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Cirrhosis and chronic liver failure: part II. Complications and treatment.

Abstract

Major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome. Diagnostic studies on ascitic fluid should include a differential leukocyte count, total protein level, a serum-ascites albumin gradient, and fluid cultures. Therapy consists of sodium restriction, diuretics, and complete abstention from alcohol. Patients with ascitic fluid polymorphonuclear leukocyte counts of 250 cells per mm3 or greater should receive empiric prophylaxis against spontaneous bacterial peritonitis with cefotaxime and albumin. Patients who survive an episode of spontaneous bacterial peritonitis should receive long-term prophylaxis with norfloxacin or trimethoprim/sulfamethoxazole. Patients with gastrointestinal hemorrhage and cirrhosis should receive norfloxacin or trimethoprim/sulfamethoxazole twice daily for seven days. Treatment of hepatic encephalopathy is directed toward improving mental status levels with lactulose; protein restriction is no longer recommended. Patients with cirrhosis and evidence of gastrointestinal bleeding should undergo upper endoscopy to evaluate for varices. Endoscopic banding is the standard treatment, but sclerotherapy with vasoconstrictors (e.g., octreotide) also may be used. Prophylaxis with propranolol is recommended in patients with cirrhosis once varices have been identified. Transjugular intrahepatic portosystemic shunt has been effective in reducing portal hypertension and improving symptoms of hepatorenal syndrome, and can reduce gastrointestinal bleeding in patients with refractory variceal hemorrhage. When medical therapy for treatment of cirrhosis has failed, liver transplantation should be considered. Survival rates in transplant recipients have improved as a result of advances in immunosuppression and proper risk stratification using the Model for End-Stage Liver Disease and Child-Turcotte-Pugh scoring systems.

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  • Authors+Show Affiliations

    ,

    Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA. jheidel@umich.edu

    Source

    American family physician 74:5 2006 Sep 01 pg 767-76

    MeSH

    Ascites
    Chronic Disease
    Diet, Sodium-Restricted
    Diuretics
    Hepatorenal Syndrome
    Humans
    Hypertension, Portal
    Liver Cirrhosis
    Liver Failure
    Liver Transplantation
    Prognosis

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16970020

    Citation

    Heidelbaugh, Joel J., and Maryann Sherbondy. "Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment." American Family Physician, vol. 74, no. 5, 2006, pp. 767-76.
    Heidelbaugh JJ, Sherbondy M. Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician. 2006;74(5):767-76.
    Heidelbaugh, J. J., & Sherbondy, M. (2006). Cirrhosis and chronic liver failure: part II. Complications and treatment. American Family Physician, 74(5), pp. 767-76.
    Heidelbaugh JJ, Sherbondy M. Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment. Am Fam Physician. 2006 Sep 1;74(5):767-76. PubMed PMID: 16970020.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cirrhosis and chronic liver failure: part II. Complications and treatment. AU - Heidelbaugh,Joel J, AU - Sherbondy,Maryann, PY - 2006/9/15/pubmed PY - 2006/10/13/medline PY - 2006/9/15/entrez SP - 767 EP - 76 JF - American family physician JO - Am Fam Physician VL - 74 IS - 5 N2 - Major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome. Diagnostic studies on ascitic fluid should include a differential leukocyte count, total protein level, a serum-ascites albumin gradient, and fluid cultures. Therapy consists of sodium restriction, diuretics, and complete abstention from alcohol. Patients with ascitic fluid polymorphonuclear leukocyte counts of 250 cells per mm3 or greater should receive empiric prophylaxis against spontaneous bacterial peritonitis with cefotaxime and albumin. Patients who survive an episode of spontaneous bacterial peritonitis should receive long-term prophylaxis with norfloxacin or trimethoprim/sulfamethoxazole. Patients with gastrointestinal hemorrhage and cirrhosis should receive norfloxacin or trimethoprim/sulfamethoxazole twice daily for seven days. Treatment of hepatic encephalopathy is directed toward improving mental status levels with lactulose; protein restriction is no longer recommended. Patients with cirrhosis and evidence of gastrointestinal bleeding should undergo upper endoscopy to evaluate for varices. Endoscopic banding is the standard treatment, but sclerotherapy with vasoconstrictors (e.g., octreotide) also may be used. Prophylaxis with propranolol is recommended in patients with cirrhosis once varices have been identified. Transjugular intrahepatic portosystemic shunt has been effective in reducing portal hypertension and improving symptoms of hepatorenal syndrome, and can reduce gastrointestinal bleeding in patients with refractory variceal hemorrhage. When medical therapy for treatment of cirrhosis has failed, liver transplantation should be considered. Survival rates in transplant recipients have improved as a result of advances in immunosuppression and proper risk stratification using the Model for End-Stage Liver Disease and Child-Turcotte-Pugh scoring systems. SN - 0002-838X UR - https://www.unboundmedicine.com/medline/citation/16970020/full_citation L2 - http://www.aafp.org/link_out?pmid=16970020 DB - PRIME DP - Unbound Medicine ER -