VIBES Mnemonic - Cirrhosis Management Checklist



V - Volume (Ascites, HRS)

	- Evaluate for Ascites, Edema, Hydrothorax, Hepatorenal Syndrome

	- Tx: Na restriction, lasix + spironolactone (2:5 ratio), paracentesis / TIPS

 I - Infection (SBP)

	- Ascites PMN count > 250

	- Tx: Ceftriaxone, Ppx: bactrim or FQ

B - Bleeding (Variceal)

	- Ddx: Gastric + esophageal gastric varices, portal hypertensive gastropathy, coagulopathy. 

	- Tx: PPI, octreotide, EGD -> variceal ligation. 

	- Ppx (non-bleeding varices): Non-selective beta-blockers 

E - Hepatic Encephalopathy 

	- Lactulose + Rifaximin. Do not restrict protein.

S - Screening (HCC and Transplant)

	- RUQUS + AFP (q6m), EGD, Transplant Eval, Vaccines (HAV, HBV, PNA)



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