[Therapy of complications of hepatic cirrhosis].
Complications of liver cirrhosis are usually confined to advanced stages of the disease. Bleeding from esophageal or gastric varices may be prevented by treatment with beta-blockers or by endoscopic band ligation in case of large varices and intolerance for beta-blockers. Treatment of an acute bleeding episode from varices can efficiently be treated by endoscopic procedures, potentially in combination with drug therapy. In case of bleeding uncontrolled by endoscopy, TIPS is an effective alternative in selected patients. Treatment of ascites consists of reduction of sodium intake, aldosterone antagonists, and loop diuretics as needed. TIPS or repeated paracentesis may be necessary in refractory ascites. Spontanous bacterial peritonitis (SBP) must be sought and treated with antibiotics in conjunction with albumin administration in order to reduce mortality. Hepatorenal syndrome is characterized by a poor prognosis. Therefore, liver transplantation should be considered in appropriate patients.
Töx
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Schwerpunkt Gastroenterologie und Hepatologie, Universität zu Köln, Köln.
Goeser
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D000208:Acute Disease; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018849:Controlled Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011322:Primary Prevention; D012008:Recurrence
D000900:Anti-Bacterial Agents; D004232:Diuretics