Mathews Ronnie E, McGuire Brendan M, Estrada Carlos A
Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
South Med J. 2006 Jun;99(6):600-6. doi: 10.1097/01.smj.0000220889.36995.54.
Cirrhosis is the 12th leading cause of death in the United States. Individuals with cirrhosis are at risk for many potential complications. Complications can be managed or detected early with proper outpatient management. The most lethal of these complications is bleeding esophageal varices. All patients with cirrhosis should be screened for the presence of varices and treated when indicated. The most common complication seen in these patients is ascites. Ascites can be treated with dietary modifications and a diuretic regimen. Other potential complications include spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatic encephalopathy, hepatorenal syndrome, and hepatopulmonary syndrome. The outpatient management of these complications will be discussed in this paper, along with the use of vaccinations, educating patients about the avoidance of hepatotoxic drugs, and when to refer a patient for liver transplant.
肝硬化是美国第12大死因。肝硬化患者有发生许多潜在并发症的风险。通过适当的门诊管理，并发症可以得到控制或早期发现。这些并发症中最致命的是食管静脉曲张破裂出血。所有肝硬化患者都应筛查是否存在静脉曲张，并在有指征时进行治疗。这些患者中最常见的并发症是腹水。腹水可以通过饮食调整和利尿剂治疗方案来处理。其他潜在并发症包括自发性细菌性腹膜炎、肝细胞癌、肝性脑病、肝肾综合征和肝肺综合征。本文将讨论这些并发症的门诊管理，以及疫苗接种的使用、教育患者避免使用肝毒性药物，以及何时将患者转诊进行肝移植。
