Show 2 more Management of portal vein thrombosis: As per AASLD 2021 guidelines, insufficient evidence regarding treatment indications for portal vein thrombosis in patients with cirrhosis without ischemic symptoms. Consider initiating treatment on a case-by-case basis. I Show 7 more As per AGA 2021 guidelines, consider initiating anticoagulation for the treatment of portal vein thrombosis in patients with cirrhosis and acute or subacute nontumoral portal vein thrombosis. C As per ACG 2020 guidelines, initiate anticoagulation in patients with cirrhosis and: acute complete main portal vein thrombosis mesenteric vein thrombosis extension of portal vein thrombosis into mesenteric veins. B Show 7 more As per EASL 2016 guidelines, implement adequate prophylaxis for gastrointestinal bleeding before initiation of anticoagulation in patients with cirrhotic portal vein thrombosis. A Show 3 more Prevention of deep vein thrombosis: As per EASL 2022 guidelines: Consider administering thromboprophylaxis with LMWH in patients with cirrhosis at risk of deep vein thrombosis/PE. C Consider administering thromboprophylaxis with direct OACs in patients with Child-Pugh class A and B cirrhosis at risk of deep vein thrombosis/PE. Do not use direct OACs in patients with Child-Pugh C cirrhosis. C As per ISTH 2022 guidelines: Do not vie thrombocytopenia and/or prolongation of PT/INR as absolute contraindications to anticoagulant thromboprophylaxis in patients with cirrhosis. D Consider administering anticoagulant thromboprophylaxis (in line with local protocols) with LMWH or fondaparinux over UFH in hospitalized patients with cirrhosis. Consider administering LMWH over UFH in patients with renal impairment. Consider administering thromboprophylaxis in critically ill patients (particularly with acute-on-chronic liver failure) on a case-by-case basis. C Management of deep vein thrombosis: https://web.pathway.md/diseases/recLkjF4yC22VlND8 14/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Be cautious when using vitamin K antagonists in patients with cirrhosis for the treatment of DVT/PE, as these patients can have baseline altered INR and the target INR remains unknown. Consider initiating LMWH and vitamin K antagonists as reasonable options in patients with Child-Pugh A. Initiate LMWH for the treatment of DVT/PE in patients with Child-Pugh B and Child-Pugh C cirrhosis, and UFH as the treatment of choice in patients with renal failure. B Recognize that there are no major concerns regarding the safety of direct OACs for the treatment of deep vein thrombosis/PE in patients with Child-Pugh class A cirrhosis. Be cautious when using direct OACs in patients with Child-Pugh class B cirrhosis and in patients with CrCl < 30 mL/min because of the possibility of accumulation. Do not use direct OACs in patients with Child-Pugh class C cirrhosis. B Prevention of spontaneous bacterial peritonitis, primary prevention: As per AASLD 2021 guidelines: Administer antibiotic prophylaxis for SBP in patients with cirrhosis and upper gastrointestinal hemorrhage. Administer IV ceftriaxone 1 g/24 hours as the antibiotic of choice for a maximum of 7 days. E Consider administering primary prophylaxis for SBP in selected patients with cirrhosis and low protein (< 1.5 g/L) ascites and renal dysfunction (serum creatinine level > 1.2 mg/dL, BUN level > 25 mg/dL or serum sodium level < 130 mEq/L) or liver failure (Child-Turcotte-Pugh score > 9 and bilirubin > 3 mg/dL). E As per BASL/BSG 2021 guidelines: Administer prophylactic antibiotic treatment (chosen based on local data) to prevent the development of SBP in patients presenting with gastrointestinal bleeding and underlying ascites due to cirrhosis. A Administer primary prophylaxis for SBP in high-risk patients, as defined by an ascitic protein count < 1.5 g/dL, with a discussion of potential risks and benefits and existing uncertainties with patients. B As per ACG/AASLD 2007 guidelines, administer short-term (maximum 7 days) antibiotic prophylaxis to prevent infectious complications, including SBP, in any patient with cirrhosis and gastrointestinal hemorrhage. A Show 2 more Prevention of spontaneous bacterial peritonitis, secondary prevention: As per AASLD 2021 guidelines, initiate long-term prophylaxis with daily norfloxacin in patients recovered from an episode of SBP. Consider initiating oral ciprofloxacin if norfloxacin is unavailable. E As per BASL/BSG 2021 guidelines, consider initiating norfloxacin (400 mg once daily), ciprofloxacin (500 mg once daily, PO), or co-trimoxazole (800 mg sulfamethoxazole and 160 mg TMP daily, PO) to prevent further episodes