Patient could be drinking too much Alcohol or might have had Hepatitis B or C for a long time or might have had none of these
Presents to ER with altered mental status, or fluid overload.
ER:
Routine Labs, EKG, CXR, UA
US of abdomen
NH3 Level, Tylenol level
IV Lasix
Hospitalist:
Telemetry
Aspiration precautions
Oxygen
Hepatitis Panel: Hepatitis A antibody, Hepatitis B Surface antigen, Hepatitis B Surface antibody, Hepatitis B Core Antibody, Hepatitis C antibody
Lactulose 15-45mg PO / Enema for elevated NH3 (explain to the patients that Lactulose is important after discharge in preventing Encephalopathy as some patients might stop taking it when they feel good so they can avoid going to bathroom frequently)
Continue diuretics like Lasix and Spironolactone
IR consult for Paracentesis
Order: LDH, Protein, Glucose, Gram Stain, C/S, Cell Count and Diff, Cytology, Albumin
Paracentesis for Ascitis–>IR consult
May need IV Albumin for large volume paracentesis
Vitamin K for high INR
Alcoholics: Thiamine 100mg, Folic acid 1mg, Multivitamin one tab daily
GI:
EGD for varices/Portal HTN evaluation–>Propranolol PO if present
Out patient evaluation for transplant at a Tertiary care center-patient needs to be sober for 6months
Other tests for Elevated LFT:
ANA IgG antibody
Anti-dsDNA antibodies
Serum Copper
Mitochondrial Antibody
Smooth Muslce Antibody
Serum Ceruloplasmin
Serum Alpha-1 Antitrypsin
Alpha Fetoprotein Tumor Marker
Earn CME from UpToDate: Cirrhosis in adults: Overview of complications, general management, and prognosis
