22nd July 2023

Decompensated liver disease

Cirrhosis secondary to ALD, or any other cause of liver disease, can either be compensated or decompensated. In compensated liver disease, the liver is still able to function, and the patient is relatively well. Decompensation refers to a sudden deterioration in liver function and presents with new or worsened symptoms. Decompensated liver disease is associated with a high mortality rate.

The classic features of decompensation include:

• Jaundice
• Ascites
• Hepatic encephalopathy
• Variceal bleeding

Other indicators of decompensation include hepatorenal syndrome, recurrent infections, and cachexia.

The British Society of Gastroenterology care bundle for decompensated cirrhosis highlights the key areas of management.

The key steps include assessment of liver biochemistry and synthetic function, screening for and treating infection (including an ascitic tap in all patients with ascites to assess for spontaneous bacterial peritonitis), establishing alcohol intake, monitoring and managing alcohol withdrawal, supporting nutrition, and identifying and managing acute kidney injury.

It is important to identify any potential underlying cause for decompensation and treat appropriately.

Additionally, certain features of decompensation have specific management, such as gastrointestinal bleeding, hepatic encephalopathy, and ascites.