Treatments for Alcoholic liver disease
Treatments for Alcoholic liver disease
The list of treatments mentioned in various sources
for Alcoholic liver disease
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Zinc - possibly used for treatment of related zinc deficiency
Alcoholic liver disease: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Alcoholic liver disease may include:
Hidden causes of Alcoholic liver disease may be incorrectly diagnosed:
Alcoholic liver disease: Research Doctors & Specialists
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- Liver Health Specialists (Hepatology):
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Latest treatments for Alcoholic liver disease:
The following are some of the latest treatments for Alcoholic liver disease:
- Aldehyde dehydrogenase inhibitors
- Curcumin
Hospital statistics for Alcoholic liver disease:
These medical statistics relate to hospitals, hospitalization and Alcoholic liver disease:
- 0.15% (19,130) of hospital consultant episodes were for alcoholic liver disease in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 61% of hospital consultant episodes for alcoholic liver disease required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 67% of hospital consultant episodes for alcoholic liver disease were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 33% of hospital consultant episodes for alcoholic liver disease were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Alcoholic liver disease
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More general information, not necessarily in relation to Alcoholic liver disease,
on hospital and medical facility performance and surgical care quality:
Discussion of treatments for Alcoholic liver disease:
Those with
cirrhosis often feel better, and the functioning of their liver may
improve, if they stop drinking. Although liver transplantation may be
needed as a last resort, many people with cirrhosis who abstain from
alcohol may never need liver transplantation. In addition, treatment for
the complications of cirrhosis is available. (Source: excerpt from
Alcohol What You Don't Know Can Harm You: NIAAA)
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Book Excerpts: Treatment of Alcoholic liver disease
Treatments of Alcoholic liver disease: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the treatments of Alcoholic liver disease.
Hepatomegaly:
Treatment
(In a Page: Signs and Symptoms)
-
Heart failure: Diuretics, inotropes, and afterload reduction
-
Viral hepatitis: Supportive care and antivirals in some chronic cases
-
Alcoholic liver disease: Abstinence from alcohol, steroids in severe cases, and possible transplant
-
Fatty liver: Treat underlying obesity, diabetes, hyperlipidemia
-
Sarcoidosis: Steroids
-
Hemochromatosis: Iron removal by weekly phlebotomy for 2–3 years and/or deferoxamine chelation
-
Wilson's disease: Copper chelation with D-penicillamine or trientine; may require liver transplantation
-
Neoplasms: Resection and chemotherapy
-
Abscess or cyst: Antimicrobials, percutaneous drainage, and/or surgical resection
-
Amyloidosis: Prednisone and alkylating agents
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Jaundice:
Treatment
(In a Page: Signs and Symptoms)
-
Discontinue and avoid potentially hepatotoxic medications
-
Supportive care for viral hepatitis
-
Rehydrate/refeed for Gilbert's syndrome
-
Consider steroids in fulminant alcoholic hepatitis
-
Cholecystectomy or ERCP with stone removal for obstructing gallstones
-
Treat underlying causes of hemolysis or other disorders
-
Antibiotics for cholangitis, sepsis
-
Hydroxyurea and folate for sickle cell disease, prevent crises by adequate hydration, vaccinating against diseases, and try to prevent other infections
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Ascites:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment is directed at underlying cause
-
Bed rest, fluid, sodium restriction is the first line
-
Diuretics: Careful use in selected cases
-
Chylous ascites
–High-protein, low-fat diet supplemented with medium-chain triglycerides
–Parenteral nutrition may be needed to decrease lymph flow and supplement nutrition
–Laparotomy may be indicated for failed dietary management, to seal leak site
-
Surgical intervention: Bile or urine ascites
-
Therapeutic paracentesis: May be repeated to relieve respiratory distress or impending umbilical rupture
-
Portacaval shunt or a peritoneovenous shunt (LeVeen) for intractable ascites
–Shunt between peritoneal cavity and superior vena cava
-
Transjugular intrahepatic portosystemic shunt (TIPSS) for cirrhosis while awaiting transplantation
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hepatomegaly:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Geared towards specific disease
-
Cholestasis
–Ursodeoxycholic acid
–Supplemental fat soluble vitamins A, D, E, K
-
Infections
–Consider interferon for hepatitis B
–Consider interferon and ribaviron for hepatitis C
-
Toxins
–Use of NTBC for tyrosinemia
-
Metabolic disease
–Metabolism consultation
–Often requires specific restricted formulas
-
Surgical repair for biliary atresia
–Kasai portoenterostomy has better outcome if done before 60 days of age
-
Mucomyst for acute acetaminophen toxicity
-
Immune suppression for autoimmune hepatitis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Jaundice in Infants – Direct:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Varies by specific disorder
-
General medication principles of cholestasis include
–Promoting bile flow with ursodeoxycholic acid
–Consider phenobarbital (increases bile excretion)
–Fat-soluble vitamins including K, D, E
