Cirrhosis E-Book

Samuel S. Lee

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 986

Veröffentlichungsjahr: 2015

Beschreibung

Cirrhosis: a practical guide to management provides gastroenterologists and hepatologists with an up-to-date clinical guide presenting the very best evidence-based practice in the diagnosis, treatment and management of liver cirrhosis and its many complications.  Designed to offer practical guidance at all times, it provides doctors with an extremely useful tool in the clinical setting, with each chapter featuring diagnostic/management algorithms, key points and other pedagogic features.

Divided into 2 parts, a diagnosis and pathophysiology section and a management of complications section, key topics include:

- Diagnostic laboratory tests
- Diagnostic imaging modalities
- Acute-on chronic liver failure
- Agents and drugs to avoid
- End stage liver failure: liver transplant evaluation
- Hepatocellular carcinoma

Aimed at the specialist, as well as the practicing trainee at the top-end of specialty training, the emphasis throughout is on providing optimum clinical management guidance most relevant to practicing hepatologists and gastroenterologists, and is an invaluable guide to this increasingly common condition.

Leseprobe

CONTENTS

Cover

Title Page

Copyright

List of Contributors

Foreword

List of Abbreviations

Part 1: Diagnosis and Pathophysiology

Chapter 1: Clinical Clues to the Diagnosis of Cirrhosis

Introduction

Clinical Presentation

Patient History

Etiologic History Taking

Examination

References

Chapter 2: Diagnostic Laboratory Tests

Introduction

Tests that Detects Hepatic Injury (Table 2.1)

Specific Tests for Determining the Etiology of Liver Cirrhosis

Conclusions

References

Chapter 3: Diagnostic Imaging Modalities

Ultrasonography-Based Approaches

CT- and MRI-Based Approaches

References

Chapter 4: Histology/Pathology

Introduction

Cirrhosis: A Pathologic Spectrum

Cirrhosis: An Evolving Concept

Cirrhosis: A Preneoplastic Condition

Cirrhosis: A Place for Biopsy?

