9.2 SFGH morning report pearls – complications of cirrhosis

  • milk maid’s grip (or sign): asterixis demonstrated by rhythmic squeezing when asked to grip two fingers
    • characteristic but not pathognomonic of liver failure, may occur in hypoxia, hypercapnia, uremia, heart failure, or sedative overdose
    • standard dose ceftriaxone is adequate for treatment of SBP
    • first line prevention of recurrent variceal hemorrhage:
    • beta blocker indefinitely; increase to max tolerated dose or until HR <55 bpm
    • endoscopic variceal ligation: ligate every 2-4 weeks until varices are obliterated; f/u with endoscopy 1-3 months after obliteration, then q 6-12 months indefinitely
Jones EA and Weissenborn K.  Neurology and the liver.  J Neurol Neurosurg Psychiatry 1997;63:279-293.
Garcia-Tsao G, Bosch Management of varices and variceal hemorrhage in cirrhosis.  NEJM 2010; 362:823-832.

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