Table of Contents
- Highlights
- Introduction
- Causes
- Symptoms
- Complications
- Diagnosis
- Treatment
- Treatment of Complications
- Liver Transplantation
- Resources
- References
- Ascites
- Bleeding Episodes
- Resources
- References
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
A protein-restricted diet may be used to lower ammonia production. The laxative lactulose, given as a syrup or enema, is used to empty the bowels and to help improve mental status. The antibiotic neomycin may be added for patients who do not improve with lactulose alone. Rifaximin (Xifaxan) is another antibiotic used for treatment of hepatic encephalopathy.
Treatment of Variceal Bleeding
Primary Prevention. Primary prevention means treating the varices (swollen or distended veins) before they have bled. Varices that are present in the esophagus, stomach, or intestines are always at risk of bleeding. Nonselective beta-blockers drugs, which are commonly used to treat high blood pressure, may be given to prevent bleeding. Propanolol (Inderal) or nadolol (Corgard) are the standard beta-blockers used for variceal prevention.
Patients with medium-to-large varices that have not bled may also be treated with a surgical procedure called endoscopic variceal ligation (EVL). EVL is also called band ligation. It involves inserting an endoscope or tube down through the esophagus. The equipment contains microcameras and tiny instruments. Latex bands are wrapped around the bleeding varices to shut off the blood supply.
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Review Date: 11/04/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
