Ghid/Protocol terapeutic in encefalopatia hepatica 1
Ghid/Protocol terapeutic in encefalopatia hepatica 1
Ghid/Protocol terapeutic in encefalopatia hepatica 1
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<strong>Ghid</strong>/<strong>Protocol</strong> <strong>terapeutic</strong> <strong>in</strong> <strong>encefalopatia</strong> <strong>hepatica</strong><br />
1. Identificarea si elim<strong>in</strong>area factorilor precipitanti<br />
• corectia diselectrolitemiei<br />
• tratamentul <strong>in</strong>fectiilor cu antibiotice<br />
• adm<strong>in</strong>istrarea de antagonisti specifici la cei tratati cu sedative<br />
• controlul hemoragiei digestive<br />
• elim<strong>in</strong>area sangelui d<strong>in</strong> tubul digestiv<br />
Masuri de clearence colonic<br />
• lactuloza per oral<br />
• clismele cu lactuloza<br />
ENCEFALOPATIA HEPATICA<br />
1. Identificarea si elim<strong>in</strong>area factorilor precipitanti<br />
2. Modificari dietetice<br />
3. Reducerea productiei de amoniu si elim<strong>in</strong>area compusilor azotati d<strong>in</strong> <strong>in</strong>test<strong>in</strong>.<br />
2. Modificari dietetice<br />
• dieta hipercalorica<br />
• dieta hiperproteica bazata pe vegetale si<br />
derivate de case<strong>in</strong>a (0.8 –1.5 g prot/Kg/zi)<br />
• restrictia tranzitorie de prote<strong>in</strong>a la 0.5 g/Kg/zi<br />
• sol. de am<strong>in</strong>oacizi (hepatam<strong>in</strong>e)<br />
3. Reducerea productiei de amoniu si elim<strong>in</strong>area compusilor azotati d<strong>in</strong> <strong>in</strong>test<strong>in</strong><br />
Antibioticele non resorbabile<br />
• Neomic<strong>in</strong>a 2-4 g/zi 7-10 zile cu sau fara lactuloza<br />
• Rifaximic<strong>in</strong>a 1200 mg/zi<br />
• Metronidazol 4x 0.2 gr/zi<br />
• Vancomic<strong>in</strong>a<br />
Dizaharidele non absorbabile<br />
• lactuloza 15-30 ml/zi, sand<strong>in</strong>a 300 ml / 1l apa<br />
• Lactilol sau clisma<br />
Fixarea amoniului circulant<br />
• Ornit<strong>in</strong> – aspartatul<br />
• z<strong>in</strong>cul<br />
1
Actiune pe flora bacteriana <strong>in</strong> <strong>in</strong>test<strong>in</strong>e<br />
• Lactobacillus acidoplusus<br />
• Enterococcus faecium<br />
Masuri generale <strong>terapeutic</strong>e<br />
• suport nutritional (sol glucozate suplimentari vitam<strong>in</strong>ive grup B<br />
• corectia diselectrolitemiei, mai ales a hipopotasemiei<br />
• corectia hipoxiei<br />
• corectia alcalozei<br />
• se evita sedativele, dar sunt permise doze mici de Haloperidol la cei agitati<br />
• suport respirator<br />
Agenti <strong>terapeutic</strong>i care <strong>in</strong>fluenteaza neurotransmisia cerebrala<br />
• Levodopa<br />
• Bromocript<strong>in</strong>a 300 mg de 2 ori/zi<br />
• Flumazenilul 1 mg i.v. <strong>in</strong> bolus<br />
Transplant hepatic<br />
2
3<br />
Costuri
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