Treatment of liver cirrhosis and ascites
An important aspect of treating a patient suffering from cirrhosis of the liver, which is accompanied by ascites, is its mode of life and nutrition.
Here are some general tips that cana positive impact on the quality of life of the patient. The best means to eliminate fatigue is a vacation, especially sleep. Because of the threat of bleeding from varices (hemorrhoidal, esophageal) should not lift weights. Control bowel movement frequency - the best to do it twice a day, with a tendency to constipation should increase the amount of dietary plant fiber (wheat bran), the ineffectiveness of honey - Add lactulose. This drug is a synthetic carbohydrate which is not digested or absorbed in the intestine. Due to this, lactulose has laxative effect. In addition, regular bowel movements in patients with cirrhosis is the basis of prevention in the home of disorders of the brain that experts combined the term "hepatic encephalopathy". This is achieved thanks to another important property of lactulose - the ability to facilitate the vital functions of normal intestinal microflora (lactic acid bacteria and bifidobacteria) and by inhibiting the processes of decay, worsen the conditions of the "life" of pathogenic bacteria.
Thus, on the one hand, lactulose,having a laxative effect, toxins from the body, and on the other, reducing their formation and, consequently, absorption in the intestine. The average therapeutic dose of lactulose ranges from 1 teaspoon to 1 tablespoon 2-3 times a day, preferably on an empty stomach. In some cases, may require higher doses of the drug. The criterion for the adequacy of the dose of lactulose is mushy stools 2-3 times a day. The drug was well tolerated.
The appearance can cause bloatingdose reduction to facilitate the digestion of the protein, and especially fatty foods patients should periodically receive polyenzyme formulations whose composition is approximately identical, and the differences are mainly determined by the amount contained therein of digestive enzymes and / or additional components (bile, gastric pepsin, etc. .) regular measurement of the body weight, abdominal volume allows the navel, in the case of an increase of one or two abovementioned parameters to identify promptly fluid retention, and therefore, it quickly respond to tightening control of salt intake to 0.5 g per day, a fluid - up 1000-1500ml day; more precise control of consumption and fluid control is achieved by daily water balance: calculation of the amount of liquid taken orally (drinks, including water, first courses, fruit, etc.) and urine. For a patient with liver cirrhosis with slight edema of the limbs and the absence / small amount of fluid in the abdomen (ascites) should strive for a water balance, so that it stands out from the 200-400 ml of liquid is greater than consumed (the so-called positive diuresis).
When expressed swelling of the extremities, ascites,which leads to an increase in the abdomen, should seek to ecuresis was 700-1000 ml per day and maintained at a level to reduce the severity of edema syndrome. Typically, a positive urine output is achieved through the use of diuretic drugs (their choice, form and frequency of administration are determined by the doctor). The most frequently used furosemide, a potent diuretic which has a dose-dependent effect and wide "therapeutic window" (the ability to receive, from 40 mg to several grams per day). However, the excessive secretion of fluid (higher values of positive urine output) is not desirable because it can provoke the appearance / progression of hepatic encephalopathy in patients with liver cirrhosis. In such cases, you should immediately contact your doctor and discuss with him the number and frequency of receiving diuretics. A simple and sensitive method for monitoring the severity of hepatic encephalopathy is a test to assess the patient's handwriting. To this day he is asked to write down in a notebook the same short phrase. It is important that the handwriting is not evaluated by the patient and his environment. Deterioration of handwriting - the certificate of increase of hepatic encephalopathy, and therefore the signal for correction of diets (see below.) And increasing doses of lactulose. If the situation does not improve - it should be discussed with your doctor.
Diet in cirrhosis and ascites
Daily kalorazh food for patients with cirrhosisliver usually is 2500 kcal, in the diet with protein-rich products are limited. This is due to the fact that such patients inherent difficulty of digestion and absorption of food protein enhances intensity decay processes in the gut. As a result of increased absorption of toxic to the liver, the brain protein breakdown products with worsening liver disease. That is why for most of the patients the daily need for protein is 80-100 g, preferably in the form of food rich in this component of the plant.
In case the patient's liverencephalopathy protein intake is limited to 50 grams per day, sometimes useful to make a "protein-free" days, filling calories from carbohydrate. Due to the desirability of salt during cooking limit its specifically add some salt. To eliminate the temptation - and there should be no salt on the table while eating a patient with liver cirrhosis. Exclude and sodium-rich mineral water.
Excluded are any products containing bakingpowder and baking soda (cakes, biscuits, cakes, pastries and the usual bread), as well as pickles, olives, ham, bacon, corned beef, tongue, oysters, mussels, smoked herring, canned fish and meat, fish and meat pate, sausage , mayonnaise, various canned sauces (except salt-free), all kinds of cheese, ice cream.
Preference should be given to salt-freeproducts. To improve the taste of food (it should excite the appetite), it is prepared with the addition of a variety of spices and seasonings: lemon juice, orange peel, onion, garlic, pepper, mustard, sage, thyme, parsley, marjoram, bay leaf, cloves, etc. .
From permitted in patients with cirrhosis of the liver products should be called veal or poultry, rabbits up to 100 grams per day, low-fat varieties of fish. One egg is equivalent to 50 grams of meat.
Milk is limited to one glass per day. Perhaps nereguryanoe consumption of low-fat sour cream. Boiled rice is consumed only without the salt. Any fruits and vegetables fresh or in the form of dishes prepared at home, should form the basis of the diet of the patient with liver cirrhosis.