Managing the complications of cirrhosis
| Complication | Risk | Management |
|---|---|---|
| Hepatocellular carcinoma | Yearly cumulative incidence 2.6% per year50 | 6 monthly abdominal USS± α-fetoprotein |
| Varices | 40%–44% if Child–Pugh grade A 75%–85% if Child–Pugh grade C92 | Endoscopic surveillance and management according to BSG or AASLD guidelines94 93 |
| Osteoporosis | Cirrhotic patients are at increased risk of osteoporosis and fractures Larger studies assessing the effects of vitamin D supplementation on BMD are lacking | Correction of vitamin D insufficiency with oral daily vitamin D3 and calcium95 Dual x-ray absorptiometry scan to assess BMD Assess fracture risk using FRAX tool (http://www.shef.ac.uk/FRAX/tool) |
AASLD, American Association for the Study of Liver Diseases; BMD, bone mineral density; BSG, British Society of Gastroenterology; USS, ultrasonography.