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ABC OF LIVER, PANCREAS AND GALL BLADDER - PART 4

Bước đầu tiên rất quan trọng trong điều trị cổ trướng là để thuyết phục bệnh nhân xơ gan do rượu để kiêng rượu. Kiêng trong một vài tháng có thể cải thiện đáng kể các thành phần hồi phục của bệnh gan do rượu. | Portal hypertension 2. Ascites encephalopathy and other conditions A crucial first step in treating ascites is to convince patients with alcoholic cirrhosis to abstain from alcohol. Abstinence for a few months can substantially improve the reversible component of alcoholic liver disease. Dietary salt restriction is the most important initial treatment. A low sodium diet of 1-1.5 g of salt 40-60 mmol day usually produces a net sodium loss which may be sufficient in patients with mild ascites but is unpalatable and virtually impossible to adhere to in the long term. In practical terms a no added salt diet with levels of 80 mmol day is the lowest that is generally sustainable. Fluid restriction is not needed for patients with cirrhotic ascites unless they have severe hyponatraemia serum sodium 120 mmol l . Although conventional recommendations suggest bed rest its value is not supported by controlled trials. Most patients need dietary restrictions combined with diuretics. The usual diuretic regimen comprises single morning doses of oral spironolactone an aldosterone antagonist increasing the dose as necessary to a maximum of 400 mg day. Dietary sodium restriction and dual diuretic therapy is effective in 90 of patients. The patient s weight electrolyte concentrations and renal function should be carefully monitored. Treatment should be cautious because of the dangers of iatrogenic complications from aggressive treatment. Patients with ascites and peripheral oedema may tolerate 1-2 kg loss per day but loss of 0.5 kg should be the goal in patients without oedema. Potential complications during diuresis are encephalopathy hypokalaemia hyponatraemia hypochloraemic alkalosis and azotaemia. Patients with tense ascites should have a total abdominal paracentesis followed by a sodium restricted diet and oral diuretics. Options for patients who do not respond to routine medical treatment include serial therapeutic paracentesis peritoneovenous shunt transjugular intrahepatic .