Cirrhosis is the irreversible fibrosis of the liver, the end stage

 of a final shared pathway in chronic damage to a major vital organ. It is

the 8th leading cause of death in the United States and the 13th leading

cause of death globally, with worldwide mortality having increased by 45.6% from

1990 to 2013.1  The pathophysiological features of cirrhosis involve progressive

liver injury and fibrosis resulting in portal hypertension and decompensation, including

ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal

hemorrhage, the hepatorenal syndrome, and hepatocellular carcinoma. This article

reviews the practical treatment of patients with cirrhosis, with a focus on recent

developments. Our recommendations are based on results from clinical trials,

when available, and on current clinical practice when controlled trials have not

been conducted.