title: The patient presenting with decompensated cirrhosis.
abstract: The rates of liver disease in the UK are rising and hence more patients than ever are presenting to acute medical units with potentially life threatening sequelae. Early recognition and treatment of sepsis, kidney injury, bleeding and alcoholic hepatitis can significantly improve outcomes, but requires a comprehensive approach to assessment. This patient cohort often suffers from a perceived uniform poor prognosis, especially in alcohol related disease, but evidence for this is changing and reassessment of prognosis after 48 hours of organ support may be more accurate than that made 'at the front door'. This article summarises the most important complications of decompensated cirrhosis, their early management, and presents a targeted system of care: 'RING Liver'--Renal failure, Infection, Nutrition, Gastrointestinal bleeding and transit, Liver dysfunction/transplantation. Factors favouring transfer to tertiary units are also explored.
authors.affiliation: Consultant Gastroenterologist and Hepatologist, Frimley Park Hospital NHS Foundation Trust.
authors.forename: P A
authors.initials: PA
authors.lastname: Berry
authors.forename: S J
authors.initials: SJ
authors.lastname: Thomson
mesh_terms: D000328:Adult; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006519:Hepatitis, Alcoholic / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology; D012720:Severity of Illness Index; D062606:Tertiary Care Centers