Some Resources for The Diagnosis and Management of Cirrhosis and Chronic Liver Disease

Reference (1) is an excellent general resource for patients and family members who want to learn more about cirrhosis.

References (2) to (4) are from and are excellent resources for physicians and for patients and family members who want an in-depth review of all the aspects of cirrhosis.

Reference (5) discusses Acute-on-chronic liver failure.

References (6) through (8) are references to the hepatology societies’ guidelines on liver disease.

Reference (9), Evaluation and Prognosis of Patients with Cirrhosis, is an excellent resource for prognosis.

The following is from Reference (2):

Overview: In an estimated 20 to 30% of patients with hepatitis C infection, chronic viremia results in inflammation followed by fibrosis and cirrhosis. Advanced fibrosis and early cirrhosis are not usually clinically detectable or symptomatic. As patients develop more extensive hepatic fibrosis, pressure begins to build within the portal system, potentially resulting in development of esophageal varices and splenic sequestration of platelets.

Defining Compensated versus Decompensated Cirrhosis: Once it has been established that a patient has cirrhosis, it becomes very important to determine whether they have compensated or decompensated cirrhosis. Patients with compensated cirrhosis do not have symptoms related to their cirrhosis, but may have asymptomatic esophageal or gastric varices. Patients with decompensated cirrhosis have symptomatic complications related to cirrhosis, including those
related to hepatic insufficiency (jaundice), and those related to portal hypertension (ascites, variceal hemorrhage, or hepatic encephalopathy).

Importance of Distinguishing Compensated versus Decompensated Cirrhosis: Prognosis and survival ismarkedly better in patients with compensated cirrhosis than in those with decompensated cirrhosis. In addition, determining that a patient has decompensated cirrhosis can have major implications regarding management and prevention of cirrhosis-related complications, as well
as consideration for a referral for liver transplantation evaluation. In general, any patient with decompensated cirrhosis should receive evaluation and medical care by a hepatologist.[Emphasis added] Some experts have proposed a 4-stage cirrhosis classification system that encompasses the spectrum of compensated and decompensated disease [See my post, The Clinical Significance of  Compensated versus Decompensated Cirrhosis].


(1) Cirrhosis from The National Institute of Diabetes and Digestive and Kidney Diseases

(2) Cirrhosis from

(3) Hepatocellular Carcinoma from

(4) Acute Liver Failure from

(5) Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis [Pubmed] [Full Text HTML] [Full Text PDF]. J Hepatol. 2015 Apr;62(1 Suppl):S131-43. doi: 10.1016/j.jhep.2014.11.045.

(6) EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis [PubMed Citation] [Full Text HTML] [Full Text PDF]. J Hepatol. 2015 Jul;63(1):237-64. doi: 10.1016/j.jhep.2015.04.006. Epub 2015 Apr 21.

(7) Clinical Practice Guidelines  [This link is to 25 Guidelines on Liver Diseases] from the Journal of Hepatology of The European Society for the Study of the Liver (EASL)

(8) Practice Guidelines from The American Association For The Study  Of Liver Diseases

(9) Evaluation and Prognosis of Patients with Cirrhosis, July 6, 2016, from Hepatitis C Online

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