How can I be sure that the patient has systemic inflammatory response syndrome? Patients with new onset decompensation of chronic liver failure secondary to cirrhosis of many causes (alcohol, viral hepatitis, autoimmune disease, metabolic disorders – e.g., metabolic syndrome or hemochromatosis) often have clinical features of systemic inflammatory response syndrome (SIRS). The challenge for the…
How can I be sure that the patient has variceal bleeding? Upper gastrointestinal hemorrhage due to bleeding from esophageal varices, gastric varices, and portal hypertensive gastropathy occurs in patients with portal hypertension from cirrhosis. Bleeding from gastroesophageal varices usually presents with hematemesis, melena, or both. Occult bleeding, particularly due to portal hypertensive gastropathy, may present…
How can I be sure that the patient has hepatorenal syndrome? Hepatorenal syndrome (HRS) presents with reduced urinary output and rising serum creatinine in patients with cirrhosis and ascites. A characteristic of HRS is that the clinical features fail to return to normal after volume expansion with intravenous colloid. A tabular or chart listing of…
