Protocol clinic standardizat pentru medicii de familie Pome) Ciroza hepatica compensata la adult ‘Codul bot (c1m 10) 703 Chroza alcool a fata rozahepatca __KT44 Clozabllaa secundard 717 Nectarea toxicaa feat ca brad y chaz’ K74.3 Craza bars prmitva K74.5 Choza bird fara preczare 746 Cioza feat ates nepreczate) ‘Gauze principale ale GH Frecvante:hepatte cronice B,C 1D (= 25%), bola alcool a eau (= 20-40%), riptogene (de etologle necunoscut) (= 10~ 40%) © Rare (<10%): steatohepatanonaleoolia (= 10%), hepatta auoimuna, raza bilara pemtva, medicaments gi eubstante chime orice (= 5%) Fare rare (= 1): hemorromatoza, boala Wison,isufcienia de canted, crazabilara senders, sindromal Bud-Chian, neuen ‘everd a vertu dept oe Clasiicares clinics « CH Eologio: vel, alcool, modicamentoasd, ata (de procizat > Aetvtae: faza act, a2 neactiva, hopaita acu pe funda do ‘uloimuns, bara priv, bard secundaré etc), crplogend Evol. stabi, lent progresiv, rapid progresiva Morfologie’ micronoduar, macronodlar mist Grad de hiperensiuns potala| » Grad da compensare: compensa, subcamponsalé, decompensat Clasiicarea prognostic CHILD-PUGH Conform abel se ealeuleaza sume in mm eee ee cso Cle | eeseacnn eat a San aae Ss = cas sense a a a 7-9 puncte ~ casa B See Smear] apnea ara = = [—tenenngare —] Tn ca oie GH compensa pre cue aeseask Tale: Dopara rece « Heo oi ai] ‘Schema de examinare a persoanelor din grpurile de rise pentru depistarea precoce a CH 1 use 2. ALT.AST, GGTP, biiubind, albunind,prtombins hemogram cu rombocte 3\_ Screening serologic: HBsAg, ant-HBcor, ant-HV gia. dupa inca comer aeri com rs ee acon x Ppate conc vale roosoaee ep cone 7 ota Paco sotor reat - = Pater tear Ropes tentchepat norlcooi - a ABE 1 Spe Cnc 0 DDS Toate, Gey sat POR Pas Ga 2 | setae pnts bon Sea Pancha a ar sare toa re aaa Parcs aarinsre ser Sala rede ators 1 aap water = po Enintsatynodarisns eurovoo_anstpetons Se] Pees aoa ob nen cers tn aS pe eparaar dein) | “a | pels Seen aaa ea Tafa aang gas aaa SE oes en oc a ees | ae a Sea eee eae 2 re aoe ee soe cee a ees ee | anne es Tso sm ——— | Seer ee ee ee ees ge eo a Soe ee | oT nad tone Eee | Toons eens bone pa a Ponag site Poomeeniahe | vilienalis > 10 mm sindrom hemoragipar “minimal ~ ALT siisau, een oa =e | STs onras ae eee oa a ces om an oe a) a 2 eerie = eae Consultafa gastrofoguuthepatologulul 2orilan in caz de evoljia tabla sau ant progres apaila semnelor de dacorpansare@ bol: enosfaloate hapa, acta, hemoragel > somnele CH depstale pony prima dath \ariceale, npersplenismuls et. hepatta acuti pe fond de croza hepaticaspitalzar ‘semnele CH depisate penta prima data ‘vollia prOgr@sva a boli, apariia sermnelor de sindroame-complcah hepatita acuta pe fon de craza hepatica ale cH inierea tratamentull anivial, cv glucocorticostero2, faza actvd a CH f8ra dinamicd poziva pe fond de tratament imunodepresante etc. ambulator ecestatea intervenilor si procedulor dagnostice gisau terapeutice atologia concomitent care poate agrava evoluia craze are pu pot f execute in conltile de ambulator (aparoscopi, (Gneumenia, vasculta hemoragica, ecutzarea pislonetiel etc) paracenteza, biopsa fleatlu,igaturarea sau sclerozarea varioelor ete.) Tratementul ‘Medificiri de comportament Ia pacten}i cu GH: ‘eviarea stetd a corsumlu de alcool renunjarea la: ‘munca cu eft mini medicamentele hepatotoxice ‘xcuderea surmenajuui fe gipshic cextractele hepatica fcinna sour in timpul Zi, feiterapia cu incdlzres regiui eat alent rajonala fracjonata de 46 orzi (masa 5 dupa Pevzner) tratamentul balnear Cee ee Cee “Tratament_hepatoprotector gi antfbatic: = Silman’ 280-420 mg zn, 1-8 lui, 2 eran + Pentoxifins 4100-200 m_x3 ofii sau 400m _x 1-207, 1-3 un, 2 ofan “Tatamnentulantoxdant- Viarine EAC Doze terapoutce medi 12 tun, Fz ofan P-adrencblocante: Propranolol sau Nadool sau 410-40 maiz, permanent sau 40-80 mg/2, permanent TAN Tor al erate de conve Enalapril sau Lisinopril 5-10 mg nictimeral permanent ‘Nira [sonra mononiat (indi bea Spirondlactona 30.200 mg nie permanent “Tratament antiviral ‘Aprecierea necesti gl iijerea alamentullanival se efeclueaza in Sect specetzae Tesi deo 025 mg mand cp (da Grae Gapnde do talaga CH) Fosfolpidele senile 600-1200 mi, 2-8 lun, 2 orfan Guucocorteostoroz hn caz de genezit autoimuna) inilerea lerapie in condiide slalonar specail: 40-60 mg tn faza activa cu seddereatraplata (5 mg s8ptaminal) a daze pind la doza de menfinere 5-10 mg , doza de mentinere se admnistreaz timo indelungal = erence) + Ademetionina 400-1600 mg/zi, 2 saptamini, 2-3 orifan “Tratament spec pentru CH de elloioge rara + Flebotomi epetate chelator al feriui (Deteroxamina) | initerea trapiel In condi de statonar specializat Cheater a cupralu (O-pericilamina) Psologie in funcio de stadiu,acvtatea boli graspuns la tratament Viamineterapia: 8, By, By, acid folic oe. (ivcaz de alologla | Daze terapautice medi, 24 sipt, 28 or/an alcool, defcenfa vtamineior) opatoprotectoare de aigine vegetal Ta comprmatels, Suni 2 oan BioR™ ‘Simgi2 one, 2-3 uni 2ovVan Pacoverna™ 1-2 caps. 2 oi 6-12 nh ee) *- efcasitates medicamentelor nu esle dove tn stl randomizae, controle" - eficaclatea medicamentelor este dovedité Insts locale ‘Supraveghorea paciontilor cu CH de citre modicul de familia le Freeventa ‘Supravegherea la medicul de famile 2 orlan Evaluarea encefaiopate: (teste pshomnetice), aseTel Zoran Hiemoleucoqrama, vompociole Zoran ALT. AST, bilrubind,protrombind,(peritu evaluarea gradulul de aciviate g de mneufionla hepatica) [2 on/an ‘Alfa-feloproleina (pena sereaning-l canceruui hepatic primar) USG organelar abdominal Zaalan ECG, miroraciogrefia ciel foradice analza generalé a url $2 orien Cosultajia mecicul_gastologihepatolog, chug, gastrochirurg Feorian ‘Suplimentar (Ia indica “Markeri viral: HBsAg, ant-HBcor, ent-HCV, ant-HOV etc. Colesorobl lueoza,K.Na, ree, eretinina protein foal fractile ot FOU! “Abrevierilofolonite In document ALT —alaninamincransfraza AST aspartataminotranstoraza H@sAg- antigen superficial (s) al vrusulut ‘ni Hoo antcog a antigonal HBcor (Caps. -capsuld hopate B (hepaliisB s antigen) {nil-HBe- anteor ia antgordl He GH croza hepatica HG hepatt erniea anil -HBs- anticorp la antigen HB ~ elecvocarogram’ iim. invamuscutar anil -HCV anor a visu hepatic © FGDS - brogastoduodenoscopie ine invavenos ant -HOV- anteorl a viusu hepatic D GGTP — gamagiutamivanspoptidaz USG -ulvasonogratio,