Cirrhosis, treatment

Lifestyle modifications can limit disease complications and slow further liver damage. Avoidance of additional hepatic insult is critical for successful cirrhosis treatment. The only proven treatment for alcoholic liver disease is the immediate cessation of alcohol consumption. Patients who have cirrhosis from etiologies other than alcoholic liver disease should also abstain from alcohol consumption to prevent further liver damage. 

Arroyo, V., Navasa, M., Rimola, A. Spontaneous bacterial peritonitis in liver cirrhosis. Treatment and prophylaxis. Infection 1994 22 (Suppl. 31) 167-175... 

Vuoristo, M., Farkklla, M., Karronen, A.-L., Leino, R., Lehtola, J., Maklnen, J., Mattila, J., Friman, C., Seppala, K., Tnomlnen, J., Mietti-nen, T-A. A placebo-controlled trial of primary biliary cirrhosis treatment with colchicine and ursodeoxychoUc acid. Gastroenterology 1995 108 1470-1478... 

Renou C, Harafa A, BouabdaUah R, Demattei C, Cummins C, Rifflet H, Muller P, VUle E, Bertrand J, Benderitter T, HaHon P. Severe neutropenia and posthepatitis C cirrhosis treatment is interferon dose adaptation at once necessary Am J Gastroenterol 2002 97(5) 1260-3. 

Calcium-channel blockers for the treatment of hypertension Calcium products Cephalosporins Cerebroactive medications Chlamydial infections treatment of Cholinergic drugs uses in medicine Cholinergic-receptor-blocking agents uses of Cirrhosis treatment of Congestive heart failure treatment of Constipation drug-induced Corticosteroids uses for Crohn s disease treatment of Cytokines their actions... 

Normally, most iron is stored as ferritin but with increasing iron overload hemosiderin increases. Hemosiderin is found in the parenchymal cells of the liver and this may result in hemosiderosis and even cirrhosis. Treatment is with the iron chelator desferrioxamine and small amounts of ascorbic acid. The effect of ascorbic acid upon iron transport has been reported for dietary iron overload and P-thalassemia. As a result of ascorbic acid administration, serum iron rapidly rises and its careful use in conjunction with the iron chelator desferrioxamine increases urinary iron excretion (O Brien, 1974 Nienuis et ai, 1976 Nienhuis, 1981 Murray, 1982). 

Child-Pugh class A or B cirrhosis Treatment refractory ascites... 

Inositols, ie, hexaliydrobenzenehexols, are sugars that have received increasing study and are useful in the treatment of a wide variety of human disorders, including vascular disease, cancer, cirrhosis of the Hver, frostbite, and muscular dystrophy (269). Myoinositol esters prepared by reaction with lower fatty acid anhydrides are useful as Hver medicines and nonionic surfactants the aluminum and ammonium salts of inositol hexasulfate are useful anticancer agents (270). Tetraarjloxybenzoquinones are intermediates in the preparation of dioxazine dyes (266,271). The synthesis of hexakis(aryloxy)benzenes has also beenpubUshed (272). 

Chinese Liver Fluke. The adult worm of the Chinese Hver fluke Clonorchis sinensis) can grow to be 2 cm long. Worms infect the bihary tree where they cause local inflammation, diarrhea, and hepatomegaly in the acute infection. Progressive biUary obstmction and cirrhosis can occur in the more advanced disease state. The presence of 20—200 worms is common, but they may number over 20,000. Infection is the consequence of eating raw fish that contain viable parasites. Untreated worms can Hve for up to 30 years. Treatment is with pra2iquantil (1). 

Diuretics are one of the dmg categories most frequendy prescribed. The principal uses of diuretics are for the treatment of hypertension, congestive heart failure, and mobilization of edema fluid in renal failure, fiver cirrhosis, and ascites. Other applications include the treatment of glaucoma and hypercalcemia, as well as the alkafinization of urine to prevent cystine and uric acid kidney stones. 

Ascites. Patients with cirrhosis, especially fiver cirrhosis, very often develop ascites, ie, accumulation of fluid in the peritoneal cavity. This is the final event resulting from the hemodynamic disturbances in the systemic and splanchnic circulations that lead to sodium and water retention. When therapy with a low sodium diet fails, the dmg of choice for the treatment of ascites is furosemide, a high ceiling (loop) diuretic, or spironolactone, an aldosterone receptor antagonist/potassium-sparing diuretic. 

Multidimensional LC has also been used to determine ursodeoxycholic acid and its conjugates in serum (14). These compounds are used in the treatment of cholesterol gallstones, hepatitis and bilary cirrhosis. These authors employed a traditional (10 X 4 mm) pre-column and a micro-bore (35 X 2 mm) analytical column that were interfaced by using a six-port switching valve. 