References

Chapter 5: Fibrosis and Fibrogenesis

Introduction

Mechanism of Liver Fibrosis in Hepatitis B and C

Diagnosis of Liver Fibrosis by Imaging

Diagnosis of Liver Fibrosis by Laboratory Tests

Cell Types Involved in Liver Fibrosis

Genes Involved in Liver Fibrosis

Onset and Progression of Liver Fibrosis

Regulation and Treatment of Liver Fibrosis

References

Chapter 6: Non-Invasive Diagnosis Tests

Introduction

Biologic Approach: Serum Biomarkers of Liver Fibrosis

Physical Approach: Measurement of Liver Stiffness

Alternatives to Transient Elastography

Monitoring of Disease Progression and Prognosis

Conclusions

References

Chapter 7: Evaluating Prognosis1

Introduction

Natural History

Child–Pugh Score

MELD Score

MELD Modifications

Child–Pugh Score Versus MELD Score

Hepatic Venous Pressure Gradient

Variceal Bleed

Surgery and Cirrhosis

Intensive Care for Cirrhotic Patients

Disease-Specific Models

Conclusions

References

Chapter 8: End-Stage Liver Failure: Liver Transplant Evaluation

Introduction

Epidemiology

Surgical Aspects of Liver Transplantation

Patient Selection

Evaluation of Candidates for Liver Transplantation

Liver Transplantation in Patients with Cirrhosis and Renal Failure

Liver Transplantation in HIV-Positive Patients

Conclusions

References

Part 2: Complications of Cirrhosis

Chapter 9: Acute-on-Chronic Liver Failure

Introduction and Definitions

Epidemiology

Pathophysiology

Management and Prognosis

Conclusions

References

Chapter 10: Hepatocellular Carcinoma

Introduction

Clinical Features

Surveillance of HCC

Diagnosis and Staging

Treatment

Conclusions

References

Chapter 11: Hepatic Encephalopathy

Introduction

Definition

Clinical Manifestation

Epidemiology

Diagnostic Tools and Differential Diagnosis

Diagnosis of Minimal and Covert HE

Etiology and Pathogenesis

Treatment

Prophylaxis

References

Chapter 12: Malnutrition and Nutritional Support

Introduction

Etiologies of Malnutrition in Cirrhosis

Nutritional Assessment in Cirrhosis

Prevalence of Malnutrition in Cirrhosis

Nutritional Support in Patients with Cirrhosis

Conclusions

References

Chapter 13: Varices, Portal Hypertensive Gastropathy and GAVE

Variceal Bleeding

Portal Hypertensive Gastropathy

Gastric Antral Vascular Ectasia

Conclusions

References

Chapter 14: Ascites

Pathophysiology of Ascites

Patients' History

Physical Examination

Patient Evaluation

Management of Patients with Ascites

References

Chapter 15: Spontaneous Bacterial Peritonitis and Other Infections

General Considerations

The Diagnostic Approach

Spontaneous Bacterial Peritonitis

Other Infections

Prevention of Organ Failure

Management of Organ Failure, Severe Sepsis, and Septic Shock

Prevention of Bacterial Infection in Cirrhosis

Conclusions

References

Chapter 16: Hepatorenal Syndrome and Acute Kidney Injury

Hepatorenal Syndrome

Acute Kidney Injury

Conclusions

References

Chapter 17: The Hepatopulmonary Syndrome

Introduction

Definition

Epidemiology

Pathogenesis

Clinical Features

Diagnosis

Natural History and Treatment

Conclusions

References

Chapter 18: Hyponatremia and Other Electrolyte/Ion Disorders

Hyponatremia

Disorders of Potassium Homeostasis

Disorders of Magnesium and Phosphate Homeostasis

References

Chapter 19: Portopulmonary Hypertension1

Introduction

Definition

Screening

Epidemiology and Natural History

Etiology and Pathogenetic Mechanisms

Clinical Manifestations

Medical Treatment

Liver Transplantation

Conclusions

References

Chapter 20: Cirrhotic Cardiomyopathy

Introduction

Pathology

Pathophysiology

Clinical Features

Systolic Dysfunction

Diastolic Dysfunction

Prolongation of the QT Interval

Diagnosis

Management

Prognosis

References

Chapter 21: Adrenal Insufficiency

Introduction

Background

Physiology of the Hypothalamic–Pituitary–Adrenal Axis

Relative Adrenal Insufficiency and Critical Illness-Related Corticosteroid Insufficiency

Pathophysiology

Adrenal Insufficiency and Liver Disease

Prevalence and Clinical Relevance of Adrenal Insufficiency in Liver Disease

RAI/CIRCI in Critically Ill Patients with Liver Disease

Prevalence of Adrenal Insufficiency in Stable Cirrhosis

Adrenal Function Testing in Cirrhosis – Which Test?

Adrenal Function and the Complications of Cirrhosis – who should be Tested and who should be Treated?

