirrhosis patients: […] Treat underlying chronic liver diseases. […] Abstain from alcohol. […] Avoid the use of hepatotoxic drugs. […] Regular health monitor.

• #2 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  For all patients with liver disease, counseling points should be discussed, including avoidance of alcohol; maintenance of a healthy weight; nutrition; medication and supplement review; prevention of infections (including receiving vaccinations); screening and treatment of causative factors; and avoidance of unnecessary surgical procedures. […] Treatment of alcohol use disorder, chronic hepatitis B or C virus infection, and nonalcoholic fatty liver disease can prevent progression and complications of liver disease and can improve fibrosis levels, even in patients with cirrhosis.

• #2 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  We refer patients with decompensated cirrhosis for liver transplantation evaluation because transplantation is effective long-term therapy for preventing variceal bleeding and other complications of portal hypertension. […] The goals of prevention for patients with esophageal varices at risk for bleeding include: Prevent variceal bleeding, Improve survival, Prevent other complications of portal hypertension (eg, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy). […] Our preferred strategy is pharmacologic prophylaxis with a nonselective beta blocker for patients without contraindications to beta blockers. […] Primary prophylaxis with a nonselective beta blocker or with EVL is supported by randomized trials demonstrating similar survival benefits with each strategy. […] Nonselective beta blockers are the cornerstone of pharmacologic prophylaxis for patients with cirrhosis and esophageal varices who do not have a contraindication or intolerance to beta blockers.

• #2 # 398:Live! From SHM: Inpatient Cirrhosis Management – The Curbsiders

  https://thecurbsiders.com/curbsiders-podcast/398live-from-shm-inpatient-cirrhosis-management

  Because of the increasing prevalence of MDROs, AASLD guidelines have more stringent criteria for who should receive prophylaxis for SBP. Patients who have recovered from an episode of SBP, who have cirrhosis and a concurrent GIB, who have low protein and renal dysfunction (Cr > 1.2, BUN > 25, Na < 130) or liver failure (Child Pugh > 9 or bilirubin > 3) should receive prophylaxis with ciprofloxacin or norfloxacin (Biggins, 2021). […] Once a patient has had and subsequently recovered from an acute variceal bleed, secondary prevention with non selective beta blockers (propranolol, nadolol) should be considered. Notably patients have a 60% risk of rebleeding the first year after an acute variceal bleed (Garcia-Tsao 2017).

• #2 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  The goal of prevention with beta blockers is to lower the portal pressure by reducing portal blood flow, which is accomplished by vasoconstricting the splanchnic circulation. […] For patients who cannot take beta blockers, we suggest endoscopic variceal ligation (EVL) rather than no intervention because evidence suggests that EVL resulted in lower risk of variceal bleeding and mortality. […] We do not use the following strategies for prophylaxis: Endoscopic sclerotherapy, Shunt intervention, Cardioselective beta blockers are not used for lowering portal pressure because they selectively block beta-1 receptors with little or no effect on beta-2 receptors.

• #2 Antibiotic Prophylaxis in Patients with Cirrhosis and Upper Gastrointestinal Bleeding | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0501/p582.html

  Antibiotics should be used for prophylaxis in hospitalized patients with cirrhosis and upper gastrointestinal bleeding. Prophylaxis reduces all-cause mortality by 21%, as well as bacterial infections and rebleeding. […] Compared with no intervention or placebo, antibiotic prophylaxis reduced all-cause mortality, mortality from bacterial infections, and bacterial infections. […] Prophylactic intravenous ceftriaxone was administered to 88 of these patients at a dosage of 1 g immediately after endoscopy, then every 12 hours until discharge. Compared with the control group, the antibiotic group had a lower risk of bacterial infections, including bacteremia, spontaneous bacterial peritonitis, pneumonia, and urinary tract infections, and a lower risk of rebleeding.

