Management of liver cirrhosis between primary care and specialists

Table 4 Standard objectives for an efficient out clinic care of cirrhotic patients

1 Early diagnosis of chronic liver disease. Identification of etiology

2   Identification of patients with chronic liver disease at risk of cirrhosis

3 Evaluation of patient’s general health status

4 Act on etiologic factors and on factors favoring disease progression. Identify treatment end-points and place the patient within his family and social setting

5 Promote family and cohabitants’ participation to primary prevention for infective forms (health education), secondary prevention for inherited or metabolic disorders, support and surveillance for toxic forms (alcohol)

6 Suggest health-dietetic measures and therapeutic remedies

7 Check parameters of effectiveness and control side effects of specific treatments (antiviral, phlebotomy, immune-depressants, β-blockers, etc.)

8 Identify and treat associated conditions (diabetes, osteoporosis, malnutrition, etc.)

9 Avoid administration of hepatotoxic drugs, drugs promoting renal sodium retention and central nervous system depressants

10 Promote vaccination against flu and pneumonia, including transplanted patients, and against hepatitis A and B virus

11  Supervise for complications by promoting clinical, biochemical and instrumental follow-up

12  Assist specialists in identifying candidates for liver transplantation

13  Assist the patient requiring legal problems