Adrenal Insufficiency and Liver Transplantation

Conclusions

References

Chapter 22: Coagulopathy and Clotting Disorders

Introduction

Hemostatic Factors

Anticoagulant Factors

Disorders of the Fibrinolytic System

Assessment of the Risk of Thrombosis and Anticoagulation

Assessment of the Risk of Bleeding

Invasive Procedures

Coagulation during Infection and Sepsis

References

Chapter 23: Agents and Drugs: Precautions in Patients with Cirrhosis

Introduction

Impaired Liver Function and Drug Biotransformation

Acetaminophen/Paracetamol

Nonsteroidal Anti-Inflammatory Drugs

Antirheumatic Agents

Opiate Replacement Therapy

Antituberculosis Agents

Antibiotics

Drugs to Treat HIV Infection

Drugs Acting on the Central Nervous System

Miscellaneous Agents

References

Chapter 24: Changing Outcomes with Antiviral or Antifibrotic Therapies

Introduction

HBV-Related Cirrhosis

HCV-Related Cirrhosis

Antifibrotic Therapy

References

Chapter 25: Bone Disorders

Introduction

Osteonecrosis

Osteomalacia

Vitamin D Deficiency

Osteoporosis

Conclusions

References

Chapter 26: Pruritus

Pathogenesis of the Pruritus of Cholestasis

The Approach to the Patient with the Pruritus of Cholestasis

Conclusions

References

Chapter 27: Quality of Life and Symptom Management

Introduction

Measuring Functional Ability and Quality of Life

Causes for Impaired Quality of Life

Is Quality of Life Really Impaired in Patients with Liver Disease?

Quality of Life and Patients with Hepatitis C

Specific Symptoms or Clinical Syndromes Affecting Quality of Life

General Approach to Evaluation and Diagnosis

General Management Approach

Treating the Underlying Liver Disease

Specific Interventions with Possible Benefits

Conclusions

Acknowledgement

References

Chapter 28: Special Considerations in Children

Introduction

Conclusions

References

Index

End User License Agreement

List of Tables

Table 1.1

Table 2.1

Table 2.2

Table 2.3

Table 2.4

Table 4.1

Table 4.2

Table 6.1

Table 6.2

Table 6.3

Table 7.1

Table 7.2

Table 7.3

Table 7.4

Table 8.1

Table 8.2

Table 9.1

Table 9.2

Table 9.3

Table 11.1

Table 11.2

Table 11.3

Table 11.4

Table 11.5

Table 11.6

Table 11.7

Table 11.8

Table 11.9

Table 12.1

Table 12.2

Table 12.3

Table 12.4

Table 12.5

Table 13.1

Table 14.1

Table 14.2

Table 15.1

Table 15.2

Table 15.3

Table 16.1

Table 16.2

Table 16.3

Table 16.4

Table 17.1

Table 18.1

Table 18.2

Table 18.3

Table 18.4

Table 19.1

Table 19.2

Table 19.3

Table 19.4

Table 19.5

Table 20.1

Table 20.2

Table 21.1

Table 21.2

Table 23.1

Table 23.2

Table 23.3

Table 25.1

Table 25.2

Table 25.3

Table 26.1

Table 27.1

Table 27.2

Table 27.3

Table 28.1

Table 28.2

List of Illustrations

Figure 3.1

Figure 3.2

Figure 3.3

Figure 3.4

Figure 3.5

Figure 4.1

Figure 4.2

Figure 4.3

Figure 4.4

Figure 4.5

Figure 4.6

Figure 5.1

Figure 5.2

Figure 5.3

Figure 5.4

Figure 5.5

Figure 8.1

Figure 8.2

Figure 9.1

Figure 9.2

Figure 10.1

Figure 10.2

Figure 10.3

Figure 10.4

Figure 10.5

Figure 11.1

Figure 11.2

Figure 11.3

Figure 11.4

Figure 11.5

Figure 11.6

Figure 12.1

Figure 12.2

Figure 13.1

Figure 13.2

Figure 13.3

Figure 13.4

Figure 13.5

Figure 13.6

Figure 13.7

Figure 13.8

Figure 14.1

Figure 14.2

Figure 14.3

Figure 14.4

Figure 15.1

Figure 16.1

Figure 16.2

Figure 16.3

Figure 17.1

Figure 17.2

Figure 17.3

Figure 18.1

Figure 18.2

Figure 19.1

Figure 19.2

Figure 19.3

Figure 20.1

Figure 21.1

Figure 21.2

Figure 21.3

Figure 22.1

Figure 23.1

Figure 23.2

Figure 24.1

Figure 24.2

Figure 25.1

Figure 25.2

Figure 25.3

Figure 25.4

Figure 26.1

Figure 28.1

Figure 28.2

Figure 28.3

Figure 28.4

Guide

Cover

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Cirrhosis

A practical guide to management

Edited by

Samuel S. Lee, MD, FRCPC

Professor of Medicine

University of Calgary Cumming School of Medicine

Calgary, Canada

Richard Moreau, MD

Deputy Director

INSERM, U114, Centre de Recherche sur l'Inflammation (CRI), Paris, France;

UMRS 1149, Université Paris Diderot-Paris 7, Paris, France;

Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France

First Edition

Foreword by Samuel S. Lee and Richard Moreau

This edition first published 2015 © 2015 by John Wiley & Sons Ltd.

