A cirrhotic patient in an internal medicine ward

Česká verzia

Authors: Karel Dvořák ²; Přemysl Falt ³; Pavla Paterová; Štěpán Šembera ¹; Michal Šenkyřík ⁵; Jiří Cyrany ¹
Authors place of work: II. interní gastroenterologická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové ¹; Oddělení gastroenterologie a hepatologie, Krajská nemocnice Liberec, a. s. ²; II. interní klinika – gastroenterologická a geriatrická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc ³; Ústav klinické mikrobiologie, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové ⁴; Interní gastroenterologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno ⁵
Published in the journal: Vnitř Lék 2022; 68(1): 19-25
Category: Main Topic

Summary

Liver cirrhosis represents a common condition with substantial mortality. Manifestation and progression of ascites, hepatic encephalopathy or gastrointestinal bleeding are among main reasons for hospital admission. Infections represent another specific area in cirrhotic patients. Timely and correct diagnosis and therapy of these conditions are the mainstay of optimal outcome. Manifestation of complications of liver cirrhosis significantly deteriorates prognosis of the patient. Ascites in portal hypertension develops as a result of sodium and consequently water retention. Therapy comprises of restriction of sodium intake, diuretic therapy with combination of spironolactone and furosemide, alternatively large-volume paracentesis. Hepatic encephalopathy comprises a spectrum of neuropsychiatric abnormalities from subtle changes to overt desorientation and asterixis to hepatic coma. Treatment includes correcting of predisposing conditions, administering of non-absorbable disaccharides or rifaximin. The most common cause of bleeding in a cirrhotic patient is oesophageal bleeding. Therapy is complex including hemodynamic stabilisation, antibiotic prophylaxis, vasoactive and endoscopic treatment. Infections are common causes of decompensation and occurrence of complications of advanced chronic liver disease. Their unfavourable outcome is a result of a complex immune disorder in cirrhotic patients. Specific type of infection in cirrhosis is spontaneous bacterial peritonitis, which has to be always excluded with diagnostic paracentesis. The mainstay of successful therapy of infections is timely and vigorous broad spectrum antibiotic therapy which can significantly improve otherwise unfavourable outcome of these patients.

Keywords:

Cirrhosis – Ascites – bleeding – infection – encephalopathy

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