• #2 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  Summarize recommendations for prophylaxis of variceal bleeding. […] The approach to primary prophylaxis depends on the findings from the screening EGD. If no varices are observed at the time of EGD, then primary prophylaxis is not indicated. […] For patients not receiving prophylaxis with a nonselective beta-blocker, EGD should be repeated (1) annually if there is ongoing liver injury or hepatic decompensation, (2) every 2 years for those individuals with liver injury that is quiescent, or (3) at the time of hepatic decompensation. […] The medium/large category of varices consists of varices greater than 5 mm in size that typically have a more prominent and tortuous appearance within the esophageal lumen than seen with small varices. For individuals with medium/large varices, use of a nonselective beta-blocker or treatment with endoscopic variceal ligation has been shown to significantly reduce the risk of variceal bleeding.

• #2 Antimicrobial prophylaxis in decompensated cirrhosis: friend or foe?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10476838/

  Infection is a major driver of mortality and morbidity in decompensated cirrhosis, and the risk of both community-acquired and nosocomial infection correlates with increased severity of liver disease. […] Prophylactic antibiotics are often considered for those patients deemed most susceptible to developing infection and subsequent poor outcomes. […] Therefore, the potential benefits of antibiotic prophylaxis need to be balanced against the principles of good antimicrobial stewardship. […] Antibiotic prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with cirrhotic ascites is one of the widely accepted indications in standard hepatology practice. […] This highlights the increased susceptibility to all infections faced by patients with decompensated cirrhosis. […] Recurrent SBP confers a devastating risk of mortality, and secondary prophylaxis following an initial episode is widely recommended as part of standard care.

• #2

  https://journals.lww.com/hep/fulltext/2016/06000/antibiotic_prophylaxis_in_cirrhosis__good_and_bad.34.aspx

  Antibiotic prophylaxis in patients with cirrhosis has been associated with a decrease in the incidence of bacterial infections. […] The probability of recurrence of spontaneous bacterial peritonitis (SBP) is extremely high in patients not receiving prophylaxis. […] Two randomized controlled trials (RCTs) evaluated the effects of norfloxacin, a poorly absorbed antibiotic, in the prevention of SBP recurrence. […] Long-term quinolone administration (norfloxacin or ciprofloxacin in countries where it is unavailable) is therefore recommended in this highly select population, particularly in those awaiting liver transplantation in whom the development of an infection would signify removal from the transplant list. […] Antibiotic prophylaxis reduces the mean incidence of in-hospital infections from 45% to 14%.

• #2 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Cirrhosis is the 12th leading cause of death in the United States. […] Treatment goals are preventing cirrhosis, decompensation, and death. […] Varices are monitored with endoscopy and often require prophylaxis with nonselective beta blockers. […] Oral antibiotic prophylaxis against spontaneous bacterial peritonitis should be initiated in patients with a history of spontaneous bacterial peritonitis or ascitic fluid protein 1.5 g per dL (15 g per L) and advanced liver disease (Child-Pugh score 9 or bilirubin 3 mg per dL) or kidney disease (serum creatinine 1.2 mg per dL, serum sodium 130 per mmol per L). […] Patients with cirrhosis who have medium, large, or high-risk varices (red wale markings) should be treated with nonselective beta blockers and/or endoscopic band ligation for primary prevention of variceal bleeds.

• #2 Why do we use antibiotics for SBP prophylaxis? | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-we-use-antibiotics-sbp-prophylaxis

  Antibiotic prophylaxis is currently recommended to be started as early as possible after upper GI bleeding according to the American Association for the Study of Liver Diseases and to continue for 7 days. […] The current antibiotic regimens recommended for primary and secondary SBP prophylaxis in the United States are ciprofloxacin 500 mg/day PO or TMP/SMX double strength PO daily. […] There are several major concerns associated with long-term antibiotic use: Antibiotic resistance. This can lead to decreased antibiotic effectiveness and cause changes in the microbiologic profile of SBP infections over time by increasing multi-drug resistant organisms. […] All and all, there is still work that needs to be done to better understand the patient groups that most benefit from SBP prophylaxis.

