TY - CHAP M1 - Book, Section TI - Management of the Patient With Cirrhosis A1 - Sakaria, Sonali A1 - Subramanian, Ram M. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Portal hypertension, resulting from increased intrahepatic resistance to portal flow and increased portal inflow, marks the transition from compensated to decompensated cirrhosis.The sequelae of portal hypertension affect each organ system, requiring multi-disciplinary management.Grades III and IV hepatic encephalopathy require immediate ICU transfer and elective intubation for airway protection.Pulmonary derangements resulting from portal hypertension may be severe and include hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax.Hepatorenal syndrome is a diagnosis of exclusion and is characterized by renal impairment in the setting of advanced liver disease, circulatory dysfunction, and increased activity of the renin-angiotensin system.SBP is a known precipitant of HRS, which is a cause of increased mortality in cirrhotic patients; therefore empiric antibiotic treatment is warranted in patients in whom the suspicion for SBP is high.Aggressive intravenous resuscitation, airway protection, and early endoscopic management of cirrhotic patients presenting with suspected variceal bleed is critical. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107711952 ER -