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The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists

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Abstract

Background

Cirrhosis and chronic liver disease carry appreciable morbidity and mortality. Cirrhotic patients frequently require hospitalization and their care is both extremely complex and labor-intensive.

Aim

We seek to provide a review for gastroenterologists, hepatologists, internists, and hospitalists on the approach to care in patients hospitalized for complications related to end-stage liver disease.

Methods

The Mount Sinai Medical Center’s inpatient liver service has developed an integrated team approach for cirrhotic patients and throughout the years has educated fellows-in-training and medical house staff on both the treatment principles and “pearls” in managing the hospitalized cirrhotic patient. We reviewed the literature and provide recommendations on the management of complications of end-stage liver disease. Additionally, we provide a review of the protocols used at our institution in the care for cirrhotic patients.

Results

Major complications of advanced liver disease include infection, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal hemorrhage, hepatorenal syndrome, and hepatocellular carcinoma. Management of these complications involves selecting the appropriate diagnostic studies and prompt administration of therapy.

Conclusions

There are many complications of cirrhosis. Management of these complications can be complex and are targeted at stabilizing the patient’s clinical condition. Liver transplantation remains the only definitive treatment.

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Acknowledgments

We would like to acknowledge all the attending staff of the Mount Sinai Division of Liver Diseases, a generation of hepatology fellows, medical housestaff, nurses, and ancillary staff who continue to provide exemplary care to our patients suffering from chronic liver disease.

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  1. Division of Liver Diseases, The Mount Sinai Medical Center, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1104, New York, NY, 10029, USA

    Ponni V. Perumalswami & Thomas D. Schiano

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  1. Ponni V. Perumalswami
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  2. Thomas D. Schiano
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Correspondence to Thomas D. Schiano.

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Perumalswami, P.V., Schiano, T.D. The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists. Dig Dis Sci 56, 1266–1281 (2011). https://doi.org/10.1007/s10620-011-1619-9

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