San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
Am J Emerg Med. 2018 Apr;36(4):689-698. doi: 10.1016/j.ajem.2017.12.047. Epub 2017 Dec 23.
Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider.
Provide an evidence-based update for the resuscitation of decompensating cirrhotic patients and an overview of cirrhosis complications.
Cirrhosis is a common condition in the U.S. and leads to several deadly complications. The disease develops from liver fibrosis, elevating portal pressures and modifying patient hemodynamics. Cirrhosis results in significant anatomic and physiologic modifications involving the gastrointestinal, cardiopulmonary, neurologic, renal, immunologic, and hematologic systems. The disease can be divided into compensated and decompensated states, with decompensation associated with significant morbidity and mortality. Complications include variceal hemorrhage, ascites, increased risk of bacterial infection, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, umbilical hernia, and hepatic hydrothorax. Resuscitation including airway and circulation measures is paramount in these patients, and several new techniques are offered for the approach to intubation and resuscitation for patients with severe cirrhosis.
Decompensating cirrhotics may require extensive resuscitation, and knowledge of the evaluation and management of complications associated with cirrhosis can improve care for patients with severe liver disease.
肝硬化是美国的一个主要死亡原因，其病因多种多样，最常见的是丙型肝炎和酒精。肝纤维化和结节形成导致门静脉高压系统的严重并发症。急诊医生必须考虑几种致命的并发症。
为失代偿性肝硬化患者的复苏提供循证更新，并概述肝硬化的并发症。
肝硬化在美国是一种常见疾病，可导致多种致命并发症。该疾病由肝纤维化发展而来，导致门静脉压力升高并改变患者的血液动力学。肝硬化导致涉及胃肠道、心肺、神经、肾脏、免疫和血液系统的显著解剖和生理改变。该疾病可分为代偿和失代偿状态，失代偿与显著的发病率和死亡率相关。并发症包括静脉曲张出血、腹水、细菌感染风险增加、自发性细菌性腹膜炎（SBP）、肝性脑病、肝肾综合征、肝肺综合征、脐疝和肝性胸水。这些患者的复苏包括气道和循环措施至关重要，并且为严重肝硬化患者的插管和复苏方法提供了一些新技术。
失代偿性肝硬化患者可能需要广泛的复苏，了解与肝硬化相关的并发症的评估和管理可以改善对严重肝脏疾病患者的护理。
