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Some Cirrhosis Treatment Complications Part 2

In Complications of Cirrhosis Treatment Part 1, you have learen more detail information about bleeding from varices, also edema and ascites. And now, in Some Cirrhosis Treatment Complications Part 2 I will give information more details about Hepatic encephalopathy, Hypersplenism, Spontaneous bacterial peritonitis (SBP)

Hepatic Encephalopathy

Patients with an abnormal sleep cycle, thought disorders, bizarre behavior, or other signs of hepatic encephalopathy usually be treated with a low protein diet and oral lactulose. The dietary protein is limited because it is a source of toxic compounds that cause hepatic encephalopathy. Lactulose, which is a liquid, the pitfalls of toxic compounds in the colon. Therefore, can be absorbed into the bloodstream and cause encephalopathy. To ensure that adequate lactulose present in the colon, at any time, patient dose should be used to produce semi-formed stools per day 2.3. (Lactulose is a laxative, and the adequacy of treatment may be tried by the looseness or increased stool frequency.) Encephalopathy If symptoms persist, oral antibiotics such as neomycin or metronidazole (Flagyl) can be added to the system. Antibiotics by blocking the production of toxic compounds by bacteria in the colon.

Hypersplenism

The filtration of blood by an enlarged spleen usually means that the cuts only mild symptoms of red blood cells (anemia), white blood cells (leukopenia) and platelets (thrombocytopenia), which do not require treatment. Severe anemia, however, may need blood transfusions or treatment with erythropoietin or epoetin alfa (Epogen, Procrit), hormones that stimulate red blood cell production. If the number of white blood cells are significantly reduced, another factor stimulating hormone called granulocyte colony is available to increase the number of white blood cells. An example of one of these factors is filgrastim (Neupogen).

There is no approved drug is still available to increase the number of platelets. As a precaution necessary, patients with low platelet count should not use aspirin or other antiinflammatory drugs (NSAIDs), because these drugs may affect platelet function. If a low number of platelets is associated with significant bleeding, platelet transfusions should be given normally. Surgical removal of the spleen (called splenectomy) should be avoided if possible because of the risk of excessive bleeding during surgery and the risk of anesthesia in advanced liver disease.

Spontaneous Bacterial Peritonitis (SBP)

Patients with suspected spontaneous bacterial peritonitis usually covered by paracentesis. The liquid that is extracted is examined for white blood cells and for bacteria. Culture is the inoculation of a sample of ascites in a bottle of fluid containing nutrients that promote growth of bacteria, facilitating the identification of even small amounts of bacteria. The blood and urine samples are often obtained for both culture, since many patients with spontaneous bacterial peritonitis has also infection in the blood and urine. In fact, many doctors believe the infection may have begun in the blood and urine and spread to cause ascites spontaneous bacterial peritonitis. Most patients with spontaneous bacterial peritonitis were hospitalized and treated with intravenous antibiotics such as ampicillin, gentamicin, and one of the most recent generations cephalosporins. In general, patients treated with antibiotics as follows:

• Patients with blood, urine and / or ascites fluid cultures containing bacteria.
• Patients without bacteria in the blood, urine and ascites, but who have a high number of white blood cells (neutrophils) in asciticfluid (> 250 neutrophils / cc). High number of neutrophils in the ascitic fluid usually means that there is a bacterial infection. Doctors believe that the absence of bacteria to grow in some patients with increased neutrophils is due either to a very small number of bacteria or inefficient farming techniques.

Spontaneous bacterial peritonitis is a serious infection. It often occurs in patients with advanced cirrhosis, whose immune system is weakened, but with modern antibiotics and early detection and treatment, the prognosis for recovery from an episode of spontaneous bacterial peritonitis is good.

In some patients, oral antibiotics (like Cipro or Septra) can be prescribed to prevent spontaneous bacterial peritonitis. All patients with cirrhosis and ascites should be treated with antibiotics to prevent spontaneous bacterial peritonitis, but some patients are at high risk for spontaneous bacterial peritonitis and justify preventive treatment :

• Patients with cirrhosis who were hospitalized for variceal bleeding are at high risk for spontaneous bacterial peritonitis and should be released in early antibiotics during hospitalization to prevent spontaneous bacterial peritonitis
• Patients with recurrent episodes of spontaneous bacterial peritonitis
• Patients with low protein content in ascites (accumulation of ascites with low protein is more susceptible to infection)

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