Materials appearing in this book prepared by individuals as part of their official duties as United States government employees are not covered by the above-mentioned copyright, and any views expressed therein do not necessarily represent the views of the United States government. Such individuals' participation in the Work is not meant to serve as an official endorsement of any statement to the extent that such statement may conflict with any official position of the United States Government. This applies to Chapters 7 and 19.

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Library of Congress Cataloging-in-Publication Data

Cirrhosis (Lee)

Cirrhosis : a practical guide to management / edited by Samuel S. Lee, Richard Moreau.

p. ; cm.

Includes index.

ISBN 978-1-118-27482-8 (cloth)

I. Lee, Samuel S., 1954- , editor. II. Moreau, Richard, 1951- , editor. III. Title.

[DNLM: 1. Liver Cirrhosis–diagnosis. 2. Liver Cirrhosis–therapy. 3. Liver Diseases–complications. WI 725]

RC848.C5

616.3′624–dc23

2014032682

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

List of Contributors

Ayman A. Abdo, MD, FRCPC

Professor, Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University;

King Saud University Liver Disease Research Center, Riyadh, Saudi Arabia

Danielle Adebayo, BSc, MBBS, MRCP

Hepatology Research Fellow, Liver Failure Group, UCL Institute for Liver and Digestive Health,

UCL Medical School, Royal Free Hospital, London, UK

Fernando Alvarez, MD

Professor of Pediatrics, Department of Pediatrics, CHU- Sainte Justine, University of Montreal, Quebec, Canada

Piero Amodio, MD

Professor of Internal Medicine, Department of Medicine (DIMED), University of Padova, Padova, Italy

Paolo Angeli, MD, PhD

Professor of Medicine, Department of Medicine (DIMED), Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Padova, Italy

Yasuhiro Asahina, MD, PhD

Professor, Department of Hepatitis Investigation, Tokyo Medical and Dental University, Tokyo, Japan

Sumeet K. Asrani, MD, MSc

Hepatology Fellow, Baylor University Medical Center, Dallas, Texas, USA

Soon Koo Baik, MD, PhD

Professor of Internal Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

Nora V. Bergasa, MD

Chief, Department of Medicine, Metropolitan Hospital Center, New York, NY, USA;

Professor of Medicine, New York Medical College, Valhalla, New York, NY, USA

Vijay Bodh, MD

Fellow in DM (Heptology), Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

A.K. Burroughs, MD (deceased)

The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, Department of Intensive Care, Royal Free Hospital, London, UK

Hai-Xia Cao, PhD, MD

Department of Gastroenterology, Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition,

Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

Andrés Cárdenas, MD, MMSc, AGAF

Faculty Member, Senior Specialist, GI Unit, Hospital Clínic and University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepaticas y Digestivas (CIBERHED)

Rodrigo Cartin-Ceba, MD

Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

Laurent Castera, MD, PhD

Senior Consultant in Hepatology, Department of Hepatology, Hopital Beaujon, Assistance Publique-Hôpitaux de Paris, INSERM U773, Clichy, France

Y.K. Chawla, MD, DM (Gastroenterology), FAMS

Professor, Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Isabelle Colle, MD, PhD

Full Professor, Ghent University, Belgium;

Department of Hepatology and Gastroenterology, Algemeen Stedelijk Ziekenhuis (ASZ), Aalst, Belgium and Ghent University

Jane Collier, MD, MBChB, FRCP

Consultant in Hepatology, John Radcliffe Hospital, Oxford, UK

Alejandro Costaguta, MD

Jefe, Servicio de Gastroenterología, Hepatología y Nutrición, Sanatorio de Niños, Rosario, Santa Fe, Argentina