of SBP in patients recovered from an episode of SBP. C As per EASL 2018 guidelines: Initiate prophylactic norfloxacin (400 mg/day, PO) in patients recovered from an episode of SBP, also to prevent hepatorenal syndrome-AKI. A https://web.pathway.md/diseases/recLkjF4yC22VlND8 15/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Insufficient evidence to support the use of rifaximin as an alternative to norfloxacin for secondary prophylaxis of SBP. I Management of spontaneous bacterial peritonitis, antibiotic therapy: As per AASLD 2021 guidelines, initiate empiric IV antibiotics in all patients with an ascites/pleural fluid polymorphonuclear count > 250/mm . E Show 3 more As per BASL/BSG 2021 guidelines: Initiate immediate empirical antibiotic therapy with due consideration of the context of SBP (community-acquired or healthcare-associated), the severity of infection, and local bacterial resistance profile. Guide the choice of an antibiotic agent by local resistance patterns and protocols. B Consider performing a second diagnostic paracentesis at 48 hours from the start of treatment to check the efficacy of antibiotic therapy in patients with apparent inadequate response or if secondary bacterial peritonitis is suspected. C As per EASL 2018 guidelines, initiate empiric IV antibiotics immediately after the diagnosis of SBP. B Show 6 more Management of spontaneous bacterial peritonitis, IV albumin: As per AASLD 2021 guidelines, administer IV albumin in addition to antibiotics (1.5 g/kg on day 1 and 1 g/kg on day 3) in patients with SBP, especially in the presence of AKI and/or jaundice at the time of SBP diagnosis. E As per BASL/BSG 2021 guidelines, administer albumin (1.5 g/kg infusion within 6 hours of diagnosis followed by 1 g/kg on day 3) in patients with SBP and increased or rising serum creatinine. B As per EASL 2018 guidelines, administer albumin (1.5 g/kg at diagnosis and 1 g/kg on day 3) in patients with SBP. A Management of spontaneous bacterial peritonitis, medications to avoid: As per AASLD 2021 guidelines: Avoid using aminoglycosides, wherever possible, for the treatment of bacterial infections in patients with cirrhosis and ascites. D Discontinue nonselective -blockers temporarily in patients with SBP developing hypotension (mean arterial pressure < 65 mmHg) or AKI. E As per EASL 2018 guidelines: Discontinue nonselective -blockers in patients with SBP. B Attempt reinitiating nonselective -blockers after recovery. B Restrict the use of PPIs to patients with a clear indication, since they may increase the risk of SBP in patients with prior SBP. B Management of other infections: recognize that infections other than SBP are frequent and associated with increased mortality in patients with cirrhosis. Assess and closely monitor https://web.pathway.md/diseases/recLkjF4yC22VlND8 16/28 6/29/23, 5:53 AM Liver cirrhosis Pathway hospitalized patients with cirrhosis for the presence of infections to enable early diagnosis and appropriate treatment. B Show 5 more Management of hepatopulmonary syndrome: As per SCCM 2020 guidelines, provide supportive care with supplemental oxygen in the management of patients with hepatopulmonary syndrome, pending possible liver transplantation. E As per EASL 2018 guidelines: Initiate long-term oxygen therapy in patients with hepatopulmonary syndrome and severe hypoxemia, recognizing that there is insufficient evidence regarding its effectiveness, tolerance, cost-effectiveness, compliance, and effects on survival rates. B Insufficient evidence to support the use of medical therapy or TIPS placement for the treatment of patients with hepatopulmonary syndrome. I As per ILTS 2016 guidelines, recognize that aside from supplemental oxygen (rest, exercise, and sleep) no medical therapies are definitively established or approved by the FDA for hepatopulmonary syndrome. B Show 14 more Management of portopulmonary hypertension: As per SCCM 2020 guidelines, consider treating portopulmonary hypertension with agents approved for pulmonary arterial hypertension in patients with mean pulmonary artery pressure > 35 mmHg. C As per EASL 2018 guidelines, consider offering therapies approved for primary pulmonary arterial hypertension in patients with portopulmonary hypertension to improve exercise tolerance and hemodynamics. Be cautious when using endothelin antagonists because of concerns over hepatic impairment. B Show 2 more As per ILTS 2016 guidelines, consider offering agents approved for pulmonary artery hypertension to improve hemodynamics and exercise capacity in patients with portopulmonary hypertension. B Show 6 more Management of