Treatment.
Cirrhosis is a liver dysfunction due to disruption of tissue structure. There is no radical cure. It mainly lies in early detection and stopping the progression of the disease.
I. Treatment for cirrhosis
1.Supportive treatment
Intravenous infusion of hypertonic glucose solution to replenish calories, vitamin C, insulin, potassium chloride, etc. can be added to the infusion. Pay attention to maintaining water, electrolyte, acid-base balance. In severe cases, albumin and fresh blood plasma can be given.
2.Hepatitis active stage
Liver protection, enzyme lowering, anti-yellowing treatment can be given: such as hepatocyte, vitamin C. If necessary, intravenous infusion treatment, such as hepatocyte growth promoter, reduced glutathione, glycyrrhetinic acid preparations, etc.
3.Oral drugs to reduce portal pressure
(1) The drug should be given in small increments, starting from small amounts.
(2) Nitrates such as cardiac pain.
(3) calcium channel blockers such as cardiac pain, emergency medication can be given sublingually.
(4) Supplementation of B vitamins and digestive enzymes such as Vicodin, Dagest, etc.
(5) Treatment of hypersplenism can take leukocyte and platelet-raising drugs (e.g., leucovorin, shark’s liver alcohol, amineptin, etc.), and if necessary, splenectomy or splenic artery embolization.
(6) Treatment of peritoneal effusion
①General treatment includes bed rest and restriction of water and sodium intake.
②Diuretic treatment such as dihydrocotrimoxazole, taken every other day or 1-2 times a week. Aminoglutethimide, taken after meals. The main use of aminoglutethimide and tachyphylaxis. If diuretic effect is not obvious, the dosage can be gradually increased. Diuretic treatment is appropriate to reduce body weight by no more than 0.5 kg per day to avoid inducing hepatic encephalopathy and hepatorenal syndrome. If the ascites gradually subsides, the diuretic can be gradually reduced.
③ Repeated massive discharge of peritoneal fluid plus intravenous infusion of albumin is used for the treatment of refractory peritoneal fluid. Daily or three times weekly release of peritoneal fluid with intravenous infusion of albumin.
④Increase plasma colloid osmotic pressure by regular small and multiple intravenous infusions of plasma or albumin per week.
⑤Concentration of peritoneal fluid back into the infusion is used to treat refractory peritoneal fluid, or patients with hypovolemic state, hyponatremia, hypoproteinemia and hepatorenal syndrome, as well as patients with large amount of peritoneal fluid due to various reasons who need urgent relief of symptoms.
(6) Abdominal-jugular venous drainage, or PVS, is an effective method for the management of cirrhosis and peritoneal effusion. However, its application is greatly limited because it has more complications, such as fever, bacterial infection, pulmonary edema, etc.
(7) Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal vein pressure with little trauma and high safety. It is suitable for hemorrhage of esophageal varices and refractory peritoneal effusion, but it is easy to induce hepatic encephalopathy.
(7) Indications for surgical treatment of portal hypertension are ruptured esophagogastric variceal bleeding, which is ineffective by non-surgical treatment; giant spleen with hypersplenism; and patients at high risk of bleeding from esophageal varices. It includes portal-venous shunt, portal-archipelvic shunt and splenectomy, etc.
(8) Liver transplantation is indicated for end-stage liver disease for which conventional medical and surgical treatment is ineffective. These include irreversible peritoneal effusion; portal hypertension with upper gastrointestinal bleeding; severe hepatic impairment; hepatorenal syndrome; hepatic encephalopathy with progressive aggravation; liver cancer complicated by cirrhosis.
II. Other treatments
1.Immunomodulatory treatment
Thymidine and alpha thymidine are commonly used in acute and chronic hepatitis B, which can regulate the immunity of the body.
2.Chinese medicine and Chinese medicinal preparation treatment
Liver-protective treatment is effective in improving clinical symptoms and liver function index.
Third, the treatment of complications
1.Spontaneous peritonitis
Select antibacterial drugs that mainly target gram-negative bacilli and take into account gram-positive cocci. Such as three generations of cephalosporin, ciprofloxacin, etc. Adjust the antibacterial drugs according to the drug sensitivity results and the patient’s response to treatment. Duration of medication is 1-2 weeks.