Cirrhosis

Last updated: April 6, 2026, 7:36 PM Pacific Time (PDT)
All Clinical risk factors Diagnostics Confirmation criteria Management Back to Main Page

Disease Pathway

risk factors -> diagnostics -> diagnostic criteria -> complication-aware management
Clinical Risk Factors

Who should trigger cirrhosis reasoning?

  • Known chronic liver disease, viral hepatitis, alcohol-associated liver disease, MASLD/MASH, autoimmune or cholestatic liver disease
  • Stigmata of chronic liver disease: jaundice, spider angiomas, palmar erythema, muscle wasting, gynecomastia
  • Portal-hypertension clues: ascites, splenomegaly, thrombocytopenia, varices, abdominal wall collaterals
  • Decompensation clues: GI bleeding, confusion, infection, kidney injury, hyponatremia, worsening ascites, or jaundice
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Diagnostics

Confirm chronic liver disease and define decompensation

Core labs
  • CBC
  • CMP
  • INR
  • Albumin
Etiology labs
  • HAV serologies
  • HBsAg / anti-HBs / anti-HBc / HBV DNA
  • Anti-HCV / HCV RNA
  • ANA / ASMA / IgG / AMA / IgM
  • Ferritin / transferrin saturation
  • A1AT level / phenotype
  • Ceruloplasmin / urine copper
Imaging / diagnostics
  • Ultrasound with Doppler
  • Ultrasound plus AFP for HCC surveillance
  • CT liver / MRI liver
  • Elastography
Procedures
  • Diagnostic paracentesis
  • Large-volume paracentesis
  • EGD
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Differential Diagnosis

Keep alternate causes of liver disease or ascites in play

Key mimics
  • Acute liver failure without chronic portal-hypertension features
  • Congestive hepatopathy
  • Budd-Chiari syndrome
  • Malignancy with ascites
  • Nephrotic syndrome or heart failure causing edema / ascites
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Confirm Diagnosis

Use compatible clinical, lab, imaging, and complication pattern

  • Cirrhosis: chronic liver disease with nodular/fibrotic morphology or compatible elastography/biopsy plus portal-hypertension features.
  • Compensated: no current or prior ascites, variceal hemorrhage, hepatic encephalopathy, or jaundice-driven decompensation.
  • Decompensated: ascites, variceal/GI bleeding, hepatic encephalopathy, SBP, hepatorenal physiology, or marked jaundice.
  • Severity: use MELD-Na and Child-Pugh context to guide transplant referral, procedure risk, and prognosis.
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Management

Use VIBES to tailor treatment to active complications

Complications driving VIBES management

Resident Pearls

Bedside Use

  • Use VIBES daily: Volume, Infection, Bleeding, Encephalopathy, Screening/Surgery.
  • Ask first: etiology, compensated vs decompensated, trigger for decompensation, Child-Pugh class, and MELD 3.0 / MELD-Na.
  • Hospitalized cirrhosis with ascites generally needs diagnostic paracentesis early.
  • GI bleeding in cirrhosis is variceal until proven otherwise; start antibiotics and vasoactive therapy early when suspected.
  • Hepatic encephalopathy treatment should include a search for triggers: infection, bleeding, constipation, dehydration, sedatives, renal failure, and electrolyte disorders.
  • AKI in cirrhosis is a management emergency: stop nephrotoxins, assess volume/infection, and consider albumin-based evaluation.

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