Care of the cirrhotic patient

The clinical manifestations of cirrhotic liver disease encompass a broad spectrum of conditions that reflect the consequence of high portal pressures that result from fibrosis and diminished hepatic synthetic reserve. Patients with cirrhosis are at heightened risk for the development of infection, and although the use of prophylactic antimicrobial therapy may be considered lifesaving in the setting of gastrointestinal hemorrhage, there remains controversy regarding such therapy in the management of cirrhotic ascites. The infectious disease specialist is now becoming familiarized with the management of viral hepatitis, which includes screening for hepatocellular carcinoma and vigilance for infectious complications of antiviral therapy.