Preventive strategies in chronic liver disease: Part II. Cirrhosis

Cirrhosis is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. The modif ied Child-Pugh score, which ranks the severity of cirrhosis based on signs and liver function test results, has been shown to predict survival. Strate gies have been established to prevent complications in patients with cirrho sis. Esophageal varices can be identified by endoscopy; if large varices ar e present, prophylactic nonselective beta blocker therapy should be adminis tered. Alpha-fetoprotein testing and ultrasonography can be effective in sc reening for hepatocellular carcinoma. Vaccines should be administered to pr event secondary infections. The use of nonsteroidal anti-inflammatory drugs should be avoided, and patients should maintain a balanced diet containing 1 to 1.5 g of protein per kg per day. An extensive assessment should be pe rformed before patients with cirrhosis undergo elective surgery. before adv anced liver decompensation occurs, patients should be referred for liver tr ansplantation evaluation. If advanced cirrhosis is present and transplantat ion is not feasible, survival is between one and two years.