–Vitamin A is a relative contraindication given hepatotoxicity at high levels
Consider formula with medium chain triglycerides as fat source (does not require bile acids to be absorbed)
Treat underlying disorder
–Kasai portoenterostomy for biliary atresia
–Surgical repair of choledochal cyst
–Special formulas for tyrosinemia
–Lactose free formula for galactosemia (e.g., soy based)
–Remove toxic exposures
–Treat infections
–Treat hypothyroidism
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Jaundice in Infants – Indirect:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment options vary based on level of bilirubin, age of presentation, and cause
–Goal is prevent levels high enough to cause kernicterus
-
Phototherapy involves the use of photon energy to change the structure of bilirubin and permit excretion without glucuronidation
–Decisions for use are age-based
–Considered when serum level above 14 mg/dL
-
Exchange transfusion should be considered with serum levels above 25 mg/dL
-
IVF or breast-feed more frequently to increase volume
-
-
-
Correct endocrine abnormality
-
Improve perfusion if cardiac problem
-
Correct anatomic abnormality
-
Consider enteral binding agents
–Cholestyramine, charcoal, calcium phosphate
-
Crigler-Najjar: Phenobarbital, may need liver transplantation
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Alcohol-related disorder:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.
Treatment of chronic alcohol abuse requires a varied approach that may include medications to deter alcohol use and treat effects of withdrawal; psychotherapy, consisting of behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy involves a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress in the event he consumes alcohol up to 2 weeks after taking it. Disulfiram is contraindicated during pregnancy and in the patient with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.
The first drug approved by the U.S. Food and Drug Administration for the treatment of alcohol-related disorder since disulfiram is naltrexone, an opiate antagonist that effectively reduces the amount of intake, severity of craving, and relapse incidence. It’s believed to work by preventing the effects of increased endorphins produced as a product of increased alcohol intake.
For long-term success, the recovering individual must learn to fill the place alcohol once occupied in his life with something constructive. Therapy using disulfiram or naltrexone may only substitute one drug dependence for another, so it should be used prudently.
Benzodiazepine isn’t recommended during rehabilitation due to its addictive nature and the potential for reinforcing the substance abuse behavior.
ELDER TIP Because the older patient may be more sensitive to these drugs, withdrawal may take longer (weeks or months) and be more severe than in a younger adult.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are helpful. In AA, a self-help group with more than 1 million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA’s members stay sober as long as 5 years, and 30% stay sober longer than 5 years.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cirrhosis and fibrosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is designed to remove or alleviate the underlying cause of cirrhosis or fibrosis, prevent further liver damage, and prevent or treat complications. The patient may benefit from a high-calorie and moderate- to high-protein diet, but developing hepatic encephalopathy mandates restricted protein intake. In addition, sodium is usually restricted to 200 to 500 mg/day and fluids to 1 to 1½ qt (1 to 1.5 L)/day.
If the patient’s condition continues to deteriorate, he may need tube feedings or total parenteral nutrition. He may also need supplemental vitamins — A, B complex, D, and K — to compensate for the liver’s inability to store them and vitamin B12, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
Drug therapy requires special caution because the cirrhotic liver can’t detoxify harmful substances efficiently. When absolutely necessary, vasopressin may be prescribed for esophageal varices, and diuretics may be given for edema. However, diuretics require careful monitoring because fluid and electrolyte imbalance may precipitate hepatic encephalopathy. Encephalopathy is treated with lactulose. Antibiotics are used to decrease intestinal bacteria and reduce ammonia production, which causes encephalopathy. Coagulopathy may be treated with blood products or vitamin K.
Low-protein diets are controversial. They aid in managing acute hepatic encephalopathy but are rarely necessary in chronic conditions because of the underlying protein-calorie malnutrition.
Paracentesis and infusions of salt-poor albumin, in addition to fluid and salt restriction, may alleviate ascites. Surgical procedures include treatment of varices by upper endoscopy with banding or sclerosis, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension. (See Portal hypertension and esophageal varices, page 758, and Circulation in portal hypertension, page 759.)
Alert If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Jaundice [Icterus]:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Alcoholism:
Treatment
(Handbook of Diseases)
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous, may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding. Acute withdrawal is also treated with oral multiple B vitamins, including thiamine. Administer fluids as needed, but avoid overhydrating the patient.
CLINICAL TIP: The possibility of intoxication with other drugs should be considered and a blood or urine sample sent for toxicology as appropriate.
