Treatment Options for a 27-Year-Old with Decompensated Cirrhosis

Decompensated cirrhosis is a serious condition often characterized by symptoms such as recurrent jaundice, ascites, hepatic encephalopathy, gastrointestinal bleeding, and in some cases, hepatorenal syndrome. When a young individual develops decompensation, it's crucial to identify the underlying cause and treat it accordingly while managing complications.

1. Identifying and Treating the Underlying Cause

Chronic Hepatitis B: This is one of the most common causes of cirrhosis. Antiviral therapy should be initiated promptly. Even if HBV DNA levels are low or undetectable, patients who test positive for hepatitis B surface antigen (HBsAg) should still receive antiviral treatment.

Alcoholic Liver Disease: The first step in treatment is complete abstinence from alcohol, which can help prevent further liver damage.

Drug-Induced Liver Injury: Discontinuation of any medications that may harm the liver is essential in managing this condition.

Wilson's Disease: Although rare, Wilson's disease can also lead to cirrhosis in young adults. It requires specific treatment to reduce copper accumulation in the body.

2. Managing Common Complications

Ascites: Management includes correcting hypoalbuminemia through albumin supplementation and reducing portal pressure using medications like propranolol. Vasodilators such as isosorbide mononitrate may also be used. Diuretics such as furosemide and spironolactone are commonly prescribed alongside albumin to manage fluid buildup. Monitoring electrolyte levels including sodium, potassium, and chloride is vital to maintain balance.

Gastrointestinal Bleeding: In addition to lowering portal pressure, gastric mucosal protection is necessary. Proton pump inhibitors like omeprazole are typically prescribed to reduce stomach acid and prevent further irritation.

Hepatic Encephalopathy: Treatment focuses on reducing ammonia absorption from the gut. Lactulose is frequently used to promote bowel movements and acidify the intestinal environment, helping to minimize toxin buildup.

In conclusion, comprehensive management of decompensated cirrhosis involves both addressing the root cause and treating associated complications. Age should not be a barrier to aggressive and timely medical intervention. Early diagnosis and consistent follow-up care are key to improving outcomes for patients at any stage of life.