title: Understanding the Complexities of Cirrhosis.
abstract: OBJECTIVE
  Cirrhosis and its related complications remain a prominent global health concern despite advances in understanding and treating the disorder. Early diagnosis and intervention strategies may reduce the impact of cirrhosis; however, it can be difficult for initial point-of-care health care providers to identify and refer patients with cirrhosis due to lack of knowledge and resources. This review examines current diagnostic strategies for cirrhosis and cirrhosis-related complications and the potential benefits of multidisciplinary care for patients with the disorder.
  
  
  METHODS
  A PubMed search of the medical literature was conducted to identify current diagnostic methods and standards and ascertain the impact of multidisciplinary care on patients with cirrhosis.
  
  
  RESULTS
  Screening of patients at risk for cirrhosis has been recommended by several professional and governmental organizations. Unfortunately, identification of early-stage cirrhosis remains challenging despite development of novel calculations for risk (eg, aspartate transaminase-to-platelet count ratio) that use values from common, noninvasive laboratory tests to determine the extent of liver disease. Abnormal liver function test results and alterations in serum liver enzyme markers (eg, alanine and aspartate transaminases) may suggest cirrhosis in patients with chronic liver disease; however, they are not definitive. Liver biopsy is the gold standard for diagnosis and staging of cirrhosis, but its cost, invasiveness, and risk of complications have prompted the development of noninvasive tests (eg, elastography). Primary care physicians should be aware of the signs and symptoms of cirrhosis-related complications, particularly portal hypertension, and refer patients to specialists for further evaluation when warranted.
  
  
  CONCLUSIONS
  Patients at risk for cirrhosis should be screened and the underlying etiologic factor(s) of the liver disease treated or appropriately managed when possible. Primary care physicians should be aware of the signs and symptoms of cirrhosis and its related complications and adopt a low threshold for referral to a specialist when the condition is suspected. An integrated, multidisciplinary approach to care between specialists and primary care physicians may improve early detection of cirrhosis and its related complications and strengthen management strategies.
authors.affiliation: Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina. Electronic address: andrew.muir@duke.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
mesh_terms: D019468:Disease Management; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D010348:Patient Care Team; D019095:Point-of-Care Systems; D012720:Severity of Illness Index
keywords: chronic liver disease; cirrhosis; fibrosis; portal hypertension; primary care