Treatment of liver cirrhosis – actually possibility of ambulant internist

Czech version

Authors: Jiří Ehrmann; Květa Aiglová; Michal Konečný; Vlastimil Procházka; Drahomíra Vrzalová
Authors‘ workplace: II. interní klinika – gastro-enterologická a hepatologická LF UP a FN Olomouc
Published in: Vnitř Lék 2016; 62(7-8): 553-563
Category: Reviews

V České republice žije 40 000–60 000 pacientů s jaterní cirhózou a ročně jich v jejím důsledku umírá asi 2 000. Jedná se o nepřehlédnutelnou skupinu nemocných vyžadující komplexní léčbu, kterou zajišťuje zejména internista ve spolupráci s dalšími odborníky. Jedním z cílů ambulantního internisty je včasná diagnostika a léčba chronických jaterních onemocnění, která mohou k cirhóze vést.

Overview

There are 40 000–60 000 patients with cirrhosis in the Czech Republic. 2 000 die of this disease yearly. This group of patients needs a complex treatment and it is mostly an internist cooperating with other specialists. The most important for an ambulant internist is to diagnose the disease as soon as possible and start with treatment of chronic liver disease that could lead to a cirrhosis. It means especially chronic viral hepatitis, alcoholic or non-alcoholic steatosis/steatohepatitis, auto-immune liver damage and metabolic disease. The next step is to diagnose the cirrhosis in time when it is in no manifest stage. The third step is to diagnose and treat the liver decompensation. It means consequences of the portal hypertension, it is ascit, esophageal or gastric varices, hepatorenal syndrome. Next there are consequences of the metabolic insufficiency, it is icterus, coagulopathy and hepatic encephalopathy. It is necessary to diagnose and cure cholestasis from the very first extrahepatic causes. For a successful treatment of the hepatocellular carcinoma originated almost exclusively in the grounds of the cirrhosis must be early diagnosed. The ambulant internist respective hepatologist must diagnose the stage of the cirrhosis and decide when a hospitalization is necessary. Also a close cooperation with other specialists is urgent if it is about a liver transplantation. The treatment of successive stages of the cirrhosis is a topic of the showed educational article.

Key words:
compensated/decompensated liver cirrhosis – diet/nutrition in liver cirrhosis – etiology and diagnose of liver cirrhosis – treatment of liver insufficiency/failure – treatment of portal hypertension and its complications

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