• #2 Antimicrobial prophylaxis in decompensated cirrhosis: friend or foe?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10476838/

  The single trial that underpins this recommendation, a landmark placebo-controlled RCT in 80 patients reported by Gins et al in 1990, demonstrated the effectiveness at 1 year of norfloxacin 400 mg/d at preventing SBP recurrence following an initial episode. […] Primary antibiotic prophylaxis to prevent a first episode of SBP in patients with cirrhotic ascites is a less well-established practice. […] Guideline-producing bodies are also split on this topic. […] The ASEPTIC trial (Primary Antibiotic prophylaxis using co-trimoxazole to prevent SpontanEous bacterial PeritoniTIs in Cirrhosis) is a multicenter RCT designed to address this question, with results anticipated in 2025. […] The most widely recommended and studied class of antibiotic for prophylaxis against SBP are quinolones. […] US guidance recommends either norfloxacin or co-trimoxazole for primary SBP prophylaxis in those with severe liver failure and/or renal dysfunction.

• #2 Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacteria peritonitis in cirrhosis: a systematic review and meta-analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08557-6

  Prophylaxis of nosocomial- and community-acquired SBP is pivotal for cirrhotic patients. […] Currently, antimicrobial prophylaxis has been suggested to prevent SBP in cirrhotic patients. […] Taking bacterial resistance into consideration, antibiotic prophylaxis must be used judiciously and sparingly in patients with high risks of developing SBP, and antibiotic alternatives to norfloxacin have been explored in SBP prophylaxis. […] Therefore, we performed the present meta-analysis primarily to compare the effects of norfloxacin and other antibiotics in SBP prophylaxis for patients with high risks of developing SBP. […] The results showed the effects of other antibiotics were comparable to norfloxacin for primary SBP prophylaxis and secondary SBP prophylaxis. […] Subgroup analysis of the available data indicated that the prophylactic effects of norfloxacin were comparable to those of other antibiotics.

• #2 Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8422913/

  Current American guidelines recommend the use of piperacillin-tazobactam, or cefotaxime plus ampicillin as routine prophylaxis during LT. […] Prophylaxis should be considered in cases where illness progression is considered likely, as in those with worsening encephalopathy, signs of systemic inflammation, or awaiting LT. […] In summary, current guidelines say that, even the routine use of prophylactic antibiotics does not increase survival in such patients, a strict surveillance for infection should be provided in order to start antibiotic therapy as early as possible.

• #2 Antibiotic Prophylaxis in Patients with Cirrhosislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40206/2016/01/19/antibiotic-prophylaxis-patients-with-cirrhosis

  Limit antibiotic treatment duration to 5 to 7 days. […] Secondary spontaneous bacterial peritonitis prophylaxis may be unnecessary in cirrhotic patients who have resolution of ascites or in Child A patients who present with upper gastrointestinal bleeding. […] Use nonabsorbable antibiotics, such as rifaximin. […] Use emerging selective gut decontamination modalities, including pre- and probiotics and fecal microbiota transplant. […] What can be employed now, and what is highlighted in this review, is antibiotic stewardship. While we wait for more evidence-based strategies, clinicians can work with their hospitals to implement antibiotic stewardship principles for cirrhotic patients.

• #2 Antibiotic Prophylaxis in Patients with Cirrhosislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40206/2016/01/19/antibiotic-prophylaxis-patients-with-cirrhosis

  A major cause of morbidity and mortality among patients with cirrhosis, especially decompensated cirrhosis, is the development of bacterial infections. The use of prophylactic antibiotics has led to improved outcomes in select high-risk cirrhotic patients, such as those with poor liver function and associated low protein ascites, upper gastrointestinal bleeding, and a prior episode of spontaneous bacterial peritonitis. […] To balance the drawbacks and benefits of antibiotic prophylaxis, investigators suggest the following strategies, based on a literature review. […] Limit broader spectrum antibiotics to those with more severe liver dysfunction or clinical status. […] Optimize antibiotic use within the first 48 to 72 hours of diagnosis of infection. […] Implement early de-escalation rules for empirical antibiotic treatment.

