Essentials of Diagnosis:-

• Anorexia, weight loss, anaemia, nausea, vomiting, abdominal pain, diarrhoea.
• Palpable, firm liver with blunt edges.
• Ascites.
• Amenorrhoea, impotence, sterility.
• Spider naevi, palmar erythema.
• Splenomegaly, jaundice in some cases.
• Gynaecomastia, testicular atrophy, axillary and
pectoral alopecia are additional findings.
• Pleural effusion, ankle oedema, haematemesis are
late findings.
• Flapping tremor, dysarthria, delirium and
drowsiness are present in pre-coma state.
• Laboratory findings include bromosulphthalein retention, elevated LDH, SGOT, alkaline phos- phatase, bilirubin, decreased albumin, and elevated
gamma globulin.
• Liver biopsy shows diffuse fibrosis and nodular
regeneration throughout the liver.

Treatment:-

Salt upto 500 mg and fluid restriction

-Diuretic like Frusemide.
-Stop alcohol completely.

-High protein diet (100 gm), if required injection Albumin 5 per cent or 20 per cent IV.
-Iron and folic acid for correction of anaemia.
-Vitamin K injection 10 mg IM.
-Tab Propanolol 20 mg twice to reduce portal
pressure.
If ascites is present
-Tab Spironolactone (Aldactone) 100-200 mg/day
increasing by 100 mg every 3 days if no improvement (suggested by 1 kg weight loss in 3 days)
-If no response add Frusemide 20 mg increased to a maximum of 120 mg.
-Check for electrolyte imbalance especially hypokalaemia and alkalosis.
If ascites persists—Human Serum Albumin 5-20 per cent 50-100 ml IV.
-In large ascites panacentesis is done.
If hematemesis is present
-Injection Vitamin K, 10 mg IV for 3 days.
-Injection Pitressin 20 CC diluted in 100 ml 5 per
cent Glucose over 10 minute. or
/Injection Glypressin 2 mg IV 6 hourly for maximum
4 dose.
or

-Injection Somatostatin 250 mg bolus followed by 250 mg/hour.
-Balloon tamponade under vigilant supervision endoscopic sclerotherapy may be done on emer- gency basis since risk of rebleeding is high.
-For long-term endoscopic sclerotherapy-injection of Varcies is done at the interval of 1-2 weeks.
-Propanolol is given in increasing daily dosage to
achieve a pulse rate of 60/minute to check rebleed- ing. Shunt surgery and liver transplantation in suitable cases.
If precoma is suspected
-Restrict protein.
-Neomycin 1 gm 6 hourly orally or through naso-
gastric tube, or
Streptomycin 1 gram six hourly by tube, or Ampicillin 500 mg 6 hourly, or
Lactulose 30 ml tds, or
Metrogyl 800 mg/day.

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