Cirrhosis medical therapy: Difference between revisions
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===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 [[ | [[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
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Cirrhosis Microchapters |
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Cirrhosis medical therapy On the Web |
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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
Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be necessary to suppress ascites.
Esophageal Variceal Bleeding
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
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
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
Cirrhotic patients with ascites are at risk of spontaneous bacterial peritonitis.