Cirrhosis have ascites
Father had liver cirrhosis have ascites, the doctor said that can be used are albumin from ascites to help, but we here do not beg my father to save everyone, to find ways and means to provide a useful point of information, what way to save my father? home really can not do without him, he is the backbone of our family, everyone beg my father to save it, and give us some food and beverage should be noted that information can also be, thank you everyone,
Answer:
(1) diet therapy: should be given high-protein, high-calorie, high vitamin diet mixed. 1g/kg daily protein weight, and fresh fruits and vegetables and so on. The general idea of food sources of heat supply, according to 20 percent protein, fat and 40% of the allocation of carbohydrates.
(2) cause of treatment: According to the special cause of cirrhosis of early treatment. Schistosomiasis patients with the disease at early adopters to a more thorough praziquantel insecticide treatment, can improve liver function, spleen shrinking. Animal experiments confirmed that by the quinoline pyrazole Early treatment can reverse one or suspension of Schistosoma infection caused by liver fibrosis. alcoholic liver disease and drug-induced liver disease, should be the suspension of drinking and drugs to disable poisoning.
(3) general drug therapy: According to the main necessary condition multivitamin supplement. In addition, drugs such as inosine Hugan cell activator, in the body improve the level of ATP, into a variety of nucleotides, involved in energy metabolism and protein synthesis. can be achieved using traditional Chinese medicine huoxuehuayu Liqi efficacy, such as salvia, astragalus, etc.. Most of the authors consider early cirrhosis patients, instead of blindly over-use will increase liver metabolism of drug load, at the same time have been unknown or known drug side effects may increase damage to the body, so patients with liver cirrhosis in the early blind long-term medication should not be excessive.
First, nutrition and care
During treatment for ascites, should not neglect the nutritional treatment of the original liver disease. The custody of ascites, Note: one to observe the mental state, tremor-like emergence of Flapping-Wing, etc.; 2 a day, weight measured; 3, Hutchison access capacity; 4 , regular checks of electrolyte, blood urea nitrogen and muscle liver; 5, repeated check the original liver disease.
Second, bed rest
Mainly of bed rest in the circumstances, appropriate activities based on the patient.
Three, restrictions limit of salt water
Sodium per day no more than 500mg (sodium chloride 3.75g), solid sodium chloride 1g sodium 0.4g. General recipes do not add saltѺsodium chloride 2-4g, so that the daily requirements of salt-free diet. Such as improved slightly relaxed, but still a day at 1.0-1.5g, some patients, cut-salt or salt restriction, the obvious impact of diet, but some patients, after less significant effect of salt diet, it is necessary to relax the limit of salt standards, must not significantly affect the diet.
In general, the total amount of water confined to 1000-1500ml, such as serum sodium less than 130mmol / L, we should strictly limit the intake of water daily within 1000ml. At substantial diuresis with diuretics, the need to control the water intake to avoid hyponatremia blood disease, liver cirrhosis which is one of the hallmarks of poor prognosis, while the main treatment for severe restrictions on water intake.
Have ascites or ascites at the tendency of patients with liver cirrhosis, if the intravenous fluids can be trickle-down to happen or aggravating ascites, when the cessation of infusion or when serving diuretics, such as ascites can rapidly reduce or disappear, call this transfusion syndrome ascites. Thus liver sclerosis patients with ascites, so as not to transfusion, to the volume of infusion is also better.
Four, diuretics
1, attach importance to whether or not accompanied by edema edema with ascites may prompt substantial diuretic, there are no side effects. Solid at the same time have some edema fluid was discharged. But once the edema disappeared or only ascites without edema, the use of diuretics should be slow, anti - hypovolemia, electrolyte disorders and azotemia. weight to lower the standard as follows: Have the surrounding edema, daily 1kg better, no peripheral edema, 0.5kg better daily.
2, drug selection
, antisterone: for preferred drugs, and aldosterone receptor competition, the maximum amount per day 400-600mg, Dayton served. But a gradual increase in volume, due to 2-4 days before onset. Male breast development or after the medication hasresponders. can be easy for Triamterene acridine chatter. The security of potassium diuretic drugs. , furosemide: Diuretic speed, strength, and for the scheduling of potassium diuretics, the most substantial for the daily 240mg, advocates Dayton morning service good. Tong'an Spironolactone with the use ratio of antisterone: Furosemide = 100mg: 40mg. Two-grams: Two grams of potassium for scheduling diuretics, furosemide usage of the same. the most substantial daily up to 200mg.
