Cirrhosis and its complications: Evidence based treatment

Table 1 Diagnostic criteria for hepatorenal syndrome

Chronic or acute hepatic disease with advanced hepatic failure and portal hypertension

Serum creatinine > 1.5 mg/dL

No sustained improvement of serum creatinine after at least 2 d of diuretic withdrawal and volume expansion with albumin or isotine saline

Absence of shock

No current or recent treatment with nephrotoxic drugs

Absence of parenchymal disease as indicated by proteinuria > 500 mg/d microhematuria (> 50 red blood cells per high-power field) and/or abnormal renal ultrasonography

Table 2 Drug therapy for portopulmonary hypertension

Drug	Route of administration	Mechanism of action
Epoprostenol	Intravenous	Vasodilator, anti-platelet and anti-proliferative
Ambrisentan	Orally	Selective endothelin-A receptor antagonist
Bosentan	Orally	Endothelin-A and Endothelin B receptor antagonist
Sildenafil	Orally	Phosphodiesterase inhibitor
Iloprost	Inhaled	Prostacyclin analogue

Table 3 Classification of gastric varices

Gastroesphageal varices		Isolated gastric varices
Type I	Extend along the lesser curvature	Type I	Involves the fundus
Type II	Extend along the fundus	Type II	Involves the body and/or antrum

Table 4 Grades of hepatic encephalopathy

	Symptoms	Asterixis	EEG abnormal
Grade 1	Mild confusion, disordered sleep, slurred speech, shortened attention span, euphoria or depression	Yes/No	No
Grade 2	Lethargy, inappropriate behavior, moderate confusion	Yes	Yes
Grade 3	Sever confusion, incoherent, somnolent but arousable	Yes	Yes
Grade 4	Coma, unresponsive to pain	No	Yes