• #2

  https://journals.lww.com/hepcomm/fulltext/2023/09010/antimicrobial_prophylaxis_in_decompensated.14.aspx

  The ASEPTIC trial (Primary Antibiotic prophylaxis using co-trimoxazole to prevent SpontanEous bacterial PeritoniTIs in Cirrhosis) is a multicenter RCT designed to address this question, with results anticipated in 2025. […] Current guidelines recommend consideration of antibiotic prophylaxis in those patients likely to be at greatest risk of developing bacterial infection, namely those who have recovered from an episode of SBP, those experiencing variceal hemorrhage or those with low-protein ascites. […] We recommend prophylaxis should not be recommended for the following patients as the risk of AMR is high and there is unlikely to be any clinical benefit: Patients receiving end-of-life care. […] Therefore, until trial data are available to suggest otherwise, we recommend prophylaxis (for SBP and acute variceal bleed) is considered for the following patients with Child-Pugh 7 and presence of clinically significant ascites: Patients on the liver transplant or transjugular intrahepatic portosystemic shunt waiting list. […] We must conclude that antimicrobial prophylaxis is more foe than friend unless accompanied by good clinical evidence of net benefit and, unless adequately addressed, we could unwittingly find ourselves in a postantimicrobial era.

• #2 Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers | Gut

  https://gut.bmj.com/content/73/6/1015

  Dietary interventions with increased consumption of fruit, vegetables, fibre and fermented food substances, prebiotics (lactulose), probiotics and synbiotics should be evaluated. […] Rifaximin- not only reduces the recurrence of overt HE but may also favourably manipulate the gut microbiome. […] FMT, therefore, could represent a promising non-antimicrobial therapeutic strategy to improve an array of clinical outcomes in cirrhotic patients, ranging from the development of encephalopathy and infection to reducing AMR rates. […] Statins are anti-inflammatory agents, blocking the action of eNOS downregulators, such as oxidised low-density lipoprotein, TNF- and caveolin-1, with antifibrotic effects which may not only reduce portal hypertension but also have a favourable impact on decompensation-free survival.

• #2 Cirrhosis of the Liver: Symptoms, Stages, and Treatment

  https://www.webmd.com/fatty-liver-disease/understanding-cirrhosis-basic-information

  Talk to your doctor about statins. These drugs are usually used to treat high cholesterol. They may also help protect you from developing cirrhosis if you have hepatitis C or hepatitis B. […] Get tested. The CDC recommends that all adults 18 and older be screened for hepatitis C at least once in their lifetime.

• #2 Vaccines and Liver Disease

  https://www.nfid.org/immunization/vaccines-and-liver-disease/

  If you have liver disease, staying up to date with recommended vaccines can help protect your health. […] Vaccination is safe and can help protect against serious disease and related complications that can lead to hospitalization and even death. […] If you have liver disease, getting vaccinated can protect against serious disease and prevent hospitalization and death. […] People who have liver disease, especially those with cirrhosis, are more likely to die from COVID-19. […] If you have cirrhosis, getting infected with flu puts you at higher risk of developing severe related complications including death. […] A study found that people with chronic liver disease who got vaccinated against flu were 27% less likely to be admitted to a hospital. […] People who have liver disease have a greater risk of serious complications from hepatitis A.

• #2 Coagulopathy in cirrhosis – EMCrit Project

  https://emcrit.org/ibcc/cirrhosis/

  DVT prophylaxis in cirrhosis […] Overall, the current consensus is that in patients with cirrhosis, the hemostasis is shifted towards a procoagulant state. […] A common misconception is that since patients with cirrhosis have an elevated INR, they are auto-anticoagulated and don’t require DVT prophylaxis. This is not true! […] Cirrhosis may actually increase the risk of DVT with an odds ratio of 1.7. […] Of course, not every patient with cirrhosis will be at increased risk of DVT there is a tremendous degree of heterogeneity among these patients. But overall, this patient group is at high risk of DVT/PE and requires DVT prophylaxis. […] Critically ill patients with cirrhosis should generally receive chemical DVT prophylaxis, similar to other critically ill patients. However, DVT prophylaxis may be contraindicated in the following situations: […] Elevated INR doesn’t reveal anything about coagulation and generally shouldn’t be a contraindication to anticoagulation.