hepatorenal syndrome, pharmacotherapy: As per ACG 2022 guidelines, consider initiating terlipressin C or norepinephrine to improve renal function in hospitalized patients with cirrhosis and hepatorenal syndrome-AKI without high- grade acute-on-chronic liver failure or major cardiopulmonary or vascular disease. C Landmark trials: CONFIRM In adult patients with type 1 hepatorenal syndrome, terlipressin was superior to placebo with respect to verified reversal of hepatorenal syndrome. https://web.pathway.md/diseases/recLkjF4yC22VlND8 17/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Florence Wong et al. N Engl J Med. 2021 Mar 4. As per AASLD 2021 guidelines, decide on the management (including initiation of vasoconstrictor therapy and RRT) by a multidisciplinary team including specialists in hepatology, nephrology, critical care, and transplant surgery, if possible, given the complexity of patients with suspected hepatorenal syndrome-AKI. E Show 5 more As per SCCM 2020 guidelines, initiate vasopressors in critically ill patients with acute-on-chronic liver failure developing hepatorenal syndrome. B As per EASL 2018 guidelines, initiate vasoconstrictors and albumin expeditiously in all patients meeting the current definition of AKI-hepatorenal syndrome stage > 1A. B Show 10 more As per EASL 2018 guidelines, discontinue diuretics and/or -blockers and other drugs that could be associated with AKI, such as vasodilators, NSAIDs, and nephrotoxic drugs. B Show 2 more As per AASLD 2017 guidelines, decrease or temporarily hold nonselective -blockers in patients with refractory ascites and hepatorenal syndrome. Consider re-introducing if clinical status improves. E Management of hepatorenal synxdrome (pharmacotherapy): discontinue all diuretics at the initial evaluation and diagnosis of hepatorenal syndrome. A Show 3 more Management of hepatorenal syndrome, renal replacement therapy: As per AASLD 2021 guidelines: Initiate RRT in candidates for liver transplantation with worsening renal function or electrolyte disturbances or increasing volume overload unresponsive to vasoconstrictor therapy. E Initiate RRT with a clear endpoint in mind in patients not being candidates for liver transplantation. E As per EASL 2018 guidelines, decide on initiating RRT based on the individual severity of illness. B Management of hepatorenal syndrome, therapeutic paracentesis: As per EASL 2018 guidelines, administer albumin with therapeutic paracentesis, even when a low volume of ascetic fluid is removed, in patients with AKI and tense ascites. B As per EASL 2010 guidelines, consider performing large-volume paracentesis with albumin in patients with tense ascites, despite the paucity of data on the use of paracentesis in patients with hepatorenal syndrome. B Management of hepatorenal syndrome (transjugular intrahepatic portosystemic shunt): Insufficient evidence to recommend TIPS placement in patients with hepatorenal syndrome-AKI. I Consider placing a TIPS in selected patients with hepatorenal syndrome outside the criteria of AKI. C https://web.pathway.md/diseases/recLkjF4yC22VlND8 18/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Management of hepatic encephalopathy: As per EASL 2018 guidelines, avoid initiating diuretic therapy in patients with persistent overt hepatic encephalopathy. D As per AASLD 2014 guidelines, treat hepatic encephalopathy as a continuum ranging from unimpaired cognitive function with intact consciousness through coma. A Show 10 more Management of hyponatremia: As per AASLD 2021 guidelines, obtain monitoring and advise water restriction in patients with mild hyponatremia (126-135 mEq/L) without symptoms. E Show 6 more As per EASL 2018 guidelines, recognize that the development of hyponatremia (serum sodium concentration < 130 mmol/L) in patients with cirrhosis carries an ominous prognosis, as it is associated with increased mortality and morbidity. Evaluate patients with hyponatremia for liver transplantation. B Show 5 more Management of anemia: Optimize Hgb levels by treating iron, folic acid, vitamin B6, and vitamin B12 deficiencies in patients with cirrhosis, especially likely to undergo invasive procedures. B Do not administer prophylactic RBC transfusion with the aim of decreasing the risk of procedure-related bleeding in the setting of invasive procedures. D Management of relative adrenal insufficiency: do not use hydrocortisone for the treatment of relative adrenal insufficiency in patients with cirrhosis. D Prevention of sarcopenia and frailty: provide education, motivation and behavioral skills support to reduce the risk of developing