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Liver Damage Symptoms



Liver Damage Symptoms and Medical Problems

Ascites

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be necessary to suppress
ascites. Diuretic options for inpatient treatment include aldosterone antagonists (spironolactone) and loop diuretics. Aldosterone
antagonists are preferred for people who can take oral medications and are not in need of an urgent volume reduction. Loop diuretics can be
added as additional therapy.

If a rapid reduction of volume is required, paracentesis is the preferred option. This procedure requires the insertion of a plastic tube
into the peritoneal cavity. Human albumin solution is usually given to prevent complications from the rapid reduction. In addition to being
more rapid than diuretics, 4–5 liters of paracentesis is more successful in comparison to diuretic therapy.

Esophageal variceal bleeding

For portal hypertension, propranolol is a commonly used agent to lower blood pressure over the portal system. In severe complications from
portal hypertension, transjugular intrahepatic portosystemic shunting (TIPS) is occasionally indicated to relieve pressure on the portal
vein. As this shunting can worsen encephalopathy, it is reserved for those patients at low risk of encephalopathy. TIPS is generally
regarded only as a bridge to liver transplantation or as a palliative measure.

Hepatic encephalopathy

High-protein food increases the nitrogen balance, and would theoretically increase encephalopathy; in the past, this was therefore
eliminated as much as possible from the diet. Recent studies show that this assumption was incorrect, and high-protein foods are even
encouraged to maintain adequate nutrition.

Hepatorenal syndrome

The hepatorenal syndrome is defined as a urine sodium less than 10 mmol/L and a serum creatinine > 1.5 mg/dl (or 24 hour creatinine
clearance less than 40 ml/min) after a trial of volume expansion without diuretics.[46]

Spontaneous bacterial peritonitis

People with ascites due to cirrhosis are at risk of spontaneous bacterial peritonitis.

Portal hypertensive gastropathy

Which refers to changes in the mucosa of the stomach in people with portal hypertension, and is associated with cirrhosis severity.[47]

Infection

Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be aspecific and are more
difficult to recognize (for example, worsening encephalopathy but no fever).

Hepatocellular carcinoma

Hepatocellular carcinoma is a primary liver cancer that is more common in people with cirrhosis. People with known cirrhosis are often
screened intermittently for early signs of this tumor, and screening has been shown to improve outcomes.


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