• #2 Patient education: Cirrhosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/cirrhosis-beyond-the-basics

  […] People with cirrhosis should avoid all substances that are known to damage the liver. This includes: Alcohol, Nonsteroidal antiinflammatory drugs, such as ibuprofen and naproxen, Some supplements and herbal remedies, such as kava kava, Some prescribed medications. […] […] Aside from needing to avoid certain medications and substances, people with cirrhosis sometimes need to take less of certain medications than people with healthy livers. […] […] To find out if anything you take could harm your liver, put all the bottles of all the medications you take into a bag and take them with you to the doctor who manages your liver disease. […] […] When it is healthy, the liver has many jobs, including filtering toxins out of the blood, breaking down certain drugs and alcohol, and making proteins that are important in clotting or digestion.

• #2 Cirrhosis and Liver Cancer: Prevention and Early Detection | Riverside Health

  https://www.riversideonline.com/en/patients-and-visitors/healthy-you-blog/blog/c/cirrhosis-and-liver-cancer

  About 4.5 million people in the US have a diagnosis of cirrhosis, a liver disease. […] The good news is that early detection and prevention can slow the progression of cirrhosis and reduce the likelihood that cancer will develop. […] You can take steps to slow the progression of your disease and prevent cancer. […] You can prevent cirrhosis by living a healthy style and avoiding behaviors that damage your liver. Here are some ways to reduce your risk of cirrhosis: Drink alcohol in moderation or not at all, Eat a healthy balanced diet filled with minimally processed foods like vegetables and fruits, Avoid added sugars, Maintain a healthy body weight, Exercise regularly and build movement into your day, Don’t share needles for illicit or prescription drug use, Treat viral hepatitis with medication, Practice safe sex. […] However, lifestyle changes can help slow the progression of liver damage. […] Patients with cirrhosis are at higher risk for developing liver cancer. […] In many cases, lifestyle measures can slow the progression and improve the quality of life.

• #3 Cirrhosis

  https://www.nhs.uk/conditions/cirrhosis/treatment/

  Cirrhosis cannot be cured, but there are treatments that can help slow it down or stop it getting worse. […] It’s also strongly recommended to make healthy lifestyle changes, including to stop drinking alcohol. […] There are some things you can do that may help stop your cirrhosis getting worse and help you to stay healthy. […] have a healthy, balanced diet […] exercise regularly […] try to keep to a healthy weight […] stay up to date with vaccinations, such as the flu vaccine and pneumococcal vaccine. […] do not drink alcohol […] do not smoke.

• #3 Cirrhosis of the Liver: Symptoms, Stages, and Treatment

  https://www.webmd.com/fatty-liver-disease/understanding-cirrhosis-basic-information

  A healthy lifestyle is a key part of preventing cirrhosis. […] Go easy on alcohol. Drinking too much alcohol causes your liver to swell. Over time, this leads to cirrhosis. But this doesn’t happen overnight. Alcohol-related cirrhosis is often the result of 10 or more years of heavy drinking, but some people are more prone to the disease than others. […] Protect yourself against hepatitis. Most often, a virus causes this inflammation of the liver. The most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Chronic (long-term) hepatitis B and C can cause cirrhosis. […] Get vaccinated. Everyone below the age of 60 should get the hepatitis B vaccine. […] Watch what you eat. Fatty buildup in your liver can cause nonalcoholic steatohepatitis and lead to cirrhosis. NASH is linked to high cholesterol, coronary artery disease, obesity, and diabetes.

• #3 Liver disease: Symptoms, treatment and prevention

  https://careplusvn.com/en/liver-disease-symptoms-treatment-and-prevention

  Periodic screening for liver disease is the best way to prevent serious liver diseases […] To prevent liver disease, it is necessary to conduct blood test and liver enzymes test […] How to prevent liver disease: Eat clean food. Do not share needles, razors, personal items such as toothbrushes. Use safety measures when having sex. Get the vaccine (hepatitis A and B viruses) fully according to the vaccination schedule or as directed by the Doctor. Have regular health check-ups. Develop a scientific diet, full of nutrients, healthy lifestyle, and reasonable rest. Consult your doctor before using any pain reliever or antibiotic. Absolutely not arbitrarily buying drugs, combining East and West medicines. Maintain a stable weight, avoid obesity. Limit alcohol and drug. Exercise at least 30 minutes per day.

