- 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.