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Some Cirrhosis Treatment Complications Part 2

In Complications of Cirrhosis Treatment Part 1, you have learen more detail information about bleeding from varices, also edema and ascites. And now, in Some Cirrhosis Treatment Complications Part 2 I will give information more details about Hepatic encephalopathy, Hypersplenism, Spontaneous bacterial peritonitis (SBP)

Hepatic Encephalopathy

Patients with an abnormal sleep cycle, thought disorders, bizarre behavior, or other signs of hepatic encephalopathy usually be treated with a low protein diet and oral lactulose. The dietary protein is limited because it is a source of toxic compounds that cause hepatic encephalopathy. Lactulose, which is a liquid, the pitfalls of toxic compounds in the colon. Therefore, can be absorbed into the bloodstream and cause encephalopathy. To ensure that adequate lactulose present in the colon, at any time, patient dose should be used to produce semi-formed stools per day 2.3. (Lactulose is a laxative, and the adequacy of treatment may be tried by the looseness or increased stool frequency.) Encephalopathy If symptoms persist, oral antibiotics such as neomycin or metronidazole (Flagyl) can be added to the system. Antibiotics by blocking the production of toxic compounds by bacteria in the colon.

Hypersplenism

The filtration of blood by an enlarged spleen usually means that the cuts only mild symptoms of red blood cells (anemia), white blood cells (leukopenia) and platelets (thrombocytopenia), which do not require treatment. Severe anemia, however, may need blood transfusions or treatment with erythropoietin or epoetin alfa (Epogen, Procrit), hormones that stimulate red blood cell production. If the number of white blood cells are significantly reduced, another factor stimulating hormone called granulocyte colony is available to increase the number of white blood cells. An example of one of these factors is filgrastim (Neupogen).

There is no approved drug is still available to increase the number of platelets. As a precaution necessary, patients with low platelet count should not use aspirin or other antiinflammatory drugs (NSAIDs), because these drugs may affect platelet function. If a low number of platelets is associated with significant bleeding, platelet transfusions should be given normally. Surgical removal of the spleen (called splenectomy) should be avoided if possible because of the risk of excessive bleeding during surgery and the risk of anesthesia in advanced liver disease.

Spontaneous Bacterial Peritonitis (SBP)

Patients with suspected spontaneous bacterial peritonitis usually covered by paracentesis. The liquid that is extracted is examined for white blood cells and for bacteria. Culture is the inoculation of a sample of ascites in a bottle of fluid containing nutrients that promote growth of bacteria, facilitating the identification of even small amounts of bacteria. The blood and urine samples are often obtained for both culture, since many patients with spontaneous bacterial peritonitis has also infection in the blood and urine. In fact, many doctors believe the infection may have begun in the blood and urine and spread to cause ascites spontaneous bacterial peritonitis. Most patients with spontaneous bacterial peritonitis were hospitalized and treated with intravenous antibiotics such as ampicillin, gentamicin, and one of the most recent generations cephalosporins. In general, patients treated with antibiotics as follows:

• Patients with blood, urine and / or ascites fluid cultures containing bacteria.
• Patients without bacteria in the blood, urine and ascites, but who have a high number of white blood cells (neutrophils) in asciticfluid (> 250 neutrophils / cc). High number of neutrophils in the ascitic fluid usually means that there is a bacterial infection. Doctors believe that the absence of bacteria to grow in some patients with increased neutrophils is due either to a very small number of bacteria or inefficient farming techniques.

Spontaneous bacterial peritonitis is a serious infection. It often occurs in patients with advanced cirrhosis, whose immune system is weakened, but with modern antibiotics and early detection and treatment, the prognosis for recovery from an episode of spontaneous bacterial peritonitis is good.

In some patients, oral antibiotics (like Cipro or Septra) can be prescribed to prevent spontaneous bacterial peritonitis. All patients with cirrhosis and ascites should be treated with antibiotics to prevent spontaneous bacterial peritonitis, but some patients are at high risk for spontaneous bacterial peritonitis and justify preventive treatment :

• Patients with cirrhosis who were hospitalized for variceal bleeding are at high risk for spontaneous bacterial peritonitis and should be released in early antibiotics during hospitalization to prevent spontaneous bacterial peritonitis
• Patients with recurrent episodes of spontaneous bacterial peritonitis
• Patients with low protein content in ascites (accumulation of ascites with low protein is more susceptible to infection)

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Hepatic Cirrhosis Complication Symptoms and Signs Part 2

Previously, we have discussed about signs and symptoms of hepatic cirrhosis complications such as edema and ascites, spontaneous bacterial peritonitis (SBP), and Bleeding esophageal varices in Part 1. Now we will discuss the continuation of hepatic cirrhosis complication symptoms and signs such as hepatic encephalopathy, hepatorenal syndrome, hepatopulmonaire syndrome, hypersplenism and hepatocellular carcinoma (liver cancer) details as below.