Drug of choice for more than antisterone, if not ideal diuretic, be the first with furosemide, but the medication after a longer time, exchangeable, and to restore the body's sensitivity.
3, medication methods: , for initial ascites, and ascites is not long, never used the early use of diuretics or diuretics patients. Patients with hospital bed rest, cut salt, limit intake of less than 1000ml, consecutive day 5. produce the best such as spontaneous diuresis. such as no significant effect, can be used diuretics. speed and usage with diuretics: to cirrhotic ascites and the surrounding edema of diuretic treatment in two stages: the first phase of edema with rapid diuresis period method; the second phase of the basic regression for the edema, the use of slow diuretic law, to clear the remaining ascites. The specific method is: 80-200mg of oral furosemide and spironolactone 100-400mg, per day will enable the discharge of urine weight loss for more than 1kg to surrounding edema disappeared, plasma concentrations of a slight increase of liver muscle, the immediate entry into the slow stages of treatment. basis of drug response in patients with a reduction in dose, the maintenance of body weight per day to reduce the 0.4-0.5kg. such as ascites without peripheral edema, direct the use of slow diuretic law.
, often caused by complications of electrolyte imbalance and lead to hepatic encephalopathy or hepatorenal syndrome, but these complications occur in many peripheral edema and continued use after the diuretic drug. In particular, hyponatremia, and low chlorine and high Hyperlipemia potassium occurred in edema disappeared. so that the edema disappeared, diuretic must be slow, and to cure, do not blindly diuretic. , diuretics invalid indications, the application of strict sodium water control, and after full use of diuretics After a certain period of time had no significant effect, known as refractory ascites. At this point the use of diuretics can not be indefinite, can not be increased ad infinitum. if hyponatremia or hepatorenal syndrome, the use of diuretics but harmful. A hospitalized for more than six weeks, after a strict medical treatment, though less edema, but there are still obvious ascites; B appears renal insufficiency, plasma muscle liver than 2.4mg%, blood urea nitrogen greater than 40mmol / L. For these people immediately disable diuretics, ascites change emissions, concentrated ascites reinfusion.
Four, emissions laws and ascites ascites ascites enrichment
Belong to second-line therapy, the treatment of diuretics in patients with poor, one-time amount of questions, based on physical condition of patients with fixed, such as good physical condition can be ranked one-time End ascites, hepatic encephalopathy, if inclined, in particular, are not accompanied by peripheral edema, the emissions can not be too much, 3000ml around. However, after discharge, we must lose the light of the economic expansion in albumin, albumin per 1000ml input 6-10g, enough to require continuous transmission, not intermittent. such as differences between the economic conditions of low input right. to prevent the cycle dysfunction. because colloidal synthesis in vivo half-life of less than 24 hours. The half-life of albumin in 21 days, so the effect of albumin, and emissions need to diuretics after ascites in order to maintain. ascites concentrate transfusion be able to retain part of albumin and electrolytes, after transfusion also need to lose albumin, but the amount could be less. back to lose as much as possible the use of heparin to prevent intra-abdominal bleeding. I have seen two cases. above a certain aseptic operation. on legs not swollen, but the large amount of ascites, the first choice of this Act can not be substantial diuretic.
Friday, albumin has the application of hypoalbuminemia in patients with ascites, in theory, supplemented albumin are logical, application sick feel comfortable after albumin, increased appetite, increased urine volume, reduced ascites. But far look no significant period effect of the advantages of albumin can not be said that the importation of so much more expensive addition.
VI ascites diagnosis and differential diagnosis
Atypical cirrhosis ascites are cirrhosis themselves have to determine the performance of, or complications appear, and with cancer, tuberculosis, portal vein thrombosis, pancreatic, cardiac, the inferior vena cava obstruction syndrome Butchart, veno-occlusive liver, nephrotic syndrome, such as identification, to exclude hemorrhagic ascites tumor, but it must be able to find a placeholder.
Because of SBP (spontaneous bacterial peritonitis), onset of occult, non-specific symptoms, clinical manifestations alone difficult to diagnose, with the following conditions should take into account the existence of SBP. clinical varying degrees of abdominal pain, diarrhea, fever and abdominal tenderness and anti - Jump pain; no other reasons for azotemia interpretable; peripheral blood leukocytes or neutrophils increased and could be excluded from other parts of the infection; ascites leukocyte count greater than 0.02 109 / L, because of massive ascites so that inflammatory cells diluted, and the cell count is often less than the diagnostic criteria. refractory ascites, ascites long time.
