1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. Goals
2.1.1.1. resolve the symptoms
2.1.1.2. slow the progression
2.1.1.3. prevent and treat complication
2.1.2. alcohol
2.1.2.1. absitence from alcohol
2.1.2.2. pharmacological is controversial?
2.1.2.3. alcohol withdrwal
2.1.2.3.1. diazepam 20 mg
2.1.2.3.2. Thiamin
2.1.2.3.3. hydration
2.1.2.4. corticosteriods for severe cases
2.1.2.4.1. not a first-line
2.1.2.5. patient improves after 6-12 mo after the complete cessation
2.1.2.6. Rehabilitation
2.1.2.6.1. family support
2.1.2.6.2. should be reffered to phcyctery
2.1.2.6.3. group therapy
2.1.3. cirrhosis
2.1.3.1. for ascites
2.1.3.1.1. diuretics
2.1.3.1.2. plan for weight loss is 0.5 kg\day
2.1.3.1.3. IV albumin or theraputic paracentesis might work
2.1.3.2. HCC
2.1.3.2.1. follow-up every 6 mo
2.1.4. hepatitis B
2.1.4.1. interferon
2.1.4.1.1. contraindicated in case of advanced cirrohsis
2.1.4.2. entecavir
2.1.4.3. vaccination
2.1.4.3.1. HAV
2.1.4.3.2. influnza
2.1.4.3.3. pnumoccoci
2.1.5. Nutrition
2.1.5.1. Thiamine supplemntation
2.1.5.2. high calories and protein diet
2.1.5.3. low salt diet
2.1.5.3.1. helps in ascites
2.1.5.4. Vitamin C
2.1.5.5. Vit. D and calcium
2.1.5.5.1. to prevent osteoprosis
2.1.5.6. Zinc
2.1.5.6.1. improves appetite
2.1.6. Liver transplant
2.1.6.1. should stop alcohol for 6 mo
2.1.6.2. contraindication
2.1.6.2.1. cardiovascular and pulmonary diseases
2.1.6.3. 5-year survival rate more than 80 %
2.1.7. Follow up and monitor regulary
2.1.7.1. US annually
2.2. Prevention
2.2.1. primary
2.2.1.1. limiting alcohol consumption
2.2.1.2. vaccination for hepatitis viruses
2.2.1.3. avoidance of hepatitis transmitting behaviors
2.2.2. secondary
2.2.2.1. blood donors screening
2.2.2.2. screen for health care providers
2.2.3. tertiary
2.2.3.1. prevent the complications
2.2.3.2. NSAIDs and hepatotoxic drugs