British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 3: special circumstances.
Dina Mansour, Steven Masson, John Hammond, Joanna A Leithead, Jill Johnson, Mussarat Nazia Rahim, Andrew C Douds, Lynsey Corless, Debbie L Shawcross, Michael A Heneghan, Dhiraj Tripathi, Stuart McPherson, Emily Bonner, Gemma Botterill, Rebecca West, Mhairi Donnelly, Allison Grapes, Coral Hollywood, Valerie Ross
The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.