t/t of ALD 1
#ALD #harrison #liver #medicine
Complete abstinence from alcohol is the cornerstone in the treatment of alcoholic liver disease. Improved survival and the potential for reversal of histologic injury regardless of the initial clinical pre- sentation are associated with total avoidance of alcohol ingestion. Referral of patients to experienced alcohol counselors and/or alco- hol treatment programs should be routine in the management of patients with alcoholic liver disease. Attention should be directed to the nutritional and psychosocial states during the evaluation and treatment periods. Because of data suggesting that the pathogenic mechanisms in alcoholic hepatitis involve cytokine release and the perpetuation of injury by immunologic processes, glucocorti- coids have been extensively evaluated in the treatment of alcoholic hepatitis. Patients with severe alcoholic hepatitis, defined as a dis- criminant function >32 or MELD >20, should be given prednisone, 40 mg/d, or prednisolone, 32 mg/d, for 4 weeks, followed by a ste- roid taper (Fig. 335-1). Exclusion criteria include active gastrointesti- nal bleeding, renal failure, or pancreatitis. Patients with infection can be concurrently treated with antibiotics and steroids. Women with encephalopathy from severe alcoholic hepatitis may be particularly good candidates for glucocorticoids. A Lille score >0.45, at http:// www.lillemodel.com, uses pretreatment variables plus the change in total bilirubin at day 7 of glucocorticoids to identify those patients unresponsive to therapy.
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- owner: nerdparty67 - (no access) - HARRISON Principles of Internal Medicine 20th Edition.pdf, p2400
- owner: Anonymouse - (no access) - @MBS_MedicalBooksStore_2018_Harrison's.pdf, p2446
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