malnutrition, frailty, and sarcopenia in all patients with cirrhosis. E Show 4 more Management of sarcopenia and frailty: treat inflammatory conditions that lead to cirrhosis, such as HCV infection, insulin resistance, obesity, and AUD to manage malnutrition, frailty, and sarcopenia. E Show 6 more Medications to avoid: As per AASLD 2021 guidelines: Avoid using NSAIDs, ACEIs, and ARBs in patients with cirrhosis and ascites. D Avoid using aminoglycosides for the treatment of bacterial infections, whenever possible. D As per EASL 2018 guidelines: Do not use NSAIDs in patients with ascites because of the high risk of developing further sodium retention, hyponatremia, and AKI. D Do not use ACEIs, ARBs, or alpha-1 receptor blockers in most patients with ascites, as these drugs have been associated with an increased risk of renal impairment. D https://web.pathway.md/diseases/recLkjF4yC22VlND8 19/28 6/29/23, 5:53 AM Liver cirrhosis Pathway 4. Nonpharmacologic interventions Physical activity: As per AASLD 2021 guidelines, offer physical activity-based interventions including the following components to improve muscle contractile function and muscle mass in patients with cirrhosis: assess and reassess frailty and/or sarcopenia using standardized tools advise a combination of aerobic and resistance exercises tailor recommendations based on assessments. E As per EASL 2018 guidelines, insufficient evidence to support prolonged bed rest for the treatment of ascites. I Weight loss: initiate weight loss, if medically required, under the supervision of a multidisciplinary team. E Show 2 more Nutrition (general principles): provide educational resources and counseling regarding the association between nutritional status and outcomes in all patients with cirrhosis (regardless of a diagnosis of malnutrition) and optimize nutritional status. E Show 5 more Nutrition (calories): personalize calorie needs to the patient. E Show 2 more Nutrition (proteins): advise protein intake of 1.2-1.5 g/kg ideal body weight per day in adult patients with cirrhosis. E Show 4 more Nutrition (micronutrients): assess micronutrient deficiencies at least annually, replace if deficient, and reassess after repletion. E Salt restriction: As per AASLD 2021 guidelines, advise moderate sodium restriction (2 g or 90 mmol/day) in patients with cirrhosis and grade 2 ascites. E As per AASLD 2021 guidelines, consider liberalizing sodium restriction to facilitate adequate oral intake in patients screened positive for frailty or sarcopenia and unable to meet nutritional targets on a sodium-restricted diet. E As per BSG 2021 guidelines: Advise moderate salt restriction with daily salt intake of 5-6.5 g (87-113 mmol sodium), meaning no added salt diet with avoidance of precooked meals, in patients with cirrhosis and ascites. B Provide nutritional counseling on the sodium content in the diet in patients with cirrhosis and ascites. B As per EASL 2018 guidelines, advise moderate restriction of sodium intake (80-120 mmol/day, corresponding to 4.6-6.9 g of salt), meaning no added salt diet with avoidance of pre-prepared meals, in patients with moderate, uncomplicated ascites. A https://web.pathway.md/diseases/recLkjF4yC22VlND8 20/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Show 2 more Fluid restriction: do not advise fluid restriction for ascites management unless there is concomitant moderate or severe hyponatremia (serum sodium 125 mmol/L). D Inpatient nutrition: provide formal consultation with a registered dietitian within 24 hours of admission or, if not available, obtain an assessment for malnutrition using the RFH-NPT in all hospitalized patients with cirrhosis. E Show 8 more 5. Perioperative care Assessment of procedural bleeding risk: As per EASL 2022 guidelines, recognize that INR and activated PTT do not predict post- procedural bleeding in patients with cirrhosis undergoing invasive procedures. B Show 6 more As per AGA 2021 guidelines: Insufficient evidence to recommend obtaining preprocedural viscoelastic testing to predict bleeding risk in patients with stable cirrhosis undergoing common gastrointestinal procedures. Avoid obtaining extensive preprocedural testing (including repeated measurements of PT/INR or platelet count) in patients with stable cirrhosis (with known baseline abnormal coagulation parameters) undergoing common gastrointestinal procedures (such as paracentesis, thoracentesis, variceal banding, colonic polypectomy, ERCP, and liver biopsy). D Prevention of procedural bleeding: As per EASL 2022 guidelines, do not administer FFP for correction of prolonged INR to decrease the rate of