358 Ch 357. Cirrhosis, Portal Hypertension, and Complications

Cirrhosis = irreversible advanced liver disease + fibrosis + nodular regeneration；台灣 ALD + viral hepatitis (HBV + HCV) + MASLD 主要原因；stages：compensated → decompensated (jaundice, ascites, encephalopathy, variceal bleeding)；MELD/MELD-Na for prognosis + transplant priority；Child-Pugh classification A/B/C；portal hypertension：HVPG > 5 mmHg；5 hallmarks of decompensation：ascites + spontaneous bacterial peritonitis (SBP) + variceal bleeding + hepatic encephalopathy + hepatorenal syndrome (HRS)；ascites management：sodium restriction + diuretics (spironolactone + furosemide) + paracentesis (large-volume) + TIPS for refractory；SBP：cell count + albumin gradient (SAAG)；cefotaxime + albumin 1.5 g/kg day 1 + 1 g/kg day 3；variceal bleeding：terlipressin/octreotide + ceftriaxone + EGD with banding + TIPS for refractory；hepatic encephalopathy：rifaximin + lactulose；HRS：terlipressin + albumin (FDA 2022) + liver transplant；2024：early TIPS, branched-chain amino acids, microbiome modulation。