- In all patients with compensated cirrhosis, assess whether the patient has clinically significant portal hypertension. If they do and there are no contraindications, consider starting carvedilol (or a non-selective beta-blocker) to reduce the risk of decompensation.
- In those patients with compensated cirrhosis who are not already on carvedilol or a non-selective beta-blocker, a fibroscan score of >20 kPA OR a platelet count of <150,000 tells you the patient should be considered for endoscopy. If the fibroscan score is <20 kPA AND platelet count is >150,000 OR the patient is on carvedilol or a non-selective beta-blocker, screening endoscopy is not needed.
- Patients with cirrhosis should undergo HCC surveillance with ultrasound and AFP every six months (notably, although by guidelines the AFP is optional, in our experience this is suggested)
- Patients who have had a diagnosis of cirrhosis at anytime (regardless of whether they have improved or even cleared their Hepatitis B or C) should continue to undergo HCC surveillance
Defined by: the absence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)
Defined by: the presence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)
This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.
Authors: Michelle Carbonneau NP, Dr. Alnoor Ramji, Dr. Puneeta Tandon
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