Mansour Dina, Masson Steven, Shawcross Debbie L, Douds Andrew C, Bonner Emily, Corless Lynsey, Leithead Joanna A, Hammond John, Heneghan Michael A, Rahim Mussarat Nazia, Tripathi Dhiraj, West Rebecca, Johnson Jill, Botterill Gemma, Hollywood Coral, Ross Valerie, Donnelly Mhairi, Compston Juliet E, McPherson Stuart, Grapes Allison
Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK.
Gastroenterology and hepatology, Gateshead Health NHS Foundation Trust, Gateshead, UK.
Frontline Gastroenterol. 2023 Jul 28;14(6):453-461. doi: 10.1136/flgastro-2023-102430. eCollection 2023.
The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Here, in part one, we focus on outpatient management of compensated cirrhosis, encompassing hepatocellular cancer surveillance, screening for varices and osteoporosis, vaccination and lifestyle measures. We also introduce a compensated cirrhosis care bundle for use in the outpatient setting. Part two concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. The third part of the guidance covers special circumstances encountered in managing people with cirrhosis: surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.
近几十年来，肝硬化的患病率显著上升，预计还会进一步上升。非侵入性检测手段的广泛应用意味着肝硬化越来越多地在早期被诊断出来。尽管如此，英国肝硬化患者的治疗结果存在显著差异，贫困程度较高地区的患者死于肝病的可能性更大。本三部分最佳实践指南旨在解决肝硬化的门诊管理问题，以规范护理并降低肝病进展、失代偿和死亡风险。在此，在第一部分中，我们重点关注代偿期肝硬化的门诊管理，包括肝细胞癌监测、静脉曲张和骨质疏松症筛查、疫苗接种和生活方式措施。我们还引入了一个用于门诊环境的代偿期肝硬化护理包。第二部分集中于失代偿期疾病的门诊管理，包括腹水、肝性脑病、静脉曲张、营养的管理以及肝移植和姑息治疗。该指南的第三部分涵盖了在管理肝硬化患者时遇到的特殊情况：手术、怀孕、旅行、管理侵入性操作的出血风险和门静脉血栓形成。
