Therapeutic Handbook - GGC Prescribing

Management of Decompensated Liver DiseaseGastrointestinal SystemAssessment / monitoring• Bloods for FBC, coagulation screen, U&Es, LFTs, glucose• Signs of chronic liver disease• Arrange ultrasound scan of abdomen• Assess for alcohol withdrawal• Dietary assessment• Liver screen including AFP (alpha fetoprotein) if not previously performed• In encephalopathy (signs = mental slowness, confusion, drowsiness, liver flap):Assess for the following precipitants and treat as appropriate:- Sepsis- Culture blood and urine- Tap ascites if present for WCC count, protein content and culture (see below)- Arrange chest x-ray- Bleeding- Renal failure, electrolyte abnormalities- Constipation- Medication (e.g. sedatives or over-diuresis)• In renal impairment:- Assess for potentially reversible factors – dehydration, diuretics, sepsis, intrinsic renaldisease.- Renal tract US to exclude obstruction. Urine dipstick – if hepatorenal should be nothingabnormal detected. If blood and protein consider renal causes.- Assess for hydration.• If ascites is present:- Consider other causes of ascites (e.g. malignancy, Budd-Chiari syndrome or cardiac failure).- Perform diagnostic ascitic tap. Aspirate 50 ml of fluid (normally straw coloured) and send for:- Microbiology – WCC and culture in blood culture bottle (anaerobic and aerobic)- Biochemistry – total protein and albumin- Cytology - send if malignancy suspected or SAAG (serum-ascites albumin gradient) < 11.Obtain > 100 ml of fluid to increase yield.Continues on next pagePage 56