• #3 Varices – Cirrhosis Care

  https://cirrhosiscare.ca/treatment-provider/varices-hcp/

  Patients with compensated cirrhosis and fibroscan based liver stiffness 20 kPa AND platelet count 150,000 OR those who are already on carvedilol or a non-selective beta blocker, do not need endoscopy to screen for varices […] All patients with a suspected variceal bleed should receive antibiotic prophylaxis (ceftriaxone, 1 g i.v. daily for 7 days or until discharge whichever occurs sooner) […] After a variceal bleed, prevention of re-bleeding includes a combination of variceal ligation and non-selective beta-blockers (in the absence of contraindications) […] Choosing between Beta-blockers versus Endoscopic variceal ligation for primary prophylaxis against variceal bleeding […] Intolerance to one NSBB may sometimes be overcome by switching to another NSBB.

• #3

  https://journals.lww.com/hep/fulltext/2016/06000/antibiotic_prophylaxis_in_cirrhosis__good_and_bad.34.aspx

  Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. […] The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low-protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. […] Preventing infections in cirrhosis is therefore essential. The main current strategy is the use of prophylactic antibiotics.

• #3 Why do we use antibiotics for SBP prophylaxis? | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-we-use-antibiotics-sbp-prophylaxis

  Antibiotic prophylaxis is currently recommended to be started as early as possible after upper GI bleeding according to the American Association for the Study of Liver Diseases and to continue for 7 days. […] The current antibiotic regimens recommended for primary and secondary SBP prophylaxis in the United States are ciprofloxacin 500 mg/day PO or TMP/SMX double strength PO daily. […] There are several major concerns associated with long-term antibiotic use: Antibiotic resistance. This can lead to decreased antibiotic effectiveness and cause changes in the microbiologic profile of SBP infections over time by increasing multi-drug resistant organisms. […] All and all, there is still work that needs to be done to better understand the patient groups that most benefit from SBP prophylaxis.

• #3 Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacteria peritonitis in cirrhosis: a systematic review and meta-analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08557-6

  Prophylaxis of nosocomial- and community-acquired SBP is pivotal for cirrhotic patients. […] Currently, antimicrobial prophylaxis has been suggested to prevent SBP in cirrhotic patients. […] Taking bacterial resistance into consideration, antibiotic prophylaxis must be used judiciously and sparingly in patients with high risks of developing SBP, and antibiotic alternatives to norfloxacin have been explored in SBP prophylaxis. […] Therefore, we performed the present meta-analysis primarily to compare the effects of norfloxacin and other antibiotics in SBP prophylaxis for patients with high risks of developing SBP. […] The results showed the effects of other antibiotics were comparable to norfloxacin for primary SBP prophylaxis and secondary SBP prophylaxis. […] Subgroup analysis of the available data indicated that the prophylactic effects of norfloxacin were comparable to those of other antibiotics.

• #3

  https://journals.lww.com/hep/fulltext/2016/06000/antibiotic_prophylaxis_in_cirrhosis__good_and_bad.34.aspx

  Antibiotic prophylaxis should therefore be instituted as early as possible, ideally before or immediately after endoscopy according to a recommendation of the Baveno VI consensus conference and the American Association for the Study of Liver Diseases guidelines. […] Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early de-escalation policies are key to achieve this balance; non-antibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis. […] To minimize the increasing development of antibiotic resistance, antibiotic stewardship programs that reduce inappropriate antibiotic use, including restriction of antibiotic prophylaxis to only those patients at the highest risk of infection, should be implemented.