In addition, the coexistence of tuberculous effusion, peritonitis is not uncommon, we must attach great importance to common in young adults, the majority at 40 years of age, women slightly more than men, primary TB lesions are found and low-grade fever, night sweats, weight loss, anemia , atypical abdominal pain. stimulate peritoneal disease was not obvious, abdominal pain and light without the anti-ʹascites fewer abdominal wall flexibility can be a sense of touch or mass. positive tuberculin test. effective anti-tuberculosis treatment.
Treatment: cefotaxime sodium 4.0g, re-import to use Rocephin daily 4.0g, course of 7-14 days, seriously extended. For those who suspected the use of ofloxacin, the disease can be severe with metronidazole can also be intra-abdominal lavage with normal saline and injected antibiotics, are firmly opposed to patients with ascites
With cefotaxime sodium with ofloxacin, initial ascites, or ascites were not serious do not need to use, some patients can Oxyfluoride alone. Solid liver stearyl SBP Statistics happened about 50%. So approximately half of patients with hepatic ascites required with antibiotics, half do not need to use. Let's application of the ratio too much.
Seven, the application of vasoactive drugs
The most common drug for the 654-2, dopamine, phentolamine, can be the expansion of renal vessels and the intrahepatic vascular bed can be 10% glucose 250ml + Dopamine 40mg + phentolamine 20mg, per minute, 20-30 drops once a day. According to the performance and adjust blood pressureper day with 50% glucose 20ml urine 40mg intravenous accelerated, 7 Tianyi treatment. hyperthyroidism on the heart and used with caution. can also be used with low right-300ml plus 654 — 2 20-40mg, according to 20 drops / min, 1 time per day, intravenous drip after furosemide 40-80mg ,7-10 Tianyi treatment. In addition 654-2 plus a low right to accelerate the increase in urinary dopamine or dopamine plus phentolaminelower than the right to accelerate the urine alone effect. I support the idea of using low-right plus 654-2, solid low-right can be expansion.
Eight, mannitol Application
Refractory ascites due to One of the reasons for the effective reduction in blood volume that can be used to accelerate the 20% mannitol 250ml urine 80mg intravenous drip, once a day or 12 changes depending on the circumstances. In particular, hyponatremia better. Solid drainage than with mannitol Pai Na, and scalability.
9, stomach Ling Tongafill up the application of Decoction
Of cirrhosis, ascites, upper gastrointestinal bleeding, it is necessary to use conventional and effective. Depending on the situation can be daily, every other day with. Can play a diuretic, to stop bleeding, prevent hemorrhage, the role of softening of the liver and spleen.
Ten, the application of amino acids
Ascites due to cirrhosis of the people, infusion volume should not too large, simply by eating a normal liver liquid 200ml can, do not need to use amino acids, such as poor diet can lose more pronounced with the liver-an amino acid, do not compound amino acid, due to too much liquid , affecting the unstable environment, and may increase the ascites.
Eleven, electrolyte balance
Ascites due to cirrhosis of the people most of potassium deficiency, so each step must add enough liquid in sufficient quantity of potassium, not a single test does not look no potassium supplement potassium deficiency is wrong. Unless there is renal insufficiency, potassium concentration of 0.03% , potassium deficiency and magnesium deficiency synchronization, as far as possible, using potassium-magnesium liquid, in accordance with the test results, the timely meeting of Calcium Gluconate, hyponatremia in refractory ascites in common, many are limited to open-water caused by salt, it is necessary to limit attention water, and continue to check electrolytes, but also has low chlorine levels, hyponatremia with normal saline fill, low-chlorine can be added potassium chloride, calcium chloride.
Twelve, cirrhosis complications
Complicated by jaundice, do not have to use Yin Chi Huang, Qingkailing one category, solid increase in the amount of fluid ascites can only rule should be aware of the merger were refractory jaundice, such as the liver compound Yiganling more unnecessary drugs.
Complicated by hepatic encephalopathy, and in accordance with the treatment of hepatic encephalopathy, but attention should be paid to prevention, such as diuretic too fast, take too much ascites, water electrolyte imbalance.
Complicated with upper gastrointestinal bleeding, and expansion has evoked the possibility of treatment, but refractory ascites many lower blood volume, do not have too many concerns.
