Cirrhosis

HISTORY:

Cirrhosis follow-up

Progress since last visit: ‍unchangedimprovedworsenedvariable in intensityresolved

Current symptoms:

‍fatigue

‍jaundice

‍abdominal distension

‍peripheral edema

‍abdominal pain

‍confusion

‍hematemesis

‍melena

‍pruritus

‍loss of appetite

‍muscle cramps

‍easy bruising or bleeding



Medications:

- ‍

Adherence: ‍goodaveragepoor, ‍adverse effects



Social history:

Alcohol use: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Recreational drugs: ‍none ‍cannabis, ‍IVDU

Diet: ‍goodaveragepoor, ‍low in salt, ‍high in carbs, ‍high in fat

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss



Labs:

Liver function tests: AST: ‍ ‍normal, ALT: ‍ ‍normal, Alkaline phosphatase: ‍ ‍normal, Bilirubin: ‍ ‍normal, Albumin: ‍ ‍normal, INR: ‍ ‍normal

Renal function: Creatinine: ‍ ‍normal, BUN: ‍ ‍normal

Electrolytes: Na: ‍ ‍normal, K: ‍ ‍normal, Ca: ‍ ‍normal, Mg: ‍ ‍normal

CBC: Hemoglobin: ‍ ‍normal, Platelets: ‍ ‍normal, WBC: ‍ ‍normal

Ammonia: ‍ ‍normal

Alpha-fetoprotein (AFP): ‍ ‍normal

Imaging: ‍UltrasoundCT scanMRI of the liver: ‍ ‍normalhepatomegalynodularityascites



Esophagogastroduodenoscopy (EGD): ‍ ‍normalvaricesgastritisulcers



Vaccinations:

Hepatitis A: ‍up-to-dateincompleteunvaccinated

Hepatitis B: ‍up-to-dateincompleteunvaccinated

Influenza: ‍up-to-dateincompleteunvaccinated

Pneumococcal: ‍up-to-dateincompleteunvaccinated

Covid: ‍up-to-dateincompleteunvaccinated



Complications:

Variceal bleeding: ‍yesno

Hepatic encephalopathy: ‍yesno

Spontaneous bacterial peritonitis: ‍yesno

Hepatocellular carcinoma: ‍yesno

Hepatorenal syndrome: ‍yesno



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Cirrhosis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍LFTs, ‍INR, ‍albumin, ‍bilirubin, ‍ammonia, ‍alpha-fetoprotein, ‍viral hepatitis serologies

- Imaging: ‍abdominal ultrasound, ‍CT scan of abdomen, ‍MRI of abdomen

- Endoscopy: ‍esophagogastroduodenoscopy

- Liver biopsy

- ‍Diuretics

- ‍Lactulose

- ‍Non-selective beta-blockers for variceal bleeding prophylaxis

- ‍Vitamin supplements

- ‍Antibiotics

- Sodium restriction (<2g/day)

- Alcohol abstinence counseling

- Ascitic fluid paracentesis

- Vaccinations: ‍Hepatitis A, ‍Hepatitis B, ‍Pneumococcal, ‍Influenza, ‍Covid

- Referral to gastroenterologist

- Referral to hepatologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen, such as increased abdominal girth, jaundice, confusion, or bleeding