Hepatic Encephalopathy

Some of the proteins in food that escapes digestion and absorption is used by bacteria normally present in the intestine. While the utilization of protein for their own purposes, bacteria that cause substances emitted in the intestine. These substances can be absorbed by the body. Some of these substances, eg ammonia, can have toxic effects on the brain. Normally, these toxic substances are transported from the intestine into the portal vein to the liver where they are eliminated from the blood and detoxification.

As mentioned above, when cirrhosis is present, liver cells can not function normally, either because they are damaged or because they have lost their normal relationship with the blood. In addition, some blood in the portal vein bypasses the liver through other veins. The result of these anomalies is that toxic substances can be removed by the liver cells, and instead, toxic substances accumulate in the blood.

When toxic substances accumulate sufficiently in the blood, brain function is disrupted, a condition called hepatic encephalopathy. Sleeping during the day instead of night (reversal of normal sleep pattern) is one of the first symptoms of hepatic encephalopathy. Other symptoms include irritability, inability to concentrate or perform calculations, memory loss, confusion, depression, or levels of consciousness. Ultimately, severe hepatic encephalopathy leading to coma and death.

Toxic chemicals also cause the brain of patients with cirrhosis very sensitive to drugs that are normally filtered and detoxified by the liver. The dose of many drugs that are normally liver detoxification should be reduced to avoid toxic accumulation in cirrhosis, particularly sedatives and drugs used to promote sleep. Alternatively, medications may be used which need not be decontaminated or disposed of the body by the liver, for example, drugs that are eliminated by the kidneys.

Hepatorenal Syndrome

Patients with cirrhosis can develop an intensification of hepatorenal syndrome. This syndrome is a serious complication in which kidney function is reduced. This is a malfunction in the kidneys, i.e. no physical damage to the kidneys. In contrast, the reduction function is due to changes in how blood flows through the kidneys themselves. Hepatorenal syndrome is defined as the progressive inability of the kidneys to clear substances from the blood and produce adequate amounts of urine, but some other important functions of the kidneys, such as salt retention are maintained. If liver function or a healthy liver is transplanted into a patient with hepatorenal syndrome, the kidneys usually start working normally. This suggests that reduced renal function is the result of accumulation of toxic substances in the blood when the liver fails. There are two types of hepatorenal syndrome. An error occurs gradually in recent months. The other is quickly over a week or two.

Hepatopulmonaire Syndrome

More rarely, some patients with advanced cirrhosis may develop hépatopulmonaire syndrome. These patients may have difficulty breathing because of certain hormones released in advanced cirrhosis causes the lungs to function abnormally. The fundamental problem in the lungs is not enough blood flows through tiny blood vessels in the lungs that are in contact with the alveoli (air sacs) of the lungs. The lung blood is diverted around the alveoli and can not collect enough oxygen in the alveoli. Consequently, the patient has trouble breathing, especially with exertion.

Hypersplenism

The spleen normally acts as a filter to remove more red blood cells, white cells and platelets (small particles that are important for blood clotting.). The blood that flows in the rate reaches the blood in the veins of the intestine. With increasing pressure in the portal vein in cirrhosis, which blocks blood flow further and further into the spleen. Blood “backs and accumulates in the spleen, the spleen and swell in size, a condition known as splenomegaly. Sometimes, the spleen is so swollen that causes abdominal pain.

As the spleen, cells from the blood leaks and more and more until the number of platelets in the blood are reduced. Hypersplenism is the term used to describe this condition, and is associated with a low number of red blood cells (anemia), low white blood cell count (leukopenia), and / or a low platelet count (thrombocytopenia). Anemia can cause weakness, infections can cause leukopenia, thrombocytopenia and may inhibit blood clotting and cause prolonged bleeding.

Hepatocellular Carcinoma ( liver cancer )

Cirrhosis due to a cause increases the risk of primary liver cancer (hepatocellular carcinoma). Principal means that the tumor originates in the liver. A secondary liver cancer is one that comes from other parts of the body and spread (metastasize) to the liver.

The most common symptoms and signs of primary liver cancer are abdominal pain and swelling, enlarged liver, weight loss, fever. In addition, cancers of the liver can produce and release a number of substances, including those that cause an increase in red blood cells (polycythemia), blood sugar (hypoglycemia) and high calcium levels (hypercalcemia).

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