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variceal bleed

Kathrin Burgmaier, Joy Brandt, Rukshana Shroff, Peter Witters, Lutz T Weber, Jörg Dötsch, Franz Schaefer, Djalila Mekahli, Max C Liebau
Introduction: Autosomal recessive polycystic kidney disease (ARPKD) is a severe hepatorenal disorder of childhood. Early renal disease in ARPKD may require renal replacement therapy and is associated with failure to thrive resulting in a need for nasogastric tube feeding or gastrostomy. In ARPKD patients, the benefit of a gastrostomy in nutrition and growth needs to be weighed against the potential risk of complications of congenital hepatic fibrosis (CHF) and portal hypertension like variceal bleeding. CHF in ARPKD has thus been considered as a relative contraindication for gastrostomy insertion...
2018: Frontiers in Pediatrics
Adnan Taş, Mehmet Suat Yalçın, Bünyamin Sarıtaş, Banu Kara
Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs) with hepatic encephalopathy. These include the Child-Turcotte-Pugh (CTP) classification, Model for End-stage Liver Disease (MELD), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosis of patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy...
June 14, 2018: Turkish Journal of Medical Sciences
Fang Wang, Shu Cui, Fengmei Wang, Fenghui Li, Fei Tang, Xu Zhang, Yanying Gao, Hongmin Lv
OBJECTIVE: Determine the optimal scoring system for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with acute variceal bleeding (AVB). Prediction effects of six scoring systems, AIMS65 score, Glasgow-Blatchford (GBS) score, full Rockall (FRS) score, the model for end-stage liver disease (MELD), the MELD-Na model and the Child-Turcotte-Pugh (CTP) score were analyzed in this study. METHODS: A total of 202 liver cirrhosis patients with AVB were enrolled between 1 January 2014, and 31 December 2014...
June 17, 2018: Scandinavian Journal of Gastroenterology
H A Rudman, M C Stott, M Y Loh, E C Clark
A 79-year-old woman presented with a large fresh rectal bleed. Computed tomography revealed that she had a large type IV hiatus hernia, which contained the stomach and pancreas. Compression of the inferior mesenteric vein and splenic vein had led to thrombosis within these vessels and retrograde flow within the inferior mesenteric vein. This had led to the formation of portosystemic rectal varices. Ectopic varices occasionally form in the rectum, often in the context of liver cirrhosis. At the time of writing, ours is the first reported case of portosystemic rectal varices formulated in response to obstruction of vessels within a hiatus hernia...
June 18, 2018: Annals of the Royal College of Surgeons of England
Indira Bhavsar, Anthony W Rooney, Brooke Corning, Neeral L Shah
A newly diagnosed 53-year-old woman with cirrhosis has repeated gastrointestinal bleeding with resulting symptomatic anaemia. She underwent routine diagnostic endoscopic evaluation without localisation of the aetiology of her bleed. Ultimately, she was found to have ectopic varices in the small bowel as a result of underlying high portal pressures. She underwent transjugular intrahepatic portosystemic shunt for portal system decompression with resolution in her bleeding.
June 15, 2018: BMJ Case Reports
Krista L Haines, Suresh Agarwal, Hee Soo Jung
INTRODUCTION: Asian-Americans and Pacific Islanders are often considered as a uniform group when examining race in health outcomes. However, the generally favorable economic outcomes in this group belie significant socioeconomic variance between its heterogeneous subgroups. This study evaluates the impact of socioeconomic status on the health outcomes of Asian trauma patients. METHODS: From 2012 to 2015, 52,704 Asians who presented to trauma centers were registered with the National Trauma Data Bank with known disposition...
August 2018: Journal of Surgical Research
Anna Piekarska, Ewa K Berkan, Kamila M Wójcik
Non-invasive liver fibrosis assessment techniques are under development for evaluating the severity of liver disease and portal hypertension. The paper presents practical arrangements for the diagnosis and treatment of portal hypertension in patients with chronic liver disease, established in the Baveno VI Consensus Workshop for diagnosis and treatment of portal hypertension. Currently, the diagnostic standard of liver disease severity is transient elastography, which can identify patients with clinically significant portal hypertension (liver stiffness > 20 kPa)...
