Gastroenterology and hepatology
Management of chronic liver disease complications
Working through ascites, refractory ascites, hyponatraemia, HRS-AKI, hepatic encephalopathy and the coagulopathy of cirrhosis, with worked results and the 2025 to 2026 AGA, ACG and Baveno VIII updates.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Decompensation means ascites, variceal bleeding, encephalopathy or jaundice. After the first event, median survival falls to about 2 years, so every decompensating episode is a cue to ask about transplant referral (MELD 15 or more, or any decompensation).
- The aetiology work-up, staging and first-line tables live in Chronic liver disease and cirrhosis. Variceal bleeding is in GI bleeding. This note covers what to do when the first-line plan stops working and how to read the results that change management.
- What's new: the AGA 2025 practice update on ascites, volume overload and hyponatraemia; the first ACG guideline on hepatic encephalopathy (March 2026); the ADQI-ICA 2024 AKI criteria; and Baveno VIII (2026).
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Sources
- Therapeutic Guidelines: Gastrointestinal (eTG complete), complications of cirrhosisAU/NZTherapeutic Guidelines Limited
- PBS item 10001J: rifaximin 550 mg tablet (prevention of hepatic encephalopathy)AU/NZPharmaceutical Benefits Scheme, Accessed November 2026
- Baveno VIII Faculty. Baveno VIII: Advancing consensus in portal hypertension. J Hepatol 2026;85:993-1018Baveno Cooperation / EASL (Journal of Hepatology), 2026
- Bajaj JS et al. ACG Clinical Guideline: Hepatic Encephalopathy. Am J Gastroenterol 2026;121:588-618American College of Gastroenterology, 2026
- Orman ES et al. AGA Clinical Practice Update on the Management of Ascites, Volume Overload, and Hyponatremia in Cirrhosis: Expert Review. Gastroenterology 2025;169:1547-57American Gastroenterological Association, 2025
- Biggins SW et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the AASLD. Hepatology 2021;74:1014-48American Association for the Study of Liver Diseases, 2021
- Nadim MK et al. Acute kidney injury in patients with cirrhosis: ADQI and International Club of Ascites joint consensus. J Hepatol 2024;81:163-83Acute Disease Quality Initiative / International Club of Ascites, 2024
- EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol 2022;76:1151-84European Association for the Study of the Liver, 2022
- Bass NM et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010;362:1071-81New England Journal of Medicine, 2010
- Wong F et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome (CONFIRM). N Engl J Med 2021;384:818-28New England Journal of Medicine, 2021
- Vilstrup H et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by AASLD and EASL. Hepatology 2014;60:715-35American Association for the Study of Liver Diseases / European Association for the Study of the Liver, 2014
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback