Abstract：
:Major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome. Diagnostic studies on ascitic fluid should include a differential leukocyte count, total protein level, a serum-ascites albumin gradient, and fluid cultures. Therapy consists of sodium restriction, diuretics, and complete abstention from alcohol. Patients with ascitic fluid polymorphonuclear leukocyte counts of 250 cells per mm3 or greater should receive empiric prophylaxis against spontaneous bacterial peritonitis with cefotaxime and albumin. Patients who survive an episode of spontaneous bacterial peritonitis should receive long-term prophylaxis with norfloxacin or trimethoprim/sulfamethoxazole. Patients with gastrointestinal hemorrhage and cirrhosis should receive norfloxacin or trimethoprim/sulfamethoxazole twice daily for seven days. Treatment of hepatic encephalopathy is directed toward improving mental status levels with lactulose; protein restriction is no longer recommended. Patients with cirrhosis and evidence of gastrointestinal bleeding should undergo upper endoscopy to evaluate for varices. Endoscopic banding is the standard treatment, but sclerotherapy with vasoconstrictors (e.g., octreotide) also may be used. Prophylaxis with propranolol is recommended in patients with cirrhosis once varices have been identified. Transjugular intrahepatic portosystemic shunt has been effective in reducing portal hypertension and improving symptoms of hepatorenal syndrome, and can reduce gastrointestinal bleeding in patients with refractory variceal hemorrhage. When medical therapy for treatment of cirrhosis has failed, liver transplantation should be considered. Survival rates in transplant recipients have improved as a result of advances in immunosuppression and proper risk stratification using the Model for End-Stage Liver Disease and Child-Turcotte-Pugh scoring systems.
journal_name
Am Fam Physicianjournal_title
American family physicianauthors
Heidelbaugh JJ,Sherbondy Msubject
Has Abstractpub_date
2006-09-01 00:00:00pages
767-76issue
5eissn
0002-838Xissn
1532-0650journal_volume
74pub_type
杂志文章,评审abstract：:More than 100,000 children are born in the U.S. each year with major congenital defects or genetic disorders, with or without mental retardation. Advances in prenatal diagnosis have now made it possible to detect an increasing number of these disorders in utero. Carrier detection is advised prior to pregnancy, rather ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1977-01-01 00:00:00
abstract：:Acute bronchitis is one of the top 10 conditions for which patients seek medical care. Physicians show considerable variability in describing the signs and symptoms necessary to its diagnosis. Because acute bronchitis most often has a viral cause, symptomatic treatment with protussives, antitussives, or bronchodilator...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2002-05-15 00:00:00
abstract：:Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guideli...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2006-05-15 00:00:00
abstract：:Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic cr...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2015-01-01 00:00:00
abstract：:Prisoners in U.S. correctional facilities constitute a unique patient population in need of health services. Physicians who provide medical services to inmates also must interact with prison officials. Drug withdrawal, self-destructive behavior and infectious diseases, including acquired immunodeficiency syndrome, are...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1988-07-01 00:00:00
abstract：:In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like pep...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2018-01-01 00:00:00
abstract：:Two large kindreds manifesting the "cancer family syndrome" have been studied. Genetic and biologic studies reveal markers which have important implications for cancer detection, control and prevention. Valuable markers may be found in the major histocompatibility system, HL-A. The presence of carcinoembryonic antigen...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1975-03-01 00:00:00
abstract：:Industrial carbon tetrachloride is used in the synthesis of chlorofluorocarbons and chlorinated solvents. Although both production and use of carbon tetrachloride are declining, industrial and hazardous waste sites remain as sources of exposure. Workers using carbon tetrachloride or products that contain it are at hig...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1992-10-01 00:00:00
abstract：:Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence. Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagn...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2020-01-01 00:00:00
abstract：:Although clinical evaluation remains the cornerstone in the diagnosis of multiple sclerosis, magnetic resonance imaging (MRI) has emerged as the ancillary study of choice. An important diagnostic tool, MRI can also be used to assess disease load, activity and progression, and distinguish between acute and chronic lesi...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1993-08-01 00:00:00
abstract：:Eczematous dermatitis is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritus may be stressful and frustrating for patients. The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence. Other comm...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-09-15 00:00:00
abstract：:Heart failure is associated with high rates of morbidity and mortality. Because heart failure is difficult to diagnose accurately on the basis of the history and physical examination alone, It is vital that clinical evaluation such as echocardiography be used to confirm the diagnosis. In addition, it is important to i...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-07-01 00:00:00
abstract：:The classic modes of heat loss affecting the newborn are conduction, convection, radiation and evaporation. The disproportionate ratio of surface area to body weight (SA/BW) of the premature infant is the basis of inefficient heat conservation, combined with a blunted metabolic response. Hypothermia leads to hypoxemia...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1977-11-01 00:00:00
abstract：:Knee effusions may be the result of trauma, overuse or systemic disease. An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation. The most common traumatic causes of knee effus...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-04-15 00:00:00
abstract：:Peritonsillar abscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicr...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2008-01-15 00:00:00
abstract：:The principle of confidentiality is one of the clearest and firmest rules of professional ethics. However, situations can arise in which confidentiality ought to be abridged in favor of other, weightier values. In the case of a teenager who asks a family physician to prescribe birth control pills for her without infor...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1982-01-01 00:00:00
abstract：:Genetic testing may be applied in a variety of clinical situations, including preconception counseling, prenatal diagnosis and postnatal determination of genetic predisposition to disease. The family physician needs to become familiar with the full range of genetic testing possibilities in all phases of the human life...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-05-01 00:00:00
abstract：:Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding associated with NSAIDs are at especia...
journal_title：American family physician
pub_type： 杂志文章,实务指引
doi：
更新日期：2009-12-15 00:00:00
abstract：:Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the pres...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1999-03-15 00:00:00
abstract：:The records of 1,381 patients with gonorrhea were examined by the Massachusetts Department of Public Health to determine the efficacy of their treatment schedules. Urethritis, cervicitis and pharyngitis were treated with 4.8 million u. of aqueous procaine penicillin G intramuscularly, without probenecid. Cure rates we...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1981-05-01 00:00:00
abstract：:The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents mor...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2015-09-01 00:00:00
abstract：:Because the prevalence of urinary incontinence increases with age, a working knowledge of the diagnosis and treatment of the various types of urinary incontinence is fundamental to the care of women. As the population of the United States ages, primary care physicians can expect to see an increasing number of patients...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-12-01 00:00:00
abstract：:The Food and Drug Administration has recommended that blood donated for transfusion in the United States be screened for antibodies to human T lymphotropic virus type I. Since seropositive donors will be referred to health care providers for advice, physicians should become familiar with HTLV-I, its modes of transmiss...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1989-08-01 00:00:00
abstract：:Schirmer's test is a simple, semiquantitative test of tear production. It is based on the physical tendency of a fluid to travel along a strip of porous material by capillary action due to surface tension. Sterile strips, standardized and prepackaged, are available from local scientific supply houses. The low cost and...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1981-11-01 00:00:00
abstract：:The interrupted vertical and horizontal mattress suture techniques are two of the most commonly used skin closure methods. These mattress sutures promote wound edge eversion and less prominent scarring. Vertical and horizontal mattress sutures allow for skin edges to be closed under tension when wound edges have to be...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2002-12-15 00:00:00
abstract：:Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, an...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2014-09-15 00:00:00
abstract：:The safety of vaginal birth after cesarean (VBAC) delivery has been documented. Fetal and neonatal morbidity is not increased, and the mortality rate is less than one in 2,000 deliveries. Maternal morbidity and mortality rates for VBAC delivery are significantly lower than those for repeat cesarean section. Family phy...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1988-06-01 00:00:00
abstract：:Nitrous oxide analgesia is a safe alternative to parenteral narcotics for outpatient surgical procedures. This type of analgesia is effective, well tolerated by most age groups, easily administered, rapidly reversible and associated with a low incidence of serious side effects. Hypoxia can be prevented by using fail-s...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-01-01 00:00:00
abstract：:Although a rare entity, laryngeal tuberculosis must be a diagnostic consideration--along with laryngeal carcinoma--whenever patients present with prolonged hoarseness or painful dysphagia. This form of tuberculosis was once thought to be especially virulent and more infectious than other forms; however, severity was p...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1992-09-01 00:00:00
abstract：:The herbal remedies referred to as "ginseng" are derived from the roots of several plants. One of the most commonly used and researched of the ginsengs is Panax ginseng, also called Asian or Korean ginseng. The main active components of Panax ginseng are ginsenosides, which have been shown to have a variety of benefic...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2003-10-15 00:00:00
