Some practical issues in the management of patients with decompensated liver cirrhosis


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Abstract

The natural course of cirrhosis is characterized by a shift from a compensated stage without clinical manifestations to a subsequent decompensated stage, which is characterized by the development of obvious clinical symptoms, the most frequent of which are ascites, bleeding from varicose veins, bacterial infections, encephalopathy. The articles and reviews of recent years emphasize the importance of etiotropic treatment of liver cirrhosis at any stage, including the final one. In addition, pathogenetic and symptomatic therapy aimed at treating complications of cirrhosis of the liver: ascites, dilution hyponatremia, gastrointestinal bleeding, bacterial infections, and kidney damage comes to the forefront at the stage of decompensation, which allows the patient to be on the waiting list for liver transplantation. This category of patients, as a rule, is difficult to treat and has features and subtleties of reference.

About the authors

E A Fedosina

Vladimirskiy Moscow Regional Research and Clinical Institute ("MONIKI")

Email: starkat@mail.ru
к.м.н., зав. гепатологическим отд-нием с дневным стационаром ГБУЗ МО «МОНИКИ им. М.Ф. Владимирского»; тORCID: 0000-0002-5446-0884 Moscow, Russia

A O Byeverov

Vladimirskiy Moscow Regional Research and Clinical Institute ("MONIKI")

д.м.н., проф. ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова», в.н.с. отд-ния гепатологии ГБУЗ МО «МОНИКИ им. М.Ф. Владимирского» Moscow, Russia

P O Bogomolov

Vladimirskiy Moscow Regional Research and Clinical Institute ("MONIKI")

к.м.н., руководитель отд-ния гепатологии ГБУЗ МО «МОНИКИ им. М.Ф. Владимирского» Moscow, Russia

N P Staroverova

Sechenov First Moscow State Medical University (Sechenov University)

доц. каф. иностранных языков ФГОБУ ВО «Финансовый университет при Правительстве Российской Федерации» Moscow, Russia

References

  1. D'Amico G, Morabito A, D’Amico M, Pasta L, Malizia G, Rebora P, Valsecchi M.G. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68(3):563-76. doi: 10.1016/j.jhep.2017.10.020
  2. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies. J Hepatol. 2006;44(1):217-31. doi: 10.1016/j.jhep.2005.10.013
  3. Alvarez M, Cirera I, Solà R, Bargalló A, Morillas R, Planas R. Long - term Clinical Course of Decompensated Alcoholic Cirrhosis. J Clin Gastroenterol. 2011;45(10):906-11. doi: 10.1097/mcg.0b013e3182284e13
  4. Abraldes J. Hemodynamic response to pharmacological treatment of portal hypertension and long - term prognosis of cirrhosis. Hepatology. 2003;37(4):902-8. doi: 10.1053/jhep.2003.50133
  5. Ginés P, Quintero E, Arroyo V, et al. Compensated cirrhosis: Natural history and prognostic factors. Hepatology. 1987;7(1):122-8. doi: 10.1002/hep.1840070124
  6. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397-417. doi: 10.1016/j.jhep.2010.05.004
  7. Santos J, Planas R, Pardo A, et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol. 2003;39(2):187-92. doi: 10.1016/s0168-8278(03)00188-0
  8. Ginès P, Titó L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988;94(6):1493-502. doi: 10.1016/0016-5085(88)90691-9
  9. Solomon R, Werner C, Mann D, D'Elia J, Silva P. Effects of Saline, Mannitol, and Furosemide on Acute Decreases in Renal Function Induced by Radiocontrast Agents. New Engl J Med. 1994;331(21):1416-20. doi: 10.1056/nejm199411243312104
  10. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по лечению осложнений цирроза печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016;26(4):71-102. doi: 10.22416/1382-4376-2016-4-71-102
  11. Fedosina E, Maevskaya M, Ivashkin V. Incidence of Dilutional Hyponatemia in Hospitalized Patients with Liver Cirrhosis. J Clin Exp Hepatol. 2014;4:S51. doi: 10.1016/j.jceh.2014.02.103
  12. Kim W, Biggins S, Kremers W, et al. Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List. New Engl J Med. 2008;359(10):1018-26. doi: 10.1056/nejmoa0801209
  13. Rodrigues S. Baveno VI Recommendation on Avoidance of Screening Endoscopy in Cirrhotic Patients: Not Quite There Yet! GE - Portuguese Journal of Gastroenterology. 2017;24(2):58-60. doi: 10.1159/000456092
  14. Urrunaga N, Rockey D. Portal Hypertensive Gastropathy and Colopathy. Clin Liver Dis. 2014;18(2):389-406. doi: 10.1016/j.cld.2014.01.008
  15. Mookerjee R, Stadlbauer V, Lidder S, et al. Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome. Hepatology. 2007;46(3):831-40. doi: 10.1002/hep.21737
  16. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-24. doi: 10.1016/j.jhep.2014.01.024
  17. Fernández J, Bert F, Nicolas-Chanoine M. The challenges of multi - drug - resistance in hepatology. J Hepatol. 2016;65(5):1043-54. doi: 10.1016/j.jhep.2016.08.006
  18. Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60(1):197-209. doi: 10.1016/j.jhep.2013.07.044
  19. Rodríguez-Roisin R, Krowka M. Hepatopulmonary Syndrome - A Liver-Induced Lung Vascular Disorder. New Engl J Med. 2008;358(22):2378-87. doi: 10.1056/nejmra0707185
  20. Маев И.В., Абдурахманов Д.Т., Андреев Д.Н., Дичева Д.Т. Алкогольная болезнь печени: современное состояние проблемы. Терапевтический архив. 2014;86(4):108-16.

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