1.

Evolution

-good evolution if we correct the : etiologic factor, hipoalbuminemia , hipoprotrombinemia , serum

creatinine , hiponatremia.

-alchoolic cirrhosis : good prognosis if the patient stops drinking alchool , 5 years survival rate=16%

2.Prognosis

Calculated with Child pugh score and MELD

Bilirubin: 4 3p creatinine 0.6

Albumin: 21 3p bilirubin 4

Ascites: important 3p inr 1.8

Encephalopathy:moderate 2p sodium 136

PT index: 40 2p

13points – Child pugh C 21points - 19.6% Estimated 3-Month Mortality

3.Treatment

-removal of the etiologic factor

-bed rest , 1h postprandial (helps digestion and absorbtion)

-Alimentation:increase chaloric intake but not that much proteins (facilitates encephalopathy)

-group B vit , folic acid , zinc , selenium replacement

-low salt intake, in decompensated patients aprox 2g/day salt intake

-protein sparing diuretic: Spironolactone(start with Spironolactone 100mg , than add Furosemide
40mg,then increase both with mantaining tha ratio until Spironolactone 400mg , Fruosemide 160mg)

-Normix 200 mg – prevents diarheea , adjuvant treatment in hiperamonimia

- Ursofalk 250mg – for biliary stones

- Lactulose – treatment of constipation and encephalopathy

- Propanolol 40mg/day – non selective beta blocker to treat portal hipertension ( varices )

- Fenobarbital 100mg : cholestatis and encephalopaty

4.Particularities

The patient was presented to the gastroenterology departemnt with an albumin of 21 g/L

5.Limitations

Low survival rate of an average of 16% in 5 years due to the decompensation status