• #3

  https://journals.lww.com/hepcomm/fulltext/2023/09010/antimicrobial_prophylaxis_in_decompensated.14.aspx

  Antimicrobial prophylaxis is currently recommended by international guidelines for patients with decompensated cirrhosis in specific clinical scenarios, namely, to prevent infection in acute variceal bleeding, as secondary prophylaxis following an episode of SBP, as primary prophylaxis in only a small subgroup of patients with ascites, and as secondary prophylaxis against recurrent HE. […] Prophylactic antibiotics are often considered for those patients deemed most susceptible to developing infection and subsequent poor outcomes. […] Antibiotics prescribed for prophylaxis should have demonstrated efficacy in high-quality clinical trials, have a low potential for AMR, be low cost and have few adverse effects. […] In our opinion, antibiotic prophylaxis can only be justified if there is a reasonable expectation that it will lead to improved length and quality of life for the patient.

• #3 Antibiotic Prophylaxis in Patients with Cirrhosislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40206/2016/01/19/antibiotic-prophylaxis-patients-with-cirrhosis

  Limit antibiotic treatment duration to 5 to 7 days. […] Secondary spontaneous bacterial peritonitis prophylaxis may be unnecessary in cirrhotic patients who have resolution of ascites or in Child A patients who present with upper gastrointestinal bleeding. […] Use nonabsorbable antibiotics, such as rifaximin. […] Use emerging selective gut decontamination modalities, including pre- and probiotics and fecal microbiota transplant. […] What can be employed now, and what is highlighted in this review, is antibiotic stewardship. While we wait for more evidence-based strategies, clinicians can work with their hospitals to implement antibiotic stewardship principles for cirrhotic patients.

• #3 Patient education: Cirrhosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/cirrhosis-beyond-the-basics

  Cirrhosis is a disease in which the liver becomes severely scarred, usually as a result of many years of continuous injury. […] In its earlier stages, cirrhosis may be reversible if the underlying cause can be treated. […] […] The first part of treatment for cirrhosis involves identifying its underlying cause and treating that, if possible. For example, if a person’s cirrhosis is due to heavy alcohol use, it’s imperative to stop using alcohol. […] […] Steps to protect the liver from further damage are described below. […] Vaccines against hepatitis A and B for those who are not already immune can help prevent further damage to the liver. […] It’s also important to get other vaccines, including vaccines to protect against diseases such as the flu (once a year), pneumonia (at least once), diphtheria and tetanus (once every 10 years), and pertussis (once during adulthood).

• #3 Back to Basics: Outpatient Management of Cirrhosis | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/back-basics/back-basics-outpatient-management-cirrhosis

  The 2023 AASLD guidelines state that NSBBs should be considered in patients with compensated cirrhosis and CSPH to prevent decompensation. […] Patients with cirrhosis should undergo endoscopic variceal surveillance if they are not a candidate for empiric NSBB. […] The 2023 AASLD guidelines recommend that patients with cirrhosis and subset populations of patients with chronic hepatitis B undergo HCC screening every 6 months with abdominal ultrasound and alpha-fetoprotein (AFP) testing. […] Recent AASLD guidelines recommend screening patients with cirrhosis for micronutrient deficiencies annually. […] AASLD guidelines recommend a goal daily protein intake of 1.2-1.5 g/kg ideal body weight. […] Sodium restriction will prevent fluid retention but may decrease the palatability of food, creating a barrier to adequate oral intake. […] Non-selective beta blockers are beneficial in patients with portal hypertension and can prevent/delay complications of variceal bleeding and ascites. […] Patients with cirrhosis should be screened for HCC every 6 months and malnutrition at least every 12 months.

• #3 Navigating Cirrhosis: Prevention Strategies for a Healthy Liver – GI AssociatesAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontReset

  https://giassoc.org/navigating-cirrhosis-prevention-strategies-for-a-healthy-liver/

  Maintaining a healthy weight through diet and regular physical activity is essential. […] Regular medical checkups and screenings play a critical role in early detection and prevention of liver diseases that could lead to cirrhosis. […] With the right knowledge and proactive measures, we can safeguard our liver health and prevent cirrhosis.

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