Treatment of chronic alcoholism involves counseling, education, and cognitive techniques; psychotherapy (consisting of behavior modification techniques, group therapy, and family therapy); and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy may involve a daily oral dose of disulfiram to prevent compulsive drinking. (See Avoiding the risks of disulfiram therapy.)
UNDER STUDY: The opioid-antagonist drug naltrexone has been shown to reduce the ability to return to drinking and shorten periods of relapse. Longer-term trials are needed.
Tranquilizers, particularly the benzodiazepines, are used to decrease withdrawal symptoms of the central nervous system and are administered routinely to decrease risk of seizures. These drugs are administered and decreased over 3 to 5 days. Status epilepticus should be treated aggressively; initial treatment with lorazepam I.V. is effective.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are also helpful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cirrhosis:
Treatment
(Handbook of Diseases)
The goals of treatment include removing or alleviating the underlying cause of cirrhosis or fibrosis, preventing further liver damage, and preventing or treating complications.
Dietary measures
The patient may benefit from a high-calorie and moderate- to high-protein diet, but if the patient develops hepatic encephalopathy, protein intake must be restricted. In addition, sodium is usually restricted to 400 to 800 mg/day; fluids, to 1,000 to 1,500 ml/day.
If the patient’s condition continues to deteriorate, he may need tube feedings or hyperalimentation. Other supportive measures include supplemental vitamins — A, B complex, D, and K — to compensate for the liver’s inability to store them and vitamin B, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
Drug therapy
With cirrhosis, drug therapy requires special caution because the cirrhotic liver can’t detoxify harmful substances efficiently. Alcohol is prohibited; sedatives should be avoided or prescribed with great care. Acetaminophen is especially hepatotoxic, particularly when combined with alcohol.
When absolutely necessary, an antiemetic, such as trimethobenzamide or benzquinamide, may be given for nausea; vasopressin, for esophageal varices; and a diuretic, such as furosemide or spironolactone, for edema. However, if the patient receives a diuretic, careful monitoring is necessary; fluid and electrolyte imbalance may precipitate hepatic encephalopathy.
Vitamin K may be given for bleeding tendencies due to hypoprothrombinemia. Transfusion of blood and fresh frozen plasma may also be necessary.
A beta-adrenergic blocker may be given to decrease pressure from varices.
Lactulose may be given orally or rectally to reduce a high ammonia level. If lactulose therapy alone is inadequate, neomycin may be used.
Other treatment
Paracentesis and infusions of salt-poor albumin may alleviate ascites. Surgical procedures include ligation of varices, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension.
Clinical tip Transjugular intrahepatic portosystemic shunt is an alternative to surgical shunting in patients with variceal bleeding refractory to standard therapy. It’s also helpful in patients with severe ascites. The technique involves insertion of an expandable metal shunt between a branch of the hepatic vein and portal vein over a catheter inserted via the jugular vein. This is usually a bridging mechanism to control variceal bleeding or ascites until liver transplantation can be performed.
Hepatorenal and hepatopulmonary syndromes may occur. Treatment is ineffective except in patients who are acceptable candidates for liver transplantation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hepatomegaly:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to avoid alcohol. Explain the importance of following the treatment plan to correct or control the underlying disorder as needed. Tell the patient to avoid exposure to people with infections and to maintain good personal hygiene. Explain the importance of pacing activities and having frequent rest periods.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Jaundice:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals. Teach the patient ways to reduce pruritus.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hepatomegaly:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for liver enzyme, alkaline phosphatase, bilirubin, albumin, and globulin studies to evaluate liver function and for X-rays, a liver scan, celiac arteriography, a computed tomography scan, and ultrasonography to confirm hepatomegaly.
▪ Provide bed rest, relief from stress, and adequate nutrition to help protect liver cells from further damage and to allow the liver to regenerate functioning cells.
▪ Monitor and restrict dietary protein as needed.
▪ Give hepatotoxic drugs or drugs metabolized by the liver in very small doses, if at all.
Patient teaching
▪ Explain the underlying disorder and its treatments.
▪ Stress the importance of avoiding alcohol and people with infections.
▪ Discuss the importance of pacing activities and rest periods.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Jaundice [Icterus]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To decrease pruritus, frequently bathe the patient; apply an antipruritic lotion, such as calamine; and administer diphenhydramine or hydroxyzine.
▪ Prepare the patient for diagnostic tests to evaluate biliary and hepatic function, including laboratory studies (such as urine and fecal urobilinogen, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count), computed tomography, ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
Patient teaching
▪ Teach the patient appropriate dietary changes.
▪ Discuss ways to reduce pruritis.
▪ Review with the patient prescribed medications and their possible adverse effects.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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