Emily Dannhorn, MBBS, MRCP

Specialist Registrar in Hepatology, Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK

Maissa El Raziky, MD

Professor of Endemic Medicine and Hepatology, Director of the Hepatic Schistosomiasis Research Unit, Faculty of Medicine, Cairo University, Cairo, Egypt

Gamal Esmat, MD

Vice President for Graduate Studies and Research Cairo University, Professor of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt

Michael B. Fallon, MD

Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas, Health Science Center at Houston, Houston, TX, USA

Jian-Gao Fan, PhD, MD

Professor and Director, Department of Gastroenterology, Shanghai Key Laboratory of Pediatric, Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

Adrián Gadano, MD, PhD

Associate Professor and Chief, Department of Medicine and Liver Unit, Hospital Italiano, Buenos Aires, Argentina

Anja Geerts, MD, PhD

Professor, Ghent University, Belgium;

Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium

Pere Ginès, MD, PhD

Chairman – Liver Unit, Professor of Medicine, Liver Unit, Hospital Clínic and University of Barcelona; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS);

Ciber de Enfermedades Hepaticas y Digestivas (CIBERHED);

Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Barcelona, Spain

Isabel Graupera, MD

Liver Unit, Hospital Clínic and University of Barcelona;

Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Barcelona, Spain

Thierry Gustot, MD, PhD

Associate Professor, Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Brussels, Belgium

Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium;

INSERM, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Paris, France

Kwang-Hyub Han, MD

Professor and Chairman, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Namiki Izumi, MD, PhD

Chief, Vice President, Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan

Rajiv Jalan, MBBS, MD, PhD, FRCPE, FRCP

Professor of Hepatology, Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK

Woo Kyoung Jeong, MD, PhD

Assistant Professor of Radiology, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Patrick S. Kamath, MD

Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA

Do Young Kim, MD, PhD

Associate Professor, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Moon Young Kim, MD, PhD

Associate Professor of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

Michael J. Krowka, MD

Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

Masayuki Kurosaki, MD, PhD

Director, Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan

Samuel S. Lee, MD, FRCPC

Professor of Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada

Han-Chieh Lin, MD, FAGG

Professor and Chief, Department of Gastroenterology and Hepatology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

Hongqun Liu, MD, PhD

Research Assistant Professor, University of Calgary Cumming School of Medicine, Calgary, Canada

Sebastián Marciano, MD

Assistant Professor, Liver Unit, Hospital Italiano, Buenos Aires, Argentina

Vincenzo Morabito, MBBS

Clinical Research Fellow, Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School Royal Free Hospital, London, UK

Filippo Morando, MD

Hepatology Fellow, Department of Medicine (DIMED), University of Padova, Padova, Italy

Richard Moreau, MD

INSERM, U1149, Centre de Recherche sur l'Inflammation (CRI);

UMR S 1149, Université Paris Diderot-Paris 7, Faculté de Médecine Bichat;

Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France

James O'Beirne, MBBS (Hons), MD, FRCP, EDIC

Consultant Hepatologist, Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK

Valérie Paradis, MD, PhD

Professor, Pathology Department, Beaujon Hospital, INSERM URM 1149, Paris, France

Salvatore Piano, MD

Hepatology Fellow, Department of Medicine (DIMED), University of Padova, Padova, Italy

Moises Ilan Nevah Rubin, MD

Assistant Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA

Faisal M. Sanai, MD, ABIM, SBG

Consultant Transplant Hepatologist, Department of Hepatobiliary Science and Liver Transplantation, King Abdul Aziz Medical City;

King Saud University Liver Disease Research Center, Riyadh, Saudi Arabia

Marco Senzolo, MD

Multivisceral Transplant Unit, Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy

Felix Stickel, MD

Associate Professor of Hepatology, Department of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland

Nobuharu Tamaki, MD

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan

Xavier Verhelst, MD

Resident Hepatology, Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium

Hans Van Vlierberghe, MD, PhD

Full Professor, Ghent University, Belgium;

Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium

Florence Wong, MBBS, MD, FRACP, FRCPC

Professor, Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Ying-Ying Yang, MD, PhD

Professor and Chief, Department of Medical Education, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

Foreword

“Cirrhosis” is derived from the Greek word kirrós meaning orange or tawny. Millennia ago, ancient people including the Greeks must have been impressed by the scarred, tawny appearance of the cirrhotic liver. They recognized that such a diseased liver was associated with many complications including ascites. Indeed, throughout history, until relatively recently, the liver was judged to be the most important organ in the body by almost all civilizations. It was felt to be the seat of most emotions including courage, anger, and love. In 1628, William Harvey discovered that the heart pumped the entire blood circulation and that arteries and veins were connected by capillaries. Until then, the arterial and venous circulations were thought to be entirely separate, and the liver made and pumped venous blood. Thus, this discovery started the process of the heart supplanting the liver as the primary organ in laypeople's understanding of the body.

Cirrhosis is the end-stage process of virtually all chronic insults to the liver. Although it was originally defined as purely a histopathologic condition characterized by extensive fibrosis with architectural disorganization and nodular regeneration, physicians have known for thousands of years that many other parts of the body are affected by cirrhosis.

Any physician caring for patients with cirrhosis is familiar with the presentation of end-stage liver failure: the emaciated, malnourished, confused patient with ascites, prone to bleeding, infections, renal failure, and liver cancer. Almost all the major organ systems in the body including the brain, heart, lungs, kidneys, gut, adrenals, bones, muscles, blood and endocrine systems show evidence of dysfunction in the presence of cirrhosis. Caring for patients with these myriad complications of cirrhosis continues to challenge physicians in the twenty-first century as it did thousands of years ago. Fortunately, we now have many more ways to diagnose and treat such complications. But, with the explosion of knowledge about pathophysiology and molecular mechanisms of disease, as well as major advances in medical and surgical therapies, such “information overload” may be a problem.

To try to address that problem, 57 distinguished authorities from 15 countries provide their expert practical guidance on the management of the many facets of cirrhosis. The operative word is “practical.” Authors provide concise but practical advice, often with algorithms and illustrations, to help the busy clinician care for the patient with cirrhosis and its complications.

The first part comprises eight chapters that expertly summarize the ways to diagnose cirrhosis, and its pathophysiology and prognosis. The second part consists of 20 chapters that cover all aspects of the management of each complication, from the specific conditions associated with cirrhosis that affect organs such as the brain (hepatic encephalopathy), heart (cirrhotic cardiomyopathy), lungs (hepatopulmonary syndrome), and kidneys (ascites, acute kidney injury, hyponatremia). Symptoms and major causes of mortality and morbidity such as bleeding, coagulopathy, infections, osteopenia, and pruritus are explained in concise but practical detail. Chapters on special considerations in children with cirrhosis, and drug therapy and potential hepatotoxicity complete this book.

We were privileged to work with such expert hepatologists on this text, and hope that clinicians who care for patients with cirrhosis will find it useful.

Samuel S. Lee

Richard Moreau

List of Abbreviations

AAA

aromatic amino acid

AaPO2

alveolar–arterial oxygen gradient

AASLD

American Association for the Study of Liver Diseases

ACG

American College of Gastroenterology

ACLF

acute-on-chronic liver failure

ACTH

adrenocorticotropic hormone

ADC

apparent diffusion coefficient

AFP

alpha-fetoprotein

AI

adrenal insufficiency

AICF

accelerated intravascular coagulation and fibrinolysis

AIH

autoimmune hepatitis

AJCC

American Joint Committee on Cancer

AKI

acute kidney injury

AKIN

Acute Kidney Injury Network

ALD

alcoholic liver disease

ARD

ammonia reducing drug

ALK-P

alkaline phosphatase

ALT

alanine aminotransferase

AMA

anti-mitochondrial antibody

ANP

atrial natriuretic peptide

APC

argon plasma coagulation