🚨LIVER-WATCH — Decompensation Events to Recognize
Compensated cirrhosis is often silent. Decompensation is when a complication first appears — and is a turning point. The patterns below are the four classic events: variceal bleeding, ascites, hepatic encephalopathy (HE), jaundice. Plus SBP infection. Severe symptoms = 911. Family often sees HE before the patient does.
🎯Three Phases · One Force Field
Every square belongs to one of three phases of mastery. Inside each square's detail panel, the four sections — Concepts · Skills · Actions · Plan — are the building blocks of these phases.
📘 Learn It Tier 1 · Aware
Identity earned: Self-Advocate. The "know" — what cirrhosis is (compensated vs decompensated), the four causes (MASH leading, alcohol, viral B/C, autoimmune/other), MELD-Na, transplant pathway, vaccination and HCC screening.
🛠 Live It Tier 2 · Active
Identity earned: Care-Team Member. The "do" — daily skills (alcohol cessation if alcohol-related, weight management for MASH, daily weight + abdominal girth, NSAID-absolute / acetaminophen-limited rules, vaccination, food safety, recognizing early HE) and this-week actions that turn skills into habits.
📣 Share It Tier 3 · Certified
Identity earned: Ambassador. The "carry forward" — handle stigma honestly (alcoholic vs MASH cirrhosis), mentor a newly-diagnosed person via American Liver Foundation, navigate the HE-driving cessation conversation, advocate for hep B vaccination and hep C screening.
🛡️Your Force Field — 16 Squares
Click any square to open its detail panel. Each square is a tile in your shield. Keep clicking, learning, and acting — your Force Field gets stronger every step.
What Is Cirrhosis?
End-stage scarring of the liver from chronic injury. Healthy liver tissue is replaced by fibrous scar that disrupts blood flow and function. Compensated: often silent, normal life. Decompensated: complications appear — varices, ascites, HE, jaundice. The transition matters.
Primer360 Human Anatomy
Liver & Portal System
The liver sits in the right upper abdomen. It detoxifies blood, makes proteins (albumin, clotting factors), produces bile, processes nutrients. Cirrhosis disrupts blood flow → portal hypertension → varices, ascites, splenomegaly, encephalopathy. Synthetic failure → low albumin, high INR, jaundice.
AnatomyWho Gets It? — Causes
MASH/NAFLD (T2D + obesity-driven) is now the leading cause in the U.S., overtaking alcohol and viral hepatitis. Other causes: alcohol-associated, Hepatitis C (now curable!), Hepatitis B, autoimmune hepatitis, hemochromatosis, primary biliary cholangitis, others. The cause shapes treatment.
PrimerThe Numbers — MELD-Na
~600,000 U.S. adults with cirrhosis; ~12,000 deaths/year. Compensated: 5-year survival ~85%. Decompensated: 5-year survival drops to ~35%. MELD-Na score (bilirubin, INR, creatinine, sodium) determines transplant priority — higher = sicker = higher on the list. ~9,000 liver transplants/year in the U.S. Hep C is now curable with 8–12 weeks of pills.
PrimerRecognize Decompensation
The four classic events: variceal bleeding (vomiting blood, dark/black stools — 911), ascites (abdominal swelling, rapid weight gain), hepatic encephalopathy (confusion, sleep changes — family sees first), jaundice (yellow skin/eyes, dark urine, pale stools). Plus SBP infection (fever + abdominal pain in someone with ascites = ED).
Learn ItHCC Screening + Variceal Screening
Hepatocellular carcinoma (HCC) risk is constant in cirrhosis (~2–4%/year). Ultrasound every 6 months ± AFP is the standard. Variceal screening: upper endoscopy at diagnosis; repeat every 1–3 years depending on findings; band ligation or beta blockers for prevention. Bone density: cirrhosis raises fracture risk. Vaccinations: Hep A, Hep B, flu, pneumococcal, COVID — essential.
Learn ItKnow My Numbers
MELD-Na (bilirubin + INR + creatinine + sodium — transplant priority) · Child-Pugh score (A/B/C, classic prognosis) · AFP (HCC marker, with ultrasound q6mo) · platelet count (low = portal hypertension) · albumin, INR, bilirubin (synthetic function) · cause-specific markers (Hep B viral load, Hep C cured?, ferritin/iron studies, autoimmune antibodies). Bring them to every visit.
Learn ItLifestyle Force Field
Alcohol cessation: immediate, lifelong, non-negotiable (regardless of cause — alcohol harms even MASH liver). Weight loss 5–10% for MASH is meaningful. Vaccinations (Hep A, Hep B, flu, pneumo, COVID). Avoid raw shellfish (Vibrio risk). NSAIDs absolute NO (variceal bleeding risk). Acetaminophen ≤2 g/day (less if active drinker). Modest sodium <2 g/day if ascites. Exercise as tolerated.
Learn ItMedications — Cause-Specific + Symptom Management
Hep C: now curable with 8–12 weeks of direct-acting antivirals (DAAs — sofosbuvir/velpatasvir, glecaprevir/pibrentasvir). Hep B: long-term antivirals (entecavir, tenofovir). NSBBs (propranolol, carvedilol, nadolol) for variceal prophylaxis. Lactulose ± rifaximin for HE. Spironolactone + furosemide for ascites. GLP-1s emerging for MASH. Statins are usually safe and beneficial in cirrhosis.
Live ItCare Team Members
Hepatology (lead) · GI · PCP · RN care manager · hepatology dietitian (essential — adequate protein matters; avoid extreme low-protein) · pharmacist (hepatic dose adjustments) · social work (transplant evaluation prep) · addiction medicine if alcohol-related · behavioral health · American Liver Foundation peer support · transplant team (refer by MELD ~15 or first decompensation).