procedure-related clinically relevant bleeding in patients with cirrhosis undergoing invasive procedures. D Show 11 more As per AGA 2021 guidelines, avoid administering blood products (such as FFP and platelet) routinely for bleeding prophylaxis in patients with stable cirrhosis undergoing common gastrointestinal procedures (such as paracentesis, thoracentesis, variceal banding, colonic polypectomy, ERCP, and liver biopsy). D Show 2 more 6. Surgical interventions Liver transplantation: As per AASLD 2021 guidelines, consider referring patients with grade 2 or 3 ascites for evaluation for liver transplantation. E Show 2 more https://web.pathway.md/diseases/recLkjF4yC22VlND8 21/28 6/29/23, 5:53 AM Liver cirrhosis Pathway As per EASL 2018 guidelines, evaluate patients with refractory ascites or hydrothorax for liver transplantation. B Show 10 more As per ILTS 2016 guidelines, consider performing liver transplantation in patients with severe hypoxemia due to hepatopulmonary syndrome (PaO < 60 mmHg). B Show 6 more As per AASLD 2014 guidelines, consider evaluating for liver transplantation once a patient with cirrhosis has experienced an index complication, such as ascites, hepatic encephalopathy, or variceal hemorrhage, or hepatocellular dysfunction results in a model for end-stage liver disease score 15. B Show 2 more As per AASLD 2014 guidelines, offer liver transplantation in patients with recurrent intractable overt hepatic encephalopathy, together with liver failure. A Elective hernia repair: As per AASLD 2021 guidelines: Perform elective hernia repair in patients with cirrhosis through a multidisciplinary approach after ascites has been controlled and the patient's overall condition, including nutritional status, has been optimized. E Consider performing TIPS placement before elective hernia repair or after an emergent surgery in patients with cirrhosis and uncontrolled ascites. E As per BSG 2021 guidelines, discuss the suitability and timing of surgical repair of umbilical hernia with the patient and multidisciplinary team involving physicians, surgeons, and anesthesiologists. B 7. Specific circumstances Pediatric patients: obtain a comprehensive evaluation of clinical history, physical examination, and diagnostic testing including abdominal ultrasound for the diagnosis of ascites and its cause in pediatric patients. E Show 6 more Patients with obesity: obtain nutritional screening in all patients with cirrhosis and overweight/obesity at the time of diagnosis and at least once a year during follow-up. Use specific tools for nutritional screening validated for chronic liver diseases (including cirrhosis), such as the Royal Free Hospital-Nutritional Prioritizing Tool or the Liver Disease Undernutrition Screening Tool. B Show 7 more Patients with acute-on-chronic liver failure (diagnosis): establish the diagnosis of acute-on- chronic liver failure in patients with cirrhosis and acute decompensation (defined as the acute development or worsening of ascites, overt encephalopathy, gastrointestinal hemorrhage, https://web.pathway.md/diseases/recLkjF4yC22VlND8 22/28 6/29/23, 5:53 AM Liver cirrhosis Pathway nonobstructive jaundice, and/or bacterial infections) when organ failures involving high short-term mortality develop. B Show 2 more Patients with acute-on-chronic liver failure (management): recognize that there is no specific therapy for acute-on-chronic liver failure aside from antiviral therapy in patients with acute-on- chronic liver failure due to reactivation of HBV infection. B Show 7 more 8. Follow-up and surveillance Surveillance for malignancy: As per EASL 2023 guidelines, consider obtaining abdominal ultrasound surveillance at 6- monthly intervals for the detection of intrahepatic cholangiocarcinoma at an early stage in patients with cirrhosis. C As per EASL 2022 guidelines, consider obtaining screening for hepatobiliary malignancy every 6 months in patients with PSC in the presence of cirrhosis. C As per AASLD 2018 guidelines: Obtain surveillance for HCC by ultrasound, with or without AFP, every 6 months (Conditional, Low) in adult patients with cirrhosis. Multiple grades). B Do not obtain surveillance in patients with cirrhosis with Child's class C unless they are on the transplant waiting list, given the low anticipated survival in these patients. D As per ESMO 2018 guidelines: Obtain surveillance for HCC in all patients with cirrhosis, irrespective of the etiology, as long as liver function and comorbidities allow curative or palliative treatments. B Obtain surveillance for HCC in patients at risk for HCC with abdominal ultrasound every 6 months with