Cirrhosis - Treatment

Treatment of Complications

Treatment of Ascites

First-line treatment of patients with ascites (fluid accumulation in the abdomen) involves:

• Dietary salt restriction (no more than 2,000 mg/day of sodium)
• Drug treatment with diuretics, usually spironolactone (Aldactone) and furosemide (Lasix).
• Complete abstention from alcohol
• Fluid restriction is usually not necessary unless sodium levels in the blood are low.

Treatment for Recurring or Refractory Ascites. Patients with ascites that does not respond to standard diuretics after a month (refractory ascites) may require procedures to reduce fluid:

• Large-volume paracentesis, (which involves using a thin needle to withdraw fluid from the abdomen), may be used for ascites refractory to medical treatment or when complications are present.
• Transjugular intrahepatic portosystemic shunt (TIPS) uses a stent placed in veins in the middle of the liver to keep open a passage connecting the hepatic and portal veins. This helps reroute blood around the scarred liver. In the procedure, a long needle is inserted into the jugular vein in the neck and passed down to the hepatic and portal veins. TIPS is used for patients with ascites unresponsive to treatment and those who may require a liver transplant. In general, TIPS should be a second-line option for ascites that does not respond to diuretics.

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Treatment of Spontaneous Bacterial Peritonitis

Patients with ascites who have high white blood cell counts should receive intravenous antibiotic therapy (usually cefotaxime) or oral antibiotic therapy with ofloxacin. Patients who have had an episode of spontaneous bacterial peritonitis are treated with long-term antibiotic therapy of norfloxacin (Noroxin) or trimethoprim/sulfamethoxazole (such as Bactrim or Septra) to prevent further infection.

Treatment of Hepatorenal Syndrome

Hepatorenal syndrome can occur in patients with ascites. This is a life-threatening condition in which kidney failure develops because of altered blood flow in the liver. Patients with hepatorenal syndrome are treated with intravenous infusion of albumin. Drug therapy includes oral midodrine (ProAmatine) and octreotide (Sandostatin). Studies suggest that the vasoconstrictor drug terlipressin, given in combination with albumin, may be helpful for treating hepatorenal syndrome.

Treatment of Hepatic Encephalopathy

The first step in managing encephalopathy (damage to the brain) is to treat any precipitating cause, such as:

• High ammonia levels
• Bleeding
• Low oxygen
• Dehydration
• Infection
• Use of sedatives