A fictional 59-year-old with cirrhosis presents with increasing ascites, jaundice, confusion and reduced urine output.
Frame the danger first.
- Acute decompensation may present with ascites, encephalopathy, bleeding, infection, jaundice or renal dysfunction.
- Search actively for infection, bleeding, alcohol-related problems, constipation, medicines and portal-vein thrombosis.
- Assess trajectory and organ failures because apparently modest observations may precede rapid deterioration.
Act, escalate, reassess.
- Escalate early and use the current BSG/BASL and local decompensated-cirrhosis care bundle.
- Begin ABCDE assessment and send a structured initial investigation set, including cultures when infection is suspected.
- Perform timely diagnostic ascitic sampling when ascites is present unless a clinical contraindication exists.
- Address bleeding, infection, encephalopathy, acute kidney injury and alcohol withdrawal using local protocols and specialist input.
Red flags that change pace.
- Shock, active gastrointestinal bleeding or worsening encephalopathy
- Acute kidney injury, severe hyponatraemia or respiratory compromise
- Suspected spontaneous bacterial peritonitis or evolving multiorgan failure
What makes care less safe.
- Attributing confusion to hepatic encephalopathy without checking other causes
- Missing infection because fever or leukocytosis is absent
- Delaying ascitic sampling or specialist escalation
Say the concern plainly.
Acute decompensated cirrhosis with [presenting complications], organ dysfunction [summary] and suspected precipitant [summary]. Care-bundle actions and ascitic/culture status are [list]. I need urgent hepatology and senior review.