Complications of alcoholic liver
1, upper gastrointestinal bleeding: Chronic alcoholics complicated with upper gastrointestinal bleeding, may be due to acute gastric erosions, ulcer disease or esophageal varices bleeding (EVB), and therefore subject to the bleeding site and treatment decisions. Plus a small amount of ice water norepinephrine gastric lavage, or other hemostatic agent, on gastric mucosal bleeding caused by erosion may be effective. The case of portal hypertension caused by portal hypertensive gastropathy hemorrhage, can be used Sandostatin, somatostatin and effective. Sandostatin Usage: 0.1mg slow intravenous injection, followed by 3mg intravenous drip, continuous infusion of at least 48h, bleeding ulcers omeprazole or ranitidine treatment available. EVB treatment, are available for three-cavity tube balloon compression, plus Sandostatin or somatostatin treatment, use ibid. In order to stop bleeding when a longer option of sclerotherapy varicose vein ligation therapy or therapy (EVL). AH (alcoholic hepatitis) caused by portal hypertension, portal vein pressure can be treated and returned to normal, varicose veins may disappear.
2, ascites: AH and AC (alcoholic cirrhosis) and have ascites, in order to improve liver function as the main treatment, when the portal venous pressure decreased to normal, serum albumin level increased, the urine that is itself growing. Had to limit sodium intake, diuretics should be cautious due to the application of AH, AC patients is often associated with low potassium, low magnesium, calcium, hypophosphatemia. Alone should be disabled in a major role in the proximal renal tubules of chlorine thiazide. Its antagonism of aldosterone on the distal tubules can not be the effect, it is not only the increase in aldosterone in patients with liver cirrhosis accompanied by a lack of diuretic effect, Japan and _ will exacerbate potassium, magnesium loss, hypokalemic alkalosis and liver induced coma, so should be combined, such as with spironolactone (50-100mg) and Hydrochlorothiazide (50-100mg / d) combination. Regular review during treatment should pay attention to blood, urine electrolytes, electrocardiogram and blood gas analysis, to prevent possible high-K learning disorders.
3, hepatic coma, such as AC, and AH patients with hepatic encephalopathy, should pay attention to look at the induced causes, such as gastrointestinal bleeding, electrolyte and acid-base disorders, secondary infection, for preventive use of sodium glutamate, potassium inappropriate, protein excessive intake and so on. The reason is sometimes complex. Gastrointestinal bleeding and infection should be controlled, electrolyte and acid-base disorders should be promptly corrected. At the same time are advised to reduce intestinal bacterial decomposition of amino acids and urea class.
4, infection due to AH, AC in patients with poor nutritional status, low immunity, as well as self-care ability and poor sanitary conditions and other factors affecting the patient vulnerable to infections, especially lung infections and spontaneous bacterial peritonitis. The incidence of pneumonia is 3-4 times higher than the crowd, and one of the most important cause of death, it should attach importance to its prevention and treatment. At the same time should be noted that spontaneous bacterial peritonitis in early diagnosis. In addition to conventional indicators, the current focus and neutral PH ascites multinucleated cells (PMN) counts. Positive in two or three should be considering the possibility of spontaneous bacterial peritonitis, and appropriate timely treatment.
5, electrolyte and acid-base imbalance due to low intake, excretion and more gastrointestinal tract and the renal tubular absorption, as well as ethanol-induced acid-base disorders, in the AC, AH patients, often appear electrolyte and acid-base disorders, complicated by low potassium , low magnesium, calcium, hypophosphatemia, and a variety of acid-base imbalance. Its mechanism of lactic acid and ethanol metabolism and other metabolic complications such as anemia, myalgia, rhabdomyolysis, alcohol syndrome, hepatic coma and other relevant. Low potassium, low magnesium, calcium, phosphorus often accompanied with the existence of clinical manifestations twitching, tremors, looking to symptoms such as difficult to distinguish, ECG is also a lack of specific performance, to monitor the blood and urine electrolytes.
Ethanol metabolism, lactic acidosis, ketosis, can lead to AG (anion gap) metabolic acidosis, ethanol inhibition of excessive anesthesia can cause respiratory respiratory acidosis, excessive breath alcohol syndrome, can cause respiratory alkalosis, severe vomiting can also caused by low-chloride, hypokalemic metabolic alkalosis, which is easy to induce hepatic encephalopathy. If associated with severe infection and inappropriate medical treatment, more complicated, therefore, must pay attention to monitoring of electrolytes, blood gas analysis, ECG, and examination and treatment if appropriate, timely adjustments combined with clinical treatment.