Decompensated liver cirrhosis, complicated by

Thrombocytopenia

Anemia

Leukopenia

Coagulopathy :  SCD only

Hyponatremia 

Child Pugh _ Cirrhosis MELD Na_(mortality rate) Maddry_(>30, prednisolone in nonseptic condition) Lille score (response, 7 days after prednisolone)

•  etiology:  Alcoholic hepatitis, Nash, hepatitis ABC (3rd country), autoimmune hepatitis, genetic disease alpha-1 antitrypsin Wilson disease, HCC
•  Ascites:  Paracentesis under guided ultrasound, Aside of fluid study -SAAG
•   SBP prophylaxis:  Ceftriaxone 1 g/ ceftriaxone 2 g therapeutic treatment
•   Pleural effusion/hepatic hydrothorax:
•   Hepato encephalopathy:  Aristerix, Lactulose, rifaximin, neuro check
•   Esophageal varices:  GI consult for EGD, Protonix twice a day
•   portal vein thrombosis:  Acute requiring anticoagulant, chronic no need.  Still require GI consult for both
•   Hepatocellular carcinoma:  CT 4 phase for diagnosis without biopsy, every 6 months AFP, right upper quadrant ultrasound for liver cirrhosis
•   Albumin_ INR_ T bili_, direct bili; hypoalbuminemia, coagulopathy, intrahepatic pathology versus extrahepatic
•  tip candidacy:  Indicated for recurrent ascites and hepatic hydro thorax refractory to oral Lasix,  Contraindication to Hepatic encephalopathy and CHF 
•  transplant candidacy:  Decompensated liver failure.  No alcohol use and yes social/family support
•  medication:  Propranolol, Spironolactone, Lasix (100:40), lactulose, no ACE/ARB, cautioned of any BP medication due to hypotension
•  AKI in cirrhosis medication:  Albumin challenging for suspected hepatorenal syndrome, if no response, likely hepatorenal syndrome, nephrology consult for hemodialysis
•  recommendation:  avoid all ETOH, no raw oyster or shellfish, Tylenol( upto 2g /day)/dietary sodium less than 2 g daily, no NSAID
•  vaccination hepatitis A and B