英文肝硬化.pptVIP

Treatment of SBP 1. Ascites PMN250/mm3 : antibiotic therapy should be initiated. 2. Ascites PMN250/mm3 and ascitic fluid culture continues to be positive: initiation of antibiotic treatment. 3. Follow-up diagnostic paracentesis performed 48 hours after starting therapy allows assessment of response to treatment and the need to modify antibiotic coverage. 4. Long-term prophylaxis ---Patients who have recovered from an episode of SBP are at a high risk of developing SBP recurrence. Therapies for HRS[I] ? Avoid use of nephrotoxic drugs: （1）Antibiotics ：aminoglycosides （2）NSAIDs：inhibit formation intrarenal prostaglandins ---marked decline in renal function ? Avoid and treat factors to hypovolaemia: （1）active treatments of upper gastrointestinal bleeding （2）Judicious use of diuretics（weight loss0.5Kg/d） ? Rectify electrolyte and metabolic imbalance, Fluid intake restriction Therapies for HRS[II] ? Volume expansion: with IV dextrose, plasma, albumin or Concomitant plasma volume expansion with albumin has been used with LVP to correct decreased effective arterial volume that leads to sodium retention, TIPS ? Vasoactive drugs: terlipressin(可利新), ornipressin, dopamine, ---increasing renal plasma flow ? Elimination of endotoxaemia and control infections ? Liver transplantation: the most effective treatment for patients with HRS Indications for Liver transplantation (irreversible, progressive chronic liver diseases) Primary biliary cirrhosis Sclerosing cholangitis Fulminant liver failure Metabolic liver diseases Alcoholic cirrhosis Postnecrotic cirrhosis Autoimmune liver disease Budd-Chiari syndrome Hepatocellular carcinoma Indications for Liver transplantation(cirrhosis) Refractory ascites Recurrent variceal bleeding Hepatic encephalopathy spontaneous bacterial peritonitis Worsening functional status, rising bilirubin, decreasing albumin, worsening coagulopathy (Child-Pugh C) * 图 4-13-3 Cirrhosis. The liver is small with a nodu