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Treatment Flow Sheet For Patient With Cirhhosis
Treatment Flow Sheet For Patient With Cirhhosis
Treatment Flow Sheet For Patient With Cirhhosis
Not recommended
Nitrates alone,
sclerotherapy, shunt
surgery, TIPS
Albumin is
recommended in
patients with renal
dysfunction and
hyperbilirubinemia
(bilirubin >4 mg/dL)
at time of SBP
diagnosis
Avoid interventions
that may further
decrease intravascular
volume (e.g. large
volume paracentesis,
diuretics)
Secondary Recommended therapy Prophylaxis should be
Prophylaxis Oral norfloxacin 400 mg PO QD; oral given until the
ciprofloxacin 250 mg QD; oral disappearance of
levofloxacin 250 mg QD ascites, time of
transplantation, or
Alternative therapy death
Trimethoprim-sulfamethoxazole
onedouble-strength tab PO every day Patients who develop
quinolone-resistant
Not recommended organism may also
have resistance to
Weekly ciprofloxacin trimethoprim-
sulfamethoxazole
Table A-3. Recommended management of ascites
Ascites Type Recommendations Comment
Uncomplicated Recommended therapy Recommended sodium
Ascites Sodium (salt) restriction +/- restriction of no less than 2
g/day
Diuretics (spironolactone +/-
furosemide) Dose of diuretics:
spironolactone 100-400
Initial LVP plus albumin mg/day, furosemide 40-160
infusion in hospitalized mg/day
patients with moderate or
tense ascites Dose of albumin 6-8 g/L of
ascites removed
Adjustment in diuretic
dosage should be performed
every 4-7 days
Alternative therapy
TIPS in patients who require
frequent LVP
Not recommended
TIPS or PVS as first-line
therapy
Dopamine
Dialysis
Nutritional support
Not recommended
Long-term protein restriction
Helicobacter
pylori eradication
CPT Classes:
A = 5-6 points
B = 7-9 points
C = 10-15 points