Hepatology

Liver disease management — cirrhosis, viral hepatitis, and liver failure

INR 2.8 (worsening coagulopathy) · Bilirubin 9.4 mg/dL · Albumin 2.2 g/dL — monitor for acute-on-chronic liver failure (ACLF).
Patient: Suresh Patil, 48M
UHID: UH-2026-0808
Diagnosis: Decompensated cirrhosis — alcohol-related liver disease
Admission: 20 Jun 2026
Child-Pugh: Class C (Score 12)
MELD-Na: 28 (high 3-month mortality risk)

Complications Assessment

ComplicationPresentSeverityManagement
Ascites
Yes
Grade 3 (tense)Therapeutic paracentesis 5L + albumin 8g/L drained. Spironolactone 200mg + furosemide 80mg OD
Hepatic Encephalopathy
Yes
West Haven Grade 2 — confusedLactulose 30mL TDS (target 2-3 soft stools/day). Rifaximin 550mg BD
Spontaneous Bacterial Peritonitis (SBP)
Excluded
—Diagnostic paracentesis: PMN < 250/mm³. Ceftriaxone prophylaxis commenced
Hepatorenal Syndrome
Watch
Cr 1.4 (rising)IV albumin 20g OD for 48h. Monitor urine output. Avoid NSAIDs/nephrotoxins
Coagulopathy
Yes
INR 2.8Vitamin K 10mg IV OD × 3d. FFP only if active bleeding. AVOID prophylactic FFP
Varices
Yes (known)
Grade 2 oesophagealCarvedilol 6.25mg BD (primary prophylaxis). OGD scheduled

Management Plan