June 2018: Clinical and experimental hepatology
Koichi Masuda, Shinsuke Takenaga, Hirokazu Ashida, Hiroya Ojiri
Rupture of small intestinal varices associated with portal hypertension can be a serious condition that is difficult to diagnose early and to manage. Moreover, optimal guidelines for the treatment of small intestinal varices have not yet been established. We herein report a case of a 73-year-old man with small intestinal varices. The man presented with bleeding from a stoma in the small intestine, which subsequently led to hemorrhagic shock. We successfully treated the patient with balloon-occluded retrograde transvenous obliteration via the right inferior epigastric vein using N-butyl-2-cyanoacrylate...
April 2018: Radiology Case Reports
Karen Tran-Harding, Michael Winkler, Driss Raissi
We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management...
April 2018: Radiology Case Reports
Edward Wolfgang Lee, Sammy Saab, Fady Kaldas, Savannah Fletcher, Ronald W Busuttil, Francisco Durazo, Justin P McWilliams, Joseph DiNorcia, Siddharth A Padia, Stephen T Kee
BACKGROUND: Overt hepatic encephalopathy (OHE) is a serious complication of liver dysfunction, which is associated with severe morbidity/mortality and healthcare resource utilization. OHE can be medically refractory due to spontaneous portosystemic shunts (SPSSs) and therefore a new treatment option for these SPSSs is critical. METHODS: This is a retrospective study of 43 patients with medically refractory OHE, who underwent CARTO (Coil-Assisted Retrograde Transvenous Obliteration) procedures between June 2012 and October 2016...
June 14, 2018: American Journal of Gastroenterology
Subhash Chandra, Adrian Holm, Rami G El Abiad, Henning Gerke
Background/Aims: Although endoscopic cyanoacrylate glue injection (ECGI) is recommended as first-line treatment for bleeding gastric varices (GV) there is still limited experience with this method in the US. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of gastric variceal bleeding. Methods: Records of patients undergoing ECGI of GV at our US tertiary care center between 6/2005 and 5/2015 were reviewed. Assessed outcomes were primary hemostasis, early rebleeding during hospitalization, recurrent bleeding during follow-up, eradication and recurrence of GV...
June 2018: Journal of Clinical and Experimental Hepatology
Camille A Kezer, Neil Gupta
PURPOSE OF REVIEW: This article aims to review current therapeutic endoscopic treatments available for the management of gastrointestinal bleeding related to cirrhosis. RECENT FINDINGS: Endoscopic band ligation is an effective treatment for primary prophylaxis, acute bleeding, and secondary prophylaxis of esophageal varices as well as for acute bleeding and secondary prophylaxis of select gastric varices. Sclerotherapy is a treatment option for acute bleeding and secondary prophylaxis of esophageal varices when band ligation is technically difficult...
June 9, 2018: Current Gastroenterology Reports
Jonathan Mitchell, James O'Beirne
No abstract text is available yet for this article.
June 5, 2018: Gut
John W Frost, Srisha Hebbar
Background and study aims : Cyanoacrylate glue is recommended first-line endoscopic therapy for gastric fundal varices but it is difficult to use and carries a risk of embolization. Thrombin is preferred by many in the UK, but its effectiveness can be difficult to establish at endoscopy and the rate of re-bleeding is higher. Endoscopic ultrasound (EUS) can help assess variceal blood flow and has the potential to improve both targeting and effectiveness of injection therapy. Whereas there is already some data for its use with glue, little data currently exist in relation to its use with thrombin...
June 2018: Endoscopy International Open
Zachary Oman, Nauman Khalid, Subbarao Boppana, Tarek Helmy, Elsayed Abo-Salem
The management of coronary thrombus is not well defined. Current therapies include medical management with anticoagulation, antiplatelet, and thrombolytic therapies or revascularization with percutaneous coronary interventions including mechanical thrombectomy, and coronary artery bypass grafting surgery. In this report, we present a patient with significant left main coronary artery thrombus burden with advanced cirrhosis and recent esophageal variceal bleeding who was successfully treated with conservative medical management...
May 17, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Alberto Ferrarese, Valerie Tikhonoff, Edoardo Casiglia, Paolo Angeli, Silvano Fasolato, Diego Faggian, Alberto Zanetto, Giacomo Germani, Francesco Paolo Russo, Patrizia Burra, Marco Senzolo
Background: Nonselective β -blockers (NSBB) have been associated with increased incidence of paracentesis-induced circulatory dysfunction (PICD) and reduced survival in patients with cirrhosis and refractory ascites. Aim: To prospectively evaluate a hemodynamic response to NSBB in