Primary care management of the patient with cirrhosis

Cirrhosis of the liver is a leading cause of death in the United States. Patients with cirrhosis are also at increased risk of morbidity resulting from their disease. Diligence towards the identification and management of underlying chronic liver disease must be sought to prevent or slow progression of cirrhosis. Lifestyle modification, therapeutic interventions against other illnesses, and referral to gastroenterologists/hepatologists for the initiation of disease-specific screenings for HCC and esophageal varices are important components of the role that primary care providers play in management of this commonly encountered patient (Table 5). Unfortunately, the initiation of all of these measures will not prevent progression to liver transplant in all patients and thus primary care providers must recognize the appropriate timing for referral and be ready to collaborate in the management of the often complex medical needs of their patients with end-stage liver disease.