Internal Med

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Liver disease: Early signs you may be missing
APCToday, 10/21/09

Grattagliano I et al. – Maximizing your care starts with zeroing in on lab values you may be overlooking and taking advantage of algorithms that can help detect fibrosis.

• Suspect compensated liver cirrhosis in a patient with abnormal liver function tests, a low platelet count, and prolonged prothrombin time. Strength of recommendation (SOR): C (Consensus, usual practice, opinion, disease–oriented evidence, case series)
• Use ultrasonography as a first–line diagnostic tool for liver cirrhosis. SOR: C
• Prescribe beta–blockers as prophylaxis for patients at risk for variceal bleeding. SOR: A (Good–quality patient–oriented evidence)
• Work collaboratively with hepatic specialists to manage the care of patients with cirrhosis. SOR: B (Inconsistent or limited–quality patient–oriented evidence)

Recovering alcohol abusers may not be considered for a liver transplant until they have had 6 months of continuous abstinence. In addition to salt restriction, prescribe spironolactone for patients with ascites; add furosemide, if needed. Without transplantation, patients with decompensated cirrhosis have an 85% mortality rate over 5 years. Patients with cirrhosis may not develop the typical signs and symptoms of infection; leukocytosis may be absent, for example, and they may be afebrile.

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