<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1684-1824</journal-id>
<journal-title><![CDATA[Revista Médica Electrónica]]></journal-title>
<abbrev-journal-title><![CDATA[Rev.Med.Electrón.]]></abbrev-journal-title>
<issn>1684-1824</issn>
<publisher>
<publisher-name><![CDATA[Universidad de Ciencias Médicas de Matanzas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1684-18242019000501269</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Acercamiento al tratamiento del paciente cirrótico]]></article-title>
<article-title xml:lang="en"><![CDATA[An approach to the treatment of the cirrhotic patient]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arredondo Bruce]]></surname>
<given-names><![CDATA[Alfredo Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Trujillo Pérez]]></surname>
<given-names><![CDATA[Yon]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chiong Quezada]]></surname>
<given-names><![CDATA[Martin]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Provincial Docente &#8220;Amalia Simoni&#8221;  ]]></institution>
<addr-line><![CDATA[ Camagüey]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2019</year>
</pub-date>
<volume>41</volume>
<numero>5</numero>
<fpage>1269</fpage>
<lpage>1278</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1684-18242019000501269&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1684-18242019000501269&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1684-18242019000501269&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La cirrosis es un estado reversible de fibrosis hepática, que se ha convertido en la 8a causa de muerte en los Estados Unidos y la 9 a causa de muerte en Cuba. Este artículo repasa el tratamiento práctico de la cirrosis basado en la revisión de ensayos clínicos obtenidos de buscadores como MEDLINE, HINARI y Scielo, durante los últimos años. Las principales causas de cirrosis hepática incluyen las hepatitis crónicas por virus B, C, alcoholismo, y la esteatohepatitis no alcohólica. La desnutrición ocurre en 20 a 60 % de los pacientes con cirrosis, por lo cual las dietas hipo proteicas están bajo revisión, se recomienda el control estricto de la sal, el uso de medicamentos debe ser valorado estrictamente, y hacer un uso juicioso de los hipotensores cuando la tensión arterial media sea inferior a 82 mm de Hg, los beta bloqueadores no selectivos tienen su indicación en varices esofágicas desarrolladas, por otro lado se recomienda la cautela en analgésicos y los inhibidores de la bomba de protones, no restringiéndose el uso de estatinas. Con respecto a los procederes invasivos, el uso de métodos quirúrgicos deben ser evaluados en situaciones extremas, donde el índice MELD puede ayudar en cuanto al pronóstico y mortalidad esperada. La paracentesis en las ascitis refractaria debe ser masiva apoyada con el uso de albúmina, y se debe realizar lo más rápido posible en la sospecha de peritonitis bacteriana espontanea. Por lo que se puede concluir que el uso adecuado de la nutrición, el control de las complicaciones y los factores de riesgo puede llevar a la reversibilidad de la cirrosis hepática.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[SUMMARY Cirrhosis is a reversible status of the liver fibrosis, being the 8th cause of death in the United States and the 9th cause of death in Cuba. This article reviews the practical treatment of cirrhosis based on the review of clinical research published in MEDLINE, HINARI and Scielo, during the last years. The main causes of hepatic cirrhosis include the chronic hepatitis caused by B and C viruses, alcoholism, and the non-alcoholic steato-hepatitis. Malnutrition occurs in 20-60 % of the patients with cirrhosis, therefore low protein diets are under revision; it is recommended a strict use of salt; the use of drugs should be strictly evaluated. Hypotensive drugs should be cautiously used when the average arterial tension is lower than 82 Hg mm. Non-selective beta-blockers are indicated in developed esophageal varices. It is also recommended to be cautious with analgesics and proton pump inhibitors while the statins use is not restricted. Regarding the invasive procedures, surgery should be evaluated very carefully, and the MELD index can help with respect to prognosis and expected mortality. In refractory ascites, paracentesis should be massive relayed on albumin use, and should be carried out as soon as possible in the suspicion of spontaneous bacterial peritonitis. In conclusion, the adequate nutrition use, the control of complications and risk factors, could lead to reversibility of hepatic cirrhosis.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[cirrosis]]></kwd>
<kwd lng="es"><![CDATA[fibrosis]]></kwd>
<kwd lng="es"><![CDATA[dieta]]></kwd>
<kwd lng="es"><![CDATA[farmacoterapia]]></kwd>
<kwd lng="es"><![CDATA[procederes invasivos]]></kwd>
<kwd lng="en"><![CDATA[cirrhosis]]></kwd>
<kwd lng="en"><![CDATA[fibrosis]]></kwd>
<kwd lng="en"><![CDATA[diet]]></kwd>
<kwd lng="en"><![CDATA[pharmacotherapy]]></kwd>
<kwd lng="en"><![CDATA[invasive procedures]]></kwd>
</kwd-group>
</article-meta>
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