### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My Patient from Assam of International Hospital, Guwahati. Dr. A. Kelkars report  USG Revels Cirrhosis liver with hypoechoic lesions in left lobe. Cholelithiasis Mild Bilateral increase in renal parenchymal echogenicity Splenomegaly. Little ascites. Suggested : Ct abdomen/us guided fnac & blood Report. we want 2 ur kind response about this topic. Thanking You.

### output:

Hi I hope you are very well As for hepatic cirrhosis in an initial way should be sought its etiology because in many cases the targeted treatment can improve liver function. To assess if there is a significant consumption of alcohol (consumption greater than 30 gr / day or 210 gr / week), the presence of metabolic risk factors such as overweight, obesity, diabetes mellitus, dyslipidemia as a cause of a probable non-alcoholic fatty liver disease. The presence of an HBV or HCV infection should be ruled out. Autoimmune or metabolic causes such as autoimmune hepatitis, primary biliary cholangitis or primary sclerosis cholangitis. Genetic or hereditary causes such as Wilson's disease or hemochromatosis. It is necessary to establish in a suitable way his chronic liver disease and to define whether he has a portal hypertension, so a Doppler ethnography of liver and biliary tract must be performed in search of collateral circulation or inversion of the portal flow, besides the characteristics of the liver And measurements of the portal vein and spleen. In addition, it is important to perform an endoscopy in search of esophageal varices, gastric or hypertensive portal osteopathy, which by definition would do so with clinically significant portal hypertension. In addition, laboratory tests should be performed to assess functional status by classifying child Pugh and meld and to better characterize the patient. You mention the presence of ascites, which is not accompanied by peripheral edema can be managed with monotherapy with spironolactone or with double therapy accompanied by furosemide, always maintaining a relationship 100 mg / 40 mg to avoid electrolytic alterations, looking for a decrease in weight Of 0.5 k / day, the goal being to keep patients free of ascites with the lowest dose of diuretic. It is necessary to improve nutritional status, to avoid hypocaloric and hypoprotective diets, with an approximate intake of 30-35 kcal / k / day and between 1 and 1.5 g / k of high nutritional value proteins. All these measures are aimed at avoiding the presence of any dysfunction or any episode of decompensation that may cause greater morbidity and mortality and improve the quality of life of the patient.