Live ItTelemedicine & Tech
Digital scale + tape measure for daily weight + abdominal girth (ascites tracking) · BP-tracking app · MyChart for labs and refills · American Liver Foundation resources + helpline · FibroScan (vibration-controlled transient elastography) for non-invasive fibrosis monitoring · video visits with hepatology and dietitian · medication reminder apps for the multi-pill regimen including DAAs (Hep C cure) and NSBBs.
TechInsurance, Treatment Cost & Help
Hep C DAAs cost ~$30K but copay programs (Gilead, AbbVie) cover most insured patients; many state Medicaid programs now cover universally. American Liver Foundation patient-assistance, NeedyMeds, Patient Advocate Foundation. Medicare covers transplant; Medicaid rules vary. FMLA covers transplant recovery; ADA covers schedule accommodations. Hospital social workers + hepatology navigators are free.
Live ItEquity, Stigma & the MASH-vs-Alcoholic Story
Cirrhosis carries deep stigma — both kinds. Alcohol-associated cirrhosis faces moral judgment that delays care. MASH cirrhosis faces "you should have lost weight" judgment. Both deserve compassion, both are treatable. Transplant access disparity exists for AA / Hispanic patients. Alcohol-cessation access varies. Hep C screening rates lag in underserved communities. Honest framing: cause matters for treatment, not for worth.
Share ItTalk to Kids, Partner, Employer
Kids: plain language + age-appropriate honesty about the cause and the plan. Partner: alcohol-cessation support is a team sport; HE recognition is a partner skill (loved one sees confusion before patient does — anosognosia is real). Employer: ADA covers cirrhosis; HE flares may require driving cessation conversations; transplant recovery is 6–12 weeks. Hep B / Hep C disclosure is personal — usually not required.
Share ItMentor & Share Insights
American Liver Foundation peer mentor program. Transplant centers run living-donor and recipient mentor pairs. The newly-diagnosed person who hears "I'm 4 years post-transplant, I work, I travel, here's what I wish I'd known" gets a different orientation than one who only hears about decompensation. Honest framing about the cause + the cessation work + the transplant arc — pep talk doesn't help.
Share ItJoin the ROI Study (PHIT)
PHIT — Population Health Impact Tracking. Aggregate & anonymous. Help prove this program improves outcomes — earlier alcohol cessation, more Hep C cures, more pre-emptive transplant evaluations, fewer first-decompensation crises — for cirrhosis populations.
Study🩺 Hand-off to my Cirrhosis Team
Print and bring to your next visit. This page tells your team what you have prepared for, what you want to focus on, and how you would like to participate as an active member of your own care team.
- I am a Prepared Patient in training for cirrhosis. I have reviewed all 16 squares of this Force Field Fact Sheet.
- I have started building my Health Passport, my daily weight and abdominal girth log, my MELD-Na trend tracker, and my medication + alcohol-cessation + NSAID-absolute / acetaminophen-limited list to bring to every visit.
- I want to teach back what I have learned and have you correct anything I have misunderstood — especially around my cause (MASH / alcohol / viral / autoimmune), my MELD-Na, HCC screening schedule, variceal status, decompensation events to recognize, transplant evaluation timing, and when to call the team versus the ED.
What helps my visit
Two minutes for me to teach back. One question I prepared. My daily weight + abdominal girth log. My med list with NO NSAIDs and acetaminophen ≤2g/day noted. Confirm latest MELD-Na, AFP, ultrasound q6mo, vaccination status, transplant referral status on the chart.
What I am working on
Alcohol cessation (if relevant) · weight loss for MASH · vaccinations complete · NSAID-absolute / acetaminophen-limited · daily weight + ascites tracking · early HE recognition · HCC ultrasound q6mo · transplant evaluation prep · family HE-recognition training.
How I want to participate
Shared decisions. Be honest about MELD-Na and prognosis. Tell me your top 1–2 priorities so we agree. Use AHRQ SHARE Approach. Refer to transplant evaluation early (by MELD ~15 or first decompensation). Hepatology dietitian referral on day one. Addiction medicine if alcohol-related.
🔬 Help Prove This Works — Join the FFH ROI & PHIT Study
The Prepared Patient program is being studied to see whether better preparation actually improves outcomes — earlier alcohol cessation, more Hep C cures, more pre-emptive transplant evaluations, fewer first-decompensation crises, better HE-recognition, complete vaccination — for cirrhosis patients and families. Your participation is voluntary, your data is aggregated and anonymized, and you can withdraw at any time.
➕ Add-On Force Field Card · Device or Skill Mastery
If your care plan adds a medical device or new skill, bolt on a 5-step Add-On Card. For cirrhosis common bolt-ons include: daily weight + abdominal girth tracking, alcohol-cessation plan with addiction medicine, vaccination completion (Hep A, Hep B, flu, pneumo, COVID), HCC ultrasound q6mo + AFP routine, variceal screening + NSBB schedule, lactulose + rifaximin routine for HE, paracentesis preparation if recurrent ascites, FibroScan monitoring, Hep C DAA treatment course, transplant evaluation pathway, family HE-recognition drill.
Introduce
What it is, why it matters, what it does
Coach
Watch a demo + walk-through
Practice
Do it with a coach watching
Train
Use it daily with a check-in
Test
Demonstrate competence + earn badge
Ready to go deeper?
The Prepared Patient · Cirrhosis course turns this fact sheet into a guided journey: pre/post knowledge checks, cause-specific literacy (MASH, alcohol, viral, autoimmune), MELD-Na understanding, decompensation recognition, alcohol cessation, vaccination + food safety, NSAID-absolute / acetaminophen-limited rules, HCC screening, transplant evaluation pathway, family HE-recognition role, and your printable Health Passport. Earn Aware → Active → Certified.