Patients with hepatic encephalopathy should have paracentesis performed during the hospitalization in which the encephalopathy is diagnosed. If ascitic fluid polymorphonuclear cell count is greater than 250 cells per mm 3, the patient should receive antibiotics within six hours if hospitalized and within 24 hours if ambulatory. Patients with new-onset ascites should receive diagnostic paracentesis consisting of cell count, total protein test, albumin level, and bacterial culture and sensitivity. Patients with cirrhosis should be screened for hepatocellular carcinoma every six to 12 months.Īscites should be treated with salt restriction and diuretics. Patients who have cirrhosis associated with a Model for End-stage Liver Disease score of 15 or greater or with complications of cirrhosis should be referred to a transplant center. Treating alcohol abuse, screening for viral hepatitis, and controlling risk factors for nonalcoholic fatty liver disease are mechanisms by which the primary care physician can reduce the incidence of cirrhosis.Īll patients should be screened for alcohol abuse.Īll pregnant women should be screened for hepatitis B virus. Physicians should also be vigilant for spontaneous bacterial peritonitis. Patients with acute episodes of gastrointestinal bleeding should be monitored in an intensive care unit, and should have endoscopy performed within 24 hours. Ascites should be treated initially with salt restriction and diuresis. These should be sought and managed before instituting the use of lactulose or rifaximin, which is aimed at reducing serum ammonia levels. Causes of hepatic encephalopathy include constipation, infection, gastrointestinal bleeding, certain medications, electrolyte imbalances, and noncompliance with medical therapy. Patients with cirrhosis should be screened for hepatocellular carcinoma with imaging studies every six to 12 months. Primary care physicians share responsibility with specialists in managing the most common complications of the disease, screening for hepatocellular carcinoma, and preparing patients for referral to a transplant center. Alcohol abuse and viral hepatitis are the most common causes of cirrhosis, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. It accounted for 29,165 deaths in 2007, with a mortality rate of 9.7 per 100,000 persons. Cirrhosis is the 12th leading cause of death in the United States.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |