Patient handout

Cirrhosis (chronic, compensated + decompensated)

PRODUCTION

1. Your condition

This handout is for cirrhosis (chronic, compensated + decompensated). Your care team identified this based on: jaundice / scleral icterus.

Other reasons your team may use this plan: new or worsening ascites; variceal bleed — hematemesis / melena; hepatic encephalopathy / confusion / asterixis.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
carvedilol	6.25 mg PO daily, titrate to 12.5-25 mg BID	PO	daily/BID	Baveno VII — preferred NSBB for primary prophylaxis (better hemodynamic effect than propranolol/nadolol); reduces decompensation
propranolol	20 mg PO BID, titrate to HR 55-60 or max 320 mg/day	PO	BID/TID	Alternative NSBB; longer track record (Baveno VII 2022)
nadolol	20 mg PO daily, titrate to HR 55-60	PO	daily	Once-daily NSBB option (Baveno VII 2022)

Plan: Cirrhosis complication-driven regimen — Baveno VII + AASLD 2024

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable compensated — continue routine care

If you have:

Stable weight (within 1-2 kg of baseline)
No new confusion, sleep changes, or asterixis
No abdominal distension or pain
No bleeding, hematemesis, melena, or hematochezia
No yellowing of skin/eyes worse than baseline

Do this:

Take all liver medications as prescribed (lactulose, rifaximin, diuretics, NSBB)
Daily weight + sodium-restricted diet (<2 g/day)
No alcohol; avoid NSAIDs and herbal supplements
Keep all hepatology and transplant clinic appointments
Continue HCC surveillance imaging

YELLOW — Caution — early decompensation signs, contact hepatology within 24h

If you have:

Weight gain >2 kg in 1 week or new abdominal swelling
Mild confusion, forgetfulness, or sleep reversal (HE grade 1)
Decreased urine output
Constipation or fewer than 2 BMs/day on lactulose
New leg swelling
Mild yellowing of skin/eyes worsening
New nausea or decreased appetite

Do this:

Increase lactulose to achieve 2-3 soft BMs/day
Strict sodium restriction <2 g/day; fluid restriction if instructed
Daily weight tracking — bring to clinic
Avoid sedatives, opioids, alcohol
Contact hepatology team within 24 hours

Call your provider if:

Weight gain >2 kg/week despite diuretics
Mild confusion or sleep changes
New leg swelling
Fewer BMs than usual

RED — Medical alert — go to ED now

If you have:

Vomiting blood or coffee-ground material
Black tarry stool or red blood per rectum
Severe confusion, very sleepy, hard to wake (HE grade 3-4)
Severe abdominal pain or fever
Cannot urinate or making very little urine
Sudden severe shortness of breath
Falls or stumbling, slurred speech

Do this:

Call 911 / go to nearest ED immediately
Bring updated medication list
Notify hepatology team of admission
Family/caregiver to accompany if patient confused

Call your provider if:

Any red zone symptom — ED now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Diagnostic paracentesis ANC ≥250/mm³ in cirrhotic with ascites (AASLD 2023)
West Haven grade 3-4 HE (somnolence, stupor, coma; airway concern) (AASLD 2023)(life-threatening)
Tense ascites with respiratory compromise, abdominal pain, or umbilical hernia rupture risk (ACG 2021 ascites)
Hematemesis / melena in cirrhotic (Baveno VII 2022)(life-threatening)
AKI in cirrhosis after albumin/diuretic withdrawal challenge — bland sediment, no shock, no nephrotoxin (AASLD 2023)(life-threatening)
Na <125 mEq/L in cirrhotic with ascites (AASLD 2023)
Maddrey discriminant function ≥32 in alcoholic hepatitis (ACG 2023 ALD)

5. Follow-up

Hepatology q3mo decompensated / q6mo compensated; transplant eval at MELD ≥15; addiction services for AUD; vaccinations (HAV/HBV/flu/PNA/COVID); palliative care for advanced (AASLD 2023 Biggins)

6. Sources

Guideline: AASLD 2024 Practice Guidance on Risk Stratification + Portal Hypertension/Varices + AASLD 2023 ACLF + Baveno VII (2022) + AASLD 2023 MASLD + AASLD 2023 HCC + ACG 2023 ALD