Treatment Of Ascites And Edema In Patients With Hepatic Cirrhosis [35

Salt restriction and diuretics may be used in patients with cirrhosis to reduce mechanical derangements and enhance patient comfort. However, these treatments do not correct or reverse the underlying hepatic abnormalities. The therapeutic goal of such therapy is the reestablishment of salt and water balance at more clinically acceptable levels of ascites and edema. Complete elimination of detectable edema and ascites is rarely possible or desired. Indeed, attempts to eliminate completely edema and ascites may produce circulatory insuffi ciency and precipitate renal failure. Aggressive diuretic efforts are also likely to produce profound electrolyte abnormalities.

Tense ascites and edema do produce significant adverse clinical consequences which can be mitigated by judicious treatment. Ascites can exacerbate gastroesophageal reflux, contribute to anorexia, and possibly increase portal venous pressures, which will heighten the risk of variceal bleeding. Massive ascites in cirrhotic patients commonly becomes infected and the abdominal wall pressure may produce umbilical eventration skin ulceration and necrosis. Elevation of the diaphragms restricts respiration and contributes to development of basilar atelectasis.

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