Hepatology

A

• Acute Cholangitis - Antibiotics and ERCP

  Diagnose with fever, jaundice, and cholestasis plus imaging; start broad spectrum antibiotics and arrange early biliary drainage with ERCP based on severity.
• Acute Cholangitis — Antibiotics and Urgent ERCP per Tokyo Guidelines

  Charcot triad (fever, jaundice, RUQ pain) ± hypotension/AMS suggests cholangitis. Start broad-spectrum antibiotics and obtain urgent biliary decompression (ERCP) in moderate-to-severe cases per Tokyo Guidelines; correct coagulopathy and fluids.
• Acute Liver Failure - Initial Management

  Defined by acute liver injury, coagulopathy, and encephalopathy in patients without prior cirrhosis; secure airway in advanced encephalopathy, treat acetaminophen toxicity with NAC, manage intracranial pressure risk, and transfer early to a transplant center.
• Acute Liver Failure — N‑Acetylcysteine, Cerebral Edema, and Transplant Criteria

  Rapid hepatic dysfunction with INR ≥1.5 and encephalopathy in a non‑cirrhotic patient. Start IV N‑acetylcysteine even in non‑acetaminophen cases; manage cerebral edema with head elevation and hypertonic saline; avoid hypoxia/hypotension. Apply King’s College criteria early for transplant referral; evaluate etiologies (acetaminophen, viral, autoimmune, ischemic, Wilson).
• Alcoholic Hepatitis - Severity and Steroids

  Assess severity with Maddrey DF or MELD; treat severe disease with prednisolone if no contraindications and reassess response with the Lille score at day 7.

C

• Cirrhotic Ascites - Initial Management

  Perform diagnostic paracentesis on admission, restrict sodium, start spironolactone plus furosemide, and give albumin after large volume paracentesis.

D

• Drug Induced Liver Injury - Evaluation

  Stop the offending agent, classify injury pattern with R ratio, exclude viral, autoimmune, and biliary causes, and consider NAC in early severe cases while reporting the event.

H

• HBV Reactivation - Screening and Prophylaxis

  Screen for HBsAg and anti HBc before immunosuppression; start antiviral prophylaxis for high risk regimens such as anti CD20 therapy and continue for months after completion.
• Hepatic Encephalopathy — Acute Management

  Treat precipitating causes, give lactulose to target two to three soft stools daily, and add rifaximin for recurrent episodes; protect airway in severe cases.
• Hepatic Encephalopathy — Lactulose/Rifaximin, Precipitant Search, and Secondary Prevention

  Neuropsychiatric dysfunction in cirrhosis. Exclude alternative causes, correct precipitants (GI bleed, infection, dehydration), and treat with lactulose titrated to 2–3 soft stools/day plus rifaximin for prevention of recurrence; counsel on protein intake and avoid sedatives.
• Hepatorenal Syndrome - Acute Management

  Diagnose HRS AKI after excluding shock, nephrotoxins, and structural kidney disease; give albumin plus vasoconstrictor therapy such as terlipressin, norepinephrine, or midodrine with octreotide, and evaluate for transplant.

O

• Obstructive Jaundice - Initial Workup

  Differentiate intrahepatic versus extrahepatic cholestasis with labs and ultrasound first; use MRCP or ERCP for further definition and treat pruritus and fat soluble vitamin issues.

S

• Spontaneous Bacterial Peritonitis - Prevention and Prophylaxis

  Provide antibiotic prophylaxis for prior SBP, during upper GI bleeding, and for selected high risk ascites; choose daily fluoroquinolone or trimethoprim sulfamethoxazole per local patterns.
• Spontaneous Bacterial Peritonitis — Diagnosis & Treatment

  In cirrhosis with ascites, diagnose when PMN count is 250 cells per mm3 or higher; start third generation cephalosporin and give IV albumin on days 1 and 3; begin prophylaxis after recovery.
• Spontaneous Bacterial Peritonitis — Diagnostic Tap, Albumin, and Third-Generation Cephalosporins

  In any cirrhotic with ascites and abdominal pain or encephalopathy, perform diagnostic paracentesis; PMN ≥250 cells/mm³ confirms SBP. Start cefotaxime or ceftriaxone promptly and give albumin on day 1 and 3 to prevent renal failure; begin long-term prophylaxis after recovery when indicated.
• Spontaneous Bacterial Peritonitis — Diagnostic Tap, Ceftriaxone, and Albumin

  In cirrhosis with ascites, perform immediate diagnostic paracentesis. Treat SBP when PMN ≥250/µL with IV third-generation cephalosporin and give IV albumin (day 1: 1.5 g/kg; day 3: 1.0 g/kg) to prevent renal failure. Start lifelong prophylaxis after an episode.

V

• Variceal Upper GI Bleeding — Acute Management

  Resuscitate with restrictive transfusion; start vasoactive drug and ceftriaxone early; urgent endoscopy with band ligation; consider TIPS for refractory bleeding.
• Variceal Upper GI Bleeding — Octreotide, Antibiotics, Band Ligation, and TIPS

  In cirrhosis with hematemesis/melena, start vasoactive therapy (octreotide) and prophylactic antibiotics immediately, resuscitate with restrictive transfusion, and perform early endoscopy for band ligation. Use balloon tamponade as a bridge if uncontrollable hemorrhage and consider early TIPS for high‑risk or refractory bleeding.
• Variceal Upper GI Bleeding — Vasoactives, Antibiotics, and Band Ligation

  Portal hypertensive bleeding in cirrhosis requires early vasoactive drugs, prophylactic antibiotics, and endoscopic band ligation; use restrictive transfusion strategy and consider TIPS for refractory or high‑risk cases.

W

• Wilson Disease - Clues in Acute Liver Failure

  Suspect in young patients with hemolysis, low alkaline phosphatase to bilirubin ratio, and low ceruloplasmin; arrange urgent transplant evaluation and start copper directed therapy as bridge.