Other Complication-cirrhosis

• Portopulmonary hypertension (POPH)
• Cirrhotic cardiomyopathy: ↓ inotropic & chronotropic response, ↓ systolic & diastolic fxn, ↑ QT, hyperkinetic circulation, high output; ↑ troponin & BNP
• Infxns: unless immune, vaccinate for HAV, HBV, PCV13, PPSV23, COVID-19; flu yearly. Cellulitis in ~20% of Pts hospitalized w/ cirrhosis, often in abd or LE a/w edema.
• Endocrine: diabetes (15–30%), ↑ frequency of adrenal insuffic. (Dig Dis Sci 2017;62:1067)
• Coagulopathy: balanced defects w/ ↓ synth of coag factors, hyperfibrinolysis, ↓ plt balanced by ↓ synthesis anticoag factors (protein C/S), defic. of profibrinolytic factors, ↑ levels of vWF. No support for routine administration of FFP, plt, cryo unless DIC.
• Nutrition: monitor and supplement fat-soluble vitamins, zinc, screen for malnutrition, sarcopenia & fraility; ensure protein intake 1.2–1.5 g/kg/d (Hepatology 2021;74:1611)
• Meds: acetaminophen can be used up to 2 g/d; avoid ASA/NSAIDs; aminoglycosides contraindicated; oral hypoglycemics if compensated but insulin if decompensated