Cirrhosis medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 8: Line 8:


===Pruritus===
===Pruritus===
[[Pruritus]] is a common symptom in chronic liver disease.  Endogenous opioids have been proposed as the culprits for causing pruritus. Less severe itching can be treated using [[antihistamines]] and ammonium lactate topical solution.  [[Cholestyramine]] is the drug of choice for treating pruritus of chronic liver disease.  Severe itching requires ultraviolet light therapy and or [[plasmapharesis]].
[[Pruritus]] is a common symptom in chronic liver disease.  Endogenous opioids have been proposed as the culprits for causing pruritus. Less severe itching can be treated using [[antihistamines]] and ammonium lactate topical solution.  [[Cholestyramine]] is the drug of choice for treating pruritus of chronic liver disease.  Severe itching requires ultraviolet light therapy and or [[plasmapheresis]].


==Treatment of Underlying Causes==
==Treatment of Underlying Causes==

Revision as of 16:33, 6 September 2012

Cirrhosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cirrhosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Cirrhosis medical therapy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cirrhosis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cirrhosis medical therapy

CDC on Cirrhosis medical therapy

Cirrhosis medical therapy in the news

Blogs on Cirrhosis medical therapy

Directions to Hospitals Treating Cirrhosis

Risk calculators and risk factors for Cirrhosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Medical Treatment

Treatment of cirrhosis is directed most of the times towards treatment of complications like ascites, Esophageal varices, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis. But some chronic constitutional symptoms, which include pruritus, hypogonadism, osteoporosis and anorexia should be treated as well.

Pruritus

Pruritus is a common symptom in chronic liver disease. Endogenous opioids have been proposed as the culprits for causing pruritus. Less severe itching can be treated using antihistamines and ammonium lactate topical solution. Cholestyramine is the drug of choice for treating pruritus of chronic liver disease. Severe itching requires ultraviolet light therapy and or plasmapheresis.

Treatment of Underlying Causes

Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with chelation therapy (e.g.penicillamine) to remove the copper.

Treatment of Complications

Ascites

Treatment of Ascites

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be necessary to suppress ascites.

Esophageal Variceal Bleeding

Esophageal Varices Treatment

For portal hypertension, propranolol is a commonly used agent to lower blood pressure over the portal system. In severe complications from portal hypertension, transjugular intrahepatic portosystemic shunting is occasionally indicated to relieve pressure on the portal vein. As this can worsen encephalopathy, it is reserved for those at low risk of encephalopathy, and is generally regarded only as a bridge to liver transplantation or as a palliative measure.

Hepatic Encephalopathy

Hepatic Encephalopathy Treatment

High-protein food increases the nitrogen balance, and would theoretically increase encephalopathy; in the past, this was therefore eliminated as much as possible from the diet. Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition.

Hepatorenal Syndrome

Hepatorenal Syndrome Treatment

The hepatorenal syndrome is defined as a urine sodium less than 10 mmol/L and a serum creatinine > 1.5 mg/dl (or 24 hourcreatinine clearance less than 40 ml/min) after a trial of volume expansion without diuretics.[1]

Spontaneous Bacterial Peritonitis

Spontaneous Bacterial Peritonitis Medical Therapy

Cirrhotic patients with ascites are at risk of spontaneous bacterial peritonitis.

References

  1. Ginés P, Arroyo V, Quintero E; et al. (1987). "Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study". Gastroenterology. 93 (2): 234–41. PMID 3297907.

Template:WH Template:WS