I have patient of cirrhosis with oesophageal varices .15 days back he had hemetemesis and landed into encephalopathy .patient recovered from encephalopathy and endoscopy revealed large bleeding eso.varices. His EVL was done and patient is fine now.there is no hemetemesis. He is on lactulose along with all other supportive therapy.for last two days despite taking lactulose 30 ml. Twice a day patient has not passed stool.should I increase the dose of lactulose or add some other laxative. His intake is not adequate also.on examination he is haemodynamically stable afebrile, no jaundice .no sign of chf/ lvf,his abdomen is soft bowel sounds normal .
Hi, Welcome to Chat Doctor, After going through the history of the patients, he is having Cirrhosis of liver with portal hypertension with Esophageal Varices. The cause of hematemesis is varices and EVIL (Endoscopic Varietal Ligation) is done to prevent the further bleeding. Blood in intestine causes ammonia level to rise he has recovered from encephalopathy. Please continue treatment lactulose is good Chat Doctor. Dietary supplementation with branched-chain amino acids is useful and even addition of probiotics with advise from your doctor may help. Take care. Good Luck.