Decompensated Portal Cirrhosis

Abstract

that it will do so is firmly implanted in his mind.Physical therapy will never restore function to a part. At this stage it is of value only as an adjuvant, and then only if physician, physical therapist and patient under¬ stand it as such. Here lies the peculiar difficulty in the care of fractures. If a man has an acute appendicitis one operates on him and removes his appendix. With the clearing up of the pathologic process he gets well. As a personality he plays relatively little part in the story. In a man who has had a fracture, however, one may achieve a perfect anatomic result and solid bony healing, check all pathologic changes and demonstrate perfect passive function, but if he does not use the part as it was used before the injury all the work has been in vain. The regaining of function is the patient's job, and once he is given the erroneous idea that the phy¬ sician can regain it for him, the groundwork is laid for prolonged convalescence and impaired end-results. I cannot emphasize this point too strongly. One can make the patient's efforts to regain function more com¬ fortable, one can ease the spasm and pain resultant on overuse and one can aid the circulatory status of the part, but one cannot restore function or circulatory efficiency by physical therapy without normal muscular activity. Active motion within pain limits is the means of regaining function : guided active motion ; gently resisted active motion ; active motion with the patient's mind concentrated on some useful, purposeful aim, rather than on the actual motion that he is making. This is much better than aimless exercises. Passive motion is a confession of inability to secure active motion. It may infrequently be necessary, but its use is always deplorable. Its use in children may be regarded as a calamity.One may use what physical therapy one will, then, in the late stages, but it must be understood that the patient is not regaining function by it ; one is merely making it easier for him to carry out his job. The only reservation that I should make as to the forms of physical therapy to be employed is that they must cause neither pain nor muscle spasm and that heat must be used in low intensity and for a prolonged time. Anything that makes it easier for the patient actively to exercise function is good physical therapy if he under¬ stands that its sole value to him lies in that help. If he sits by and does nothing but receive physical therapythree times a week for fifteen minutes or half an hour, as thousands of them do every day, his dependence on physical therapy is doing him harm. I believe that it is just as much the physical therapist's as it is the physician's part to implant in the patient's mind the proper valua¬ tion of late physical therapy in treatment of fracture. In a way, I feel that it is the physical therapist's job to help educate the physician, who is prone to treat his patients after the splints are off by simply sending them for physical therapy at intervals, as to the real intrinsic value of early physical therap...

Umbilical hernias and cirrhose

“…UH, the most common, is present in 20%; this is 10 times higher than the incidence of UH in the overall population [1][2][3]. This elevated prevalence is essentially due to the presence of ascites, abdominal wall attenuation and denutrition.…”

Umbilical paracentesis for acute hernia reduction in cirrhotic patients

“…The prevalence of umbilical hernias in patients with cirrhosis is at least 20%, which is 10 times higher than that observed in the general population,1 and in as high as 42% of patients with ascites 2. Ascites causes an increase in intra-abdominal pressure, thereby applying pressure on intestinal contents and causing protrusion through weaknesses in the abdominal wall, most commonly at the umbilical ring.…”

Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the treatment of ascites

“…1 The majority of patients with umbilical hernias require only expectant management. Elective repair of asymptomatic hernias is often complicated by wound dehiscence, peritonitis, and marked worsening of ascites.…”

“…1 These hernias are infrequently symptomatic and rarely incarcerate. Reduction in ascites, however, has been reported to result in bowel incarceration in the hernia, requiring surgical repair.…”