Plzz guide. What is the problem nd what should b further treatment ?

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Clinical manifestations of cirrhosis Symptoms Anorexia Weight loss Weakness Fatigue Muscle cramps Easy bruising Amenorrhea/oligomenorrhea/metrorrhagia (women) Impotence (men) Infertility Decreased libido (men) Jaundice* Dark or "cola-colored" urine* Pruritus* Hematemesis/melena/hematochezia* Abdominal distension* Lower extremity edema* Confusion or sleep disturbances* Physical examination Hepatomegaly Splenomegaly Spider angiomata/spider telangiectasias Palmar erythema Digital clubbing Hypertrophic osteoarthropathy Dupuytren's contracture Muehrcke nails Terry nails Parotid gland enlargement (likely due to alcohol use and not cirrhosis per se) Gynecomastia (men) Loss of chest or axillary hair (men) Testicular atrophy (men) Caput medusa Cruveilhier-Baumgarten murmur (venous hum heard best with the stethoscope over the epigastrium) Jaundice* Ascites (abdominal distension, shifting dullness, fluid wave)* Asterixis* Fetor hepaticus* Laboratory tests Moderately elevated aminotransferases (often with an AST:ALT ratio >1) Elevated alkaline phosphatase (2 to 3 times the ULN) Elevated gamma-glutamyl transpeptidase Thrombocytopenia Leukopenia/neutropenia Anemia Low serum albumin* Prolonged prothrombin time/elevated INR* Hyperbilirubinemia* Hyponatremia* Elevated serum creatinine* Imaging tests Surface nodularity Increased echogenicity (ultrasound) Atrophy of the right lobe Hypertrophy of the caudate or left lobes Small, nodular liver* Ascites* Hepatocellular carcinoma* Portal/splenic/superior mesenteric vein thrombosis* Portosystemic collaterals*

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A meta-analysis found that the factors with the best ability to predict cirrhosis in adults with known or suspected liver disease included [47]: ●Presence of ascites (likelihood ratio [LR] 7.2) ●Platelet count <160,000/mm3 (LR 6.3) ●Spider angiomata (LR 4.3) ●Bonacini cirrhosis discriminant score greater than 7 (LR 9.4) The Bonacini cirrhosis discriminant score is calculated by giving points for the following parameters [48]: ●Platelets (x1000/mm3): •>340 – zero points •280 to 339 – one point •220 to 279 – two points •160 to 219 – three points •100 to 159 – four points •40 to 99 – five points •<40 – six points ●Alanine aminotransferase to aspartate aminotransferase (ALT/AST) ratio: •>1.7 – zero points •1.2 to 1.7 – one point •0.6 to 1.19 – two points •<0.6 – three points ●International normalized ratio (INR): •<1.1 – zero points •1.1 to 1.4 – one point •>1.4 – two points Factors associated with a low likelihood of cirrhosis included: ●Lok index <20 percent (LR 0.09) ●Platelet count of 160,000/mm3 or higher (LR 0.29) ●Absence of hepatomegaly (LR 0.37) The Lok index is calculated using the platelet count, AST, ALT, and INR [49]. In a validation study, when a cutoff of <20 percent was used to exclude cirrhosis, the test had a specificity of 92 percent. When a cutoff of >50 percent was used to diagnose cirrhosis, the test had a sensitivity of 85 percent. Of note, the Lok index has only been validated in patients with hepatitis C virus.

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In developed countries, common causes of cirrhosis include [2]: ●Chronic viral hepatitis (hepatitis B, C) ●Alcoholic liver disease ●Hemochromatosis ●Nonalcoholic fatty liver disease Less common causes include: ●Autoimmune hepatitis ●Primary and secondary biliary cirrhosis ●Primary sclerosing cholangitis ●Medications (eg, methotrexate, isoniazid) ●Wilson disease ●Alpha-1 antitrypsin deficiency ●Celiac disease ●Idiopathic adulthood ductopenia ●Granulomatous liver disease ●Idiopathic portal fibrosis ●Polycystic liver disease ●Infection (eg, brucellosis, syphilis, echinococcosis) ●Right-sided heart failure ●Hereditary hemorrhagic telangiectasia ●Veno-occlusive disease

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Referral to a hepatologist is recommended if the patient develops decompensated cirrhosis or major complications of cirrhosis. Patients with a MELD score ≥10 should be referred to a liver transplantation center for evaluation. In addition, referral to a hepatologist should be considered if the patient requires treatment for the underlying cause of the cirrhosis (eg, hepatitis C, autoimmune hepatitis) or if the clinician managing the patient would like the assistance of a hepatologist in the patient's general management.

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Once these complications develop, patients are considered to have decompensated cirrhosis. Multiple factors can predispose to decompensation in a patient with cirrhosis. Risk factors for decompensation include bleeding, infection, alcohol intake, medications, dehydration, and constipation [3-5]. In addition, patients with obesity are at increased risk for decompensation [6]. Once decompensation has developed, patients should be considered for liver transplantation.

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The major goals of managing patients with cirrhosis include: ●Slowing or reversing the progression of liver disease ●Preventing superimposed insults to the liver ●Identifying medications that require dose adjustments or should be avoided entirely (table 2 and table 3) ●Managing symptoms and laboratory abnormalities ●Preventing, identifying, and treating the complications of cirrhosis ●Determining the appropriateness and optimal timing for liver transplantation

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●Cirrhosis represents a late stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules. It is generally considered to be irreversible in its advanced stages. In earlier stages, specific treatments aimed at the underlying cause of liver disease may improve or even reverse cirrhosis.

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Complications of portal hypertension include: ●Ascites ●Hepatic encephalopathy ●Variceal hemorrhage ●Spontaneous bacterial peritonitis ●Hepatorenal syndrome ●Portal hypertensive gastropathy ●Hepatic hydrothorax ●Hepatopulmonary syndrome ●Portopulmonary hypertension ●Cirrhotic cardiomyopathy

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Common complications of cirrhosis Variceal hemorrhage Ascites Spontaneous bacterial peritonitis Hepatic encephalopathy Hepatocellular carcinoma Hepatorenal syndrome Hepatopulmonary syndrome Hepatic hydrothorax Portopulmonary hypertension Cirrhotic cardiomyopathy Portal vein thrombosis

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Alcoholic liver cirrhosis .

Sir patient don't consume alcohol.. But he eats too much Ghutkas ? Plzz guide
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