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Erschienen in: Current Treatment Options in Gastroenterology 2/2022

17.03.2022 | Liver (J Bajaj, Section Editor)

Symptom Management in Patients with Cirrhosis: a Practical Guide

verfasst von: Alyson Kaplan, Russell Rosenblatt

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2022

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Abstract

Purpose of the review

Though it is well known that cirrhosis is associated with significant morbidity and mortality, management of symptoms in cirrhosis can be difficult. This review serves to offer practical guidance in the management of liver-specific symptoms of cirrhosis as well as other symptoms with special hepatic considerations.

Recent findings

We discuss liver-specific symptoms and management, including ascites and refractory ascites, hepatic encephalopathy, pruritus, and muscle cramping. We also discuss the challenges of treating more generalized symptoms in cirrhosis, including pain, depression/anxiety, appetite, and fatigue. Medication management is, especially complex in this population given the altered metabolism of drugs, and we consider some strategies to approach this.

Summary

With the right tools, provided throughout this review, hepatologists should be well equipped to manage the nuanced liver-specific and generalized symptoms in patients with cirrhosis.
Literatur
1.
Zurück zum Zitat Centers for Disease Control and Prevention. CDC Wonder. Centers for Disease Control and Prevention. CDC Wonder.
3•.
Zurück zum Zitat Waterman BL, Ramsey SU, Whitsett MP, et al. Top ten tips palliative care clinicians should know about end-stage liver disease. J Palliat Med. 2021;24(6):924–31. https://doi.org/10.1089/jpm.2021.0097. Very helpful recently published tips about palliative care's role in end-stage liver disease. It has a very detailed table of commonly used medications and their potential risks when used in patients with liver disease.CrossRefPubMed Waterman BL, Ramsey SU, Whitsett MP, et al. Top ten tips palliative care clinicians should know about end-stage liver disease. J Palliat Med. 2021;24(6):924–31. https://​doi.​org/​10.​1089/​jpm.​2021.​0097. Very helpful recently published tips about palliative care's role in end-stage liver disease. It has a very detailed table of commonly used medications and their potential risks when used in patients with liver disease.CrossRefPubMed
6•.
Zurück zum Zitat Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the study of liver diseases. Hepatology. 2021;74(2):1014–48. https://doi.org/10.1002/hep.31884. The most recent AASLD guidelines regarding management.CrossRefPubMed Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the study of liver diseases. Hepatology. 2021;74(2):1014–48. https://​doi.​org/​10.​1002/​hep.​31884. The most recent AASLD guidelines regarding management.CrossRefPubMed
11•.
Zurück zum Zitat Bureau C, Thabut D, Oberti F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152:157–63. https://doi.org/10.1053/j.gastro.2016.09.016. Very helpful recently published tips about palliative care's role in end-stage liver disease. It has a very detailed table of commonly used medications and their potential risks when used in patients with liver disease.CrossRefPubMed Bureau C, Thabut D, Oberti F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152:157–63. https://​doi.​org/​10.​1053/​j.​gastro.​2016.​09.​016. Very helpful recently published tips about palliative care's role in end-stage liver disease. It has a very detailed table of commonly used medications and their potential risks when used in patients with liver disease.CrossRefPubMed
23•.
26•.
Zurück zum Zitat Jesudian AB, Ahmad M, Bozkaya D, Migliaccio-Walle K. Cost-effectiveness of rifaximin treatment in patients with hepatic encephalopathy. J Manag care Spec Pharm. 2020;26(6):750–7. https://doi.org/10.18553/JMCP.2020.26.6.750. Important study that highlights that Rifaximin is cost-effective. This probably argues that it should be made more accessible to patients than it is currently.CrossRefPubMed Jesudian AB, Ahmad M, Bozkaya D, Migliaccio-Walle K. Cost-effectiveness of rifaximin treatment in patients with hepatic encephalopathy. J Manag care Spec Pharm. 2020;26(6):750–7. https://​doi.​org/​10.​18553/​JMCP.​2020.​26.​6.​750. Important study that highlights that Rifaximin is cost-effective. This probably argues that it should be made more accessible to patients than it is currently.CrossRefPubMed
47•.
Metadaten
Titel
Symptom Management in Patients with Cirrhosis: a Practical Guide
verfasst von
Alyson Kaplan
Russell Rosenblatt
Publikationsdatum
17.03.2022
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 2/2022
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-022-00377-y

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