In part 2 of our coagulopathy series, we take a deeper dive and learn the ways in which end-stage liver disease alters the body’s normal hemostatic mechanisms.

Patients with end-stage liver disease have elevated INRs. They bleed frequently and they clot perhaps more frequently. Do they need FFP before a paracentesis? What’s a TEG? These questions answered, and more, in our multi-part series on the coagulopathy of liver disease!

In Part 1 of this series, we reviewed what came BEFORE the MELD score—Child-Turcotte-Pugh classification. We additionally discussed the history behind MELD, what is included in its calculation and why, and how it is used in transplant listing. Is everyone excited for Part 2?

The Model for End-stage Liver Disease (or MELD) score is used to determine patient priority for liver transplantation. But have you ever wondered why? Let us review the history and the literature to better understand why this score is so meaningful!

Ursodeoxycholic acid (or UDCA, Ursodiol) is a very commonly-used medication in the hepatologist’s arsenal. But have you ever wondered what it is? Why does it work? I know I have.

Let’s try and answer some of those questions for you today!

Why, after an episode of prolonged biliary obstruction, or after severe forms of acute liver injury, does the alkaline phosphatase (ALP) rise in a delayed fashion? And why do the ALP and total bilirubin often take a while to normalize? We’ve all heard (or said) this before. Today, let’s get to the bottom of why this happens!

This one is easy peasy. Liver disease impairs albumin, so let’s give albumin replacement, right? Not so fast. There is A LOT more to albumin than meets the eye. Let’s dive in.

How many times have you prescribed diuretic therapy for a cirrhotic patient with ascites? It’s muscle memory at this point: furosemide 40mg, spironolactone 100mg. Done.…