西安交通大学医学院消化系统疾病课件 cirrhosis22.pptVIP

ii. Banding a technique in which varices sucked into an endoscope allowing them to be occlude with a tight rubber band.More effective,less trauma,fewer side effects. iii. Tips A technique in which a stent placed between the portal vein and hepatic vein in the liver to provide a portasystemic shunt to reduce portal hypertension. The procedure is carried out under radiological control through the internal jugular vein. Successful shunt placement will stop/  prevent bleeding. Side effects:  (1)rebleeding due to shunt occlusion (angiography). (2)hepatic encephalopathy(transient). iiii. portasystemic shunt surgery decompressing portal hypertension (portacaval shunt,mesocaval shunt,spl- enocaval shunt) mortality very high poor survival iiiii. Propranolol(80-160mg/day) reducing the portal venous pressure used for prevention of rebleeding.D. Ascites refers to the accumulation of free fluid in the peritoneal cavity. Cirrhotic ascites very common, serious development phase. a. Mechanisms for ascites: arenal sodium and water retention: * activation of the renin-angiotension system with secondary ALD ; * increased sympathetic nervous activity; * increased antidiurtic hormone; b hepatic and splanchnic lymph production and transudation (high venous pressure in the mesenteric circulation). c hypoalbuminemia. d portal hypertension  Three general theories: *overfill theory:primary renal retention of sodium and water with overspill of fluid into the peritoneum; *underfilling theory: compensatory renal retention of sodium and water due to hypovolum with fluid into the peritoneum. * Splanchnic vasodilatation b. Treatment of ascites aGeneral measure: *bed rest; *restriction of sodium and water intake. bdiuretics: * spironolactone(ALD antagonist) supplemented with a loop diur