Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Cirrhosis with Decompensation

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In one line

·A scarred liver that can no longer hold things together.

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Normal physiology

·The liver sits in the upper right part of your belly, tucked under your ribs. It is the size of a football and does more than 500 jobs to keep you alive. Blood flows into the liver from two sources: the hepatic artery brings oxygen-rich blood from the heart, and the portal vein brings nutrient-rich blood from your intestines, stomach, spleen, and pancreas. Inside the liver, that blood filters through tiny channels lined with liver cells that clean toxins, make proteins, store sugar, and break down old blood cells. After the liver does its work, clean blood flows out through the hepatic veins into the big vein that returns to your heart.

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What goes wrong

·Cirrhosis is what happens when the liver gets damaged over and over, and scar tissue replaces healthy liver cells. The most common causes are drinking too much alcohol for years, chronic hepatitis B or C virus infection, nonalcoholic fatty liver disease (often tied to obesity and diabetes), and autoimmune hepatitis (when your immune system attacks your liver). Other causes include bile duct diseases, inherited iron or copper overload, and some medicines. Every time the liver gets hurt, it tries to heal by laying down scar tissue, like a scab. But unlike skin, the liver scab is thick, hard, and permanent. Over time, the liver shrinks, gets lumpy, and the scar tissue blocks the normal flow of blood through those tiny channels. That makes pressure build up in the portal vein — portal high blood pressure (hypertension) — like a traffic jam. Blood has nowhere to go, so it backs up and finds detours through veins that are too thin and fragile to handle the load.

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Hallmark signs

·Fluid building up in the belly (ascites)
·Yellow skin and eyes (jaundice)
·Confusion or sleepiness (hepatic encephalopathy)
·Vomiting blood or black, tarry stools
·Easy bruising or bleeding that won't stop
·Swollen legs and ankles (edema)
·Feeling very tired and weak
·Belly pain or infection of the fluid (spontaneous bacterial peritonitis)

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Red flags · escalate now

·Confusion, drowsiness, or not waking up easily (suggests toxins are affecting the brain)
·Vomiting blood or black, sticky stools like tar (life-threatening bleeding from swollen veins)
·Fever and belly pain with fluid buildup in the belly (ascites) (possible infection of the fluid in the belly)
·Making very little urine or none at all (kidneys may be failing)
·Trouble breathing or very fast breathing (fluid may be pressing on the lungs or infection is spreading)

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Workup

·Complete Blood Count (CBC)
·Comprehensive Metabolic Panel (CMP) including creatinine and sodium
·Liver function tests (AST, ALT, bilirubin, albumin, INR)
·Ammonia level (venous or arterial)
·Paracentesis (belly fluid tap) with cell count, albumin, and culture
·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Abdominal ultrasound with Doppler
·Model for End-Stage Liver Disease (MELD) score

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Treatment

·Octreotide IV drip + urgent upper endoscopy with band ligation or sclerotherapy for variceal bleeding
·Ceftriaxone 2 g IV daily (or norfloxacin oral if stable) to prevent or treat spontaneous bacterial peritonitis (SBP)
·Lactulose syrup (20–30 g every 1–2 hours until bowel movement, then adjusted) + rifaximin 550 mg twice daily for hepatic encephalopathy
·IV albumin 1–1.5 g/kg on day 1, then 1 g/kg on day 3 + midodrine and octreotide (or terlipressin where available) for hepatorenal syndrome
·Spironolactone 100 mg daily + furosemide 40 mg daily (water pills) for fluid buildup in the belly (ascites), with low-salt diet (< 2 g sodium/day)
·Non-selective beta-blocker (propranolol or carvedilol, dose adjusted to lower heart rate ~25%) for primary or secondary prevention of variceal bleeding
·Liver transplant evaluation and listing

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NCLEX trap

·Yellow skin (jaundice) in decompensated cirrhosis happens because the broken liver cannot clear bilirubin, a yellow waste product from old blood cells. It is not an infection. The right move is to support the failing liver and stop any bleeding—give octreotide to squeeze bleeding veins tight, and ceftriaxone antibiotic to prevent infection in the fluid-filled belly. Treat the cause, not just the color.
·In decompensated cirrhosis, pouring in salt water (normal saline) makes the belly and legs swell worse because the broken liver leaks fluid everywhere and cannot balance salt. It does not fix the real problem—sick blood vessels and failing kidneys. Instead, give albumin (a protein solution that pulls fluid back into blood vessels) and medicines like midodrine or octreotide to tighten blood vessels and help kidneys keep working.
·Confusion in decompensated cirrhosis means ammonia and other poisons are building up in the blood and damaging the brain right now. This is called hepatic encephalopathy. Start lactulose (a sweet liquid that traps ammonia in the gut and flushes it out in stool) and rifaximin (an antibiotic that kills ammonia-making bacteria in the gut) immediately. Every hour of delay risks permanent brain injury or coma.
·Too much blood transfusion in decompensated cirrhosis raises pressure inside the twisted, swollen veins in the esophagus and actually triggers more bleeding. Transfuse red blood cells only to keep hemoglobin around 7 (not 10). The real fix is octreotide to squeeze veins, ceftriaxone to prevent infection, and endoscopy with rubber bands to tie off the bleeding vessel at its source.
·In decompensated cirrhosis, bleeding, belly swelling (ascites), confusion (encephalopathy), and kidney failure (hepatorenal syndrome) are all pieces of one broken system—the liver. You must treat all of them at the same time: octreotide and bands for bleeding, lactulose for brain, paracentesis (needle drainage) and albumin for belly, midodrine or terlipressin for kidneys, and ceftriaxone to prevent infection. They are connected, not separate.
·Decompensated cirrhosis means the liver is failing so badly it cannot keep the body alive on its own. Medicine buys time and keeps the patient safe, but only a new liver fixes the problem forever. Start the transplant evaluation now—do not wait until the patient crashes or gets too sick to survive surgery. Transplant is the cure; everything else is a bridge.

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