Cirrhosis is a liver dysfunction due to disruption of tissue structure. There is no cure for it.
The main focus is on early detection and stopping the progression of the disease, prolonging life and maintaining the workforce.
I. Treatment for cirrhosis of the liver
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, electrolytes, acid-base balance. In severe cases, albumin and fresh plasma can be administered. Zhang Zhimei, Department of Gastroenterology, Lianyungang First People’s Hospital
2. Hepatitis active stage.
Liver protection, enzyme lowering, anti-yellowing and other treatments can be given: such as vitamin C. Intravenous infusion therapy, if necessary.
3, oral drugs to reduce portal pressure.
(1) insulin should be given in small increments, starting with small amounts.
(2) Nitrates such as cardiac pain.
(3) calcium channel blockers such as cardiac pain, emergency medication can be given sublingually.
(4) B vitamins and digestive enzymes.
(5) Treatment of hypersplenism, leukocyte- and platelet-raising drugs can be given, and splenectomy or splenic artery embolization can be performed if necessary.
(6) Treatment of peritoneal effusion
①General treatment includes bed rest and restriction of water and sodium intake.
②Diuretic treatment mainly uses Antiseptic and tachyphylaxis. If the diuretic effect is not obvious, the amount can be gradually increased. Diuretic therapy 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 to treat refractory peritoneal fluid. Daily or 3 times weekly release of peritoneal fluid with intravenous infusion of albumin.
④Increase plasma colloid osmotic pressure Regular small and multiple intravenous infusions of plasma or albumin per week.
⑤Concentration of peritoneal effusion for the treatment of refractory peritoneal effusion, or patients with hypovolemia, hyponatremia, hypoproteinemia and hepatorenal syndrome, as well as patients with large amount of peritoneal effusion due to various reasons who need urgent relief of symptoms.
(6) Abdominal-jugular venous drainage, or PVS, is an effective method for managing 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) Surgical treatment of portal hypertension Indications are ruptured esophagogastric variceal bleeding, ineffective by non-surgical treatment; giant spleen with hypersplenism; high-risk patients with esophageal variceal bleeding. It includes portal-venous shunt, portal-archipelvic shunt and splenectomy, etc.
(8) Liver transplantation For end-stage liver disease in which conventional medical and surgical treatment is ineffective. It includes irreversible peritoneal effusion; portal hypertension with upper gastrointestinal bleeding; severe liver function impairment (Child grade C); hepatorenal syndrome; hepatic encephalopathy with progressive aggravation; liver cancer complicated on the basis of cirrhosis.
Second, the antiviral treatment of cirrhosis of liver B
1.General indications include.
① HBeAg-positive patients with HBV-DNA ≥ 105 copies/ml (equivalent to 20,000 IU/ml);
HBeAg negative, HBV-DNA ≥ 104 copies/ml (equivalent to 2000U/ml);
②ALT≥2×ULN; if treated with IFN, ALT should be ≤10×ULN and total serum bilirubin should be 2×ULN;
③ ALT 2×ULN, but liver histology shows KnodellHAI ≥ 4, or inflammatory necrosis ≥ G2, or fibrosis ≥ S2.
Antiviral therapy should also be considered for those who are persistently HBV-DNA positive and do not meet the above treatment criteria, but have one of the following conditions.
①Antiviral therapy should also be considered for those with ALT > ULN and age 40 years (III);
②For those with persistently normal ALT but older (40 years old), close follow-up should be performed, preferably with liver tissue biopsy; if liver histology shows KnodellHAI ≥ 4, or inflammatory necrosis ≥ G2, or fibrosis ≥ S2, antiviral therapy should be actively administered (II);
(iii) If dynamic observation reveals evidence of disease progression (e.g., enlarged spleen), liver histology is recommended, and antiviral therapy should be given if necessary (III).
Therapeutic drugs include interferon (regular interferon, long-acting interferon) and nucleoside (acid) analogues (lamivudine, adefovir, telbivudine, entecavir, tenofovir, clavudine, etc.). Please visit a specialist clinic and follow the doctor’s instructions for medication!
III. Other treatments
1.Immunomodulatory therapy.
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 indexes.