Loop diuretics are the drugs of choice for the treatment of edematous patients with congestive heart failure, cirrhosis of the liver, and nephrotic syndrome. Excretion of Na is helpful only to the extent that some of the... 

The use of V2 antagonists is promising in the treatment of the hyponatremia that usually accompanies congestive heart failure and cirrhosis, two edematous conditions in which the use of diuretics is indicated. In addition, V2 antagonists may be beneficial in the treatment of polycystic kidney disease. 

HBV infection remains a major worldwide public health problem. The World Health Organization estimates that there are still 350 million chronic carriers of the vims, who are at risk of developing chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The success of IFN-a treatment - mainly performed as combined treatment with adenine-arabinoside - has been measured by the normalization of liver enzymes, loss of HBe antigen and of detectable viral DNA in the serum of patients. It has been estimated from several clinical trials that as many as 40% of treated HBV patients would respond to therapy with IFN-a or combined treatment with nucleoside analogues and IFN-a. 

Similar to HBV, infections with hepatitis C virus (HCV) have a high rate of progression from an acute to a chronic state that frequently leads to cirrhosis or hepatocellular carcinoma [2]. Monotherapy for HCV infection with IFN-a or combined therapy with ribavirin and IFN-a is associated with initial rates of response as high as 40%. The rates of sustained responses are, however, lower and also depend on the viral genotype. In patients infected with HCV genotype 2 or 3, the response was maximal after 24 weeks of treatment, whereas patients infected with genotype 1 -the most frequent in the USA and Europe - required a minimum treatment course of 48 weeks for an optimal outcome. 

Loop diuretics are used in the treatment of edema associated with CHF, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. These drug s are particularly useful when a greater diuretic effect is desired. Furosemide is the drug of choice when a rapid diuresis is needed or if the patient has renal insufficiency. Furosemide and torsemide are also used to treat hypertension. Ethacrynic acid is also used for the short-term management of ascites caused by a malignancy, idiopathic edema, or lymphedema. 

Amiloride (Midamor) is used in the treatment of CHF and hypertension and is often used with a thiazide diuretic. Spironolactone and triamterene are also used in tiie treatment of hypertension and edema caused by CHF, cirrhosis, and the nephrotic syndrome Amiloride, spironolactone, and triamterene are also available with hydrochlorothiazide, a thiazide diuretic that enhances tiie antihypertensive and diuretic effects of the drug combination while still conserving potassium. 

Thiazides and related diuretics are used in the treatment of hypertension, edema caused by CHF, hepatic cirrhosis, corticosteroid and estrogen therapy, and renal dysfunction. 

Standard IFN-a treatment has been shown to rednce the risk of cirrhosis and hepa-tocellnlar carcinoma (Lin et al. 2007). 

Worldwide, 15 million HBsAg carriers are also infected with hepatitis D/delta virus (HDV) (Gaeta et al. 2000). This situation represents a major therapentic challenge, as most of these patients have advanced liver disease, inclnding cirrhosis in 60-70% of cases, and hepatocellular carcinoma (Fattovich et al. 2000 Saracco et al. 1987). No specific HDV inhibitors have been developed, and IFN-a-based treatment is more difficnlt in HBV-HDV infection than in HBV monoinfection. HDV RNA levels in sernm can be nsed to monitor treatment efficacy. The endpoint of therapy is HDV RNA clearance and ALT normalization, and this is sometimes achieved after the end of treatment. A snstained response can lead to HBsAg clearance from serum. 

Cirrhosis is irreversible treatments are directed at limiting disease progression and minimizing complications. 

Cirrhosis is a high aldosterone state spironolactone is a direct aldosterone antagonist and a primary treatment for ascites. 

Once cirrhosis is diagnosed, disease progression is relentless, regardless of the initial insult to the liver. Determining the specific cause of cirrhosis requires examination of both physical presentation and past medical history. An accurate social history is particularly important because few factors in the physical and laboratory examination aid in determining disease etiology. Understanding the cause of a patient s cirrhosis is imperative because it can affect therapeutic options and treatment decisions. 

Genetics and metabolic risk factors mediate other less common causes of cirrhosis. These diseases vary widely in prevalence, disease progression, and treatment options. 

O Prevention and treatment of viral hepatitis may prevent progression to chronic hepatitis, cirrhosis, and end-stage liver disease. 

Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. Chronic viral hepatitis may lead to the development of cirrhosis, which may induce end-stage liver disease (ESLD). Complications of ESLD include ascites, edema, jaundice, hepatic encephalopathy, infections, and bleeding esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD. 

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