or without AFP. A Clinical findings Symptoms Past medical history Fatigue AAT deficiency Itching AIH Loss of appetite AKI RUQ pain ALD Weight loss AUD Budd-chiari syndrome Vascular exam Gastroesophageal varices HBV infection Peripheral edema HCC Abdominal exam HCV infection https://web.pathway.md/diseases/recLkjF4yC22VlND8 23/28 6/29/23, 5:53 AM Liver cirrhosis Pathway HF Abdominal distension Hemochromatosis Ascites Hepatic encephalopathy Flank dullness Lower gastrointestinal bleeding Shifting dullness Nonalcoholic fatty liver disease Splenomegaly Obesity fluid wave sign PBC Breast exam PSC Portal hypertension Gynecomastia Portal vein thrombosis Rectal varices Lab findings Upper gastrointestinal bleeding Lactic acidosis Wilson's disease Prolonged serum PT Neurological exam serum ALP serum ALT Altered mental status serum AST Asterixis serum TBIL serum gamma- glutamyltransferase Genitourinary exam serum albumin Testicular atrophy serum sodium Integument exam Caput medusae Digital clubbing Jaundice Muehrcke's lines Palmar erythema Spider angiomata Telangiectasia Terry's nails Hematological findings Coagulopathy Pancytopenia blood platelet count Studies 2019 AVB-TIPS In patients with advanced cirrhosis and acute variceal bleeding who had been treated with vasoactive drugs plus endoscopic therapy, early TIPS was superior to standard care with respect to death or liver transplantation. https://web.pathway.md/diseases/recLkjF4yC22VlND8 24/28 6/29/23, 5:53 AM Liver cirrhosis Pathway Yong Lv et al. Lancet Gastroenterol Hepatol. 2019 Aug. 2010 Early TIPS for variceal hemorrhage In patients with cirrhosis and acute variceal bleeding who had been treated with vasoactive drugs plus endoscopic therapy, early TIPS implantation was superior to vasoactive drugs and endoscopic band ligation with respect to freedom from rebleeding or failure to control bleeding. Garcia-Pagan JC et al. N Engl J Med. 2010 Jun 24. Show 2 more References 1. Scott W Biggins, Paulo Angeli, Guadalupe Garcia-Tsao et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74 2 1014 1048. Open 2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69 2 406 460. Open 3. Joo Ha Hwang, Amandeep K Shergill, Ruben D Acosta et al. 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Michael J Krowka, Michael B Fallon, Steven M Kawut et al. International Liver Transplant Society Practice Guidelines: Diagnosis and Management of Hepatopulmonary Syndrome and Portopulmonary Hypertension. Transplantation. 2016 Jul;100 7 1440 52. Open 21. Rahul Nanchal, Ram Subramanian, Constantine J Karvellas et al. Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU Cardiovascular, Endocrine, Hematologic, Pulmonary and Renal Considerations: Executive Summary. Crit Care Med. 2020 Mar;48 3 415 419. Open 22. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on Sclerosing Cholangitis. J Hepatol. 2022 May 31;S0168 8278 22 00326 9. Open 23. Lara N Roberts, Virginia Hernandez-Gea, Maria Magnusson et al. Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients with cirrhosis: Guidance from the SSC of the ISTH. J Thromb Haemost. 2022 Jul 25. Open 24. Vilstrup H, Amodio P, Bajaj J et al. 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R N Pugh, I M Murray-Lyon, J L Dawson et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60 8 646 9. Open 40. Runyon BA, AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013 Apr;57 4 1651 3. Open 41. Hiroshi Fukui, Hidetsugu Saito, Yoshiyuki Ueno et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016 Jul;51 7 629 50. Open 42. Italian Association for the Study of the Liver AISF , Italian Association for the Study of the Liver AISF. AISF position paper on liver disease and pregnancy. Dig Liver Dis. 2016 Feb;48 2 120 37. Open https://web.pathway.md/diseases/recLkjF4yC22VlND8 27/28 6/29/23, 5:53 AM Liver cirrhosis Pathway 43. Monika Sarkar, Carla W Brady, Jaquelyn Fleckenstein et al. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73 1 318 365. Open 44. Rahul Nanchal, Ram Subramanian, Waleed Alhazzani et al. Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations. Crit Care Med. 2023 May 1;51 5 657 676. Open 45. Steven L Flamm, Florence Wong, Joseph Ahn et al. AGA Clinical Practice Update on the Evaluation and Management of Acute Kidney Injury in Patients With Cirrhosis: Expert Review. Clin Gastroenterol Hepatol. 2022 Dec;20 12 2707 2716. Open 46. Heather Patton, Julie Heimbach, Arthur McCullough. AGA Clinical Practice Update on Bariatric Surgery in Cirrhosis: Expert Review. Clin Gastroenterol Hepatol. 2021 Mar;19 3 436 445. Open https://web.pathway.md/diseases/recLkjF4yC22VlND8 28/28