Patients with cirrhosis should have a high carbohydrate diet with low fat, as malnutrition is a serious clinical problem they can face. Patients should have a low sodium diet to decrease edema and ascites, and should take B complex vitamins and abstain from alcohol.
Paracentesis, which is a needle puncture into the peritoneum, is used as a diagnostic and therapeutic intervention. It helps remove the ascitic fluid, but this fluid can also be tested for infection.
There is no specific drug therapy for cirrhosis, but there are several medications used to treat the various complications of disease. Bleeding varices can be controlled by vasopressin and octreotide, and beta blockers are used to reduce portal venous pressure.
Endoscopic band ligation (endoscopic variceal ligation also called banding) or sclerotherapy may be used to reduce bleeding of varices in patients with cirrhosis. Ligation is done by placing an o-ring around the base of the enlarged vein, and sclerotherapy involves injecting a sclerosing agent into the varix (base of enlarged vein).
Balloon tamponade mechanically compresses the varices, controlling hemorrhage. This procedure involves two balloons with three lumens, one for the gastric balloon, one for the esophageal and one for gastric aspiration (Sengstaken-Blakemore tube). It is an important safety precaution to label the lumens to avoid confusion during the procedure.
TIPS, or transjugular intrahepatic portosystemic shunt is a nonsurgical procedure that creates a shunt. This shunt connects systemic and portal venous systems, which redirects portal blood flow to reduce venous pressure. This is done by puncturing the wall of the hepatic vein and using a catheter to connect it to the portal vein. This is contraindicated in those with severe hepatic encephalopathy.
Lactulose is used to eliminate ammonia in the blood stream. It does so by acidifying the feces in the bowel, trapping ammonia, allowing it to be eliminated during defecation.
Antibiotics like rifaximin (Xifaxan) work to decrease bacterial flora, which normally would form ammonia in the gut. Removing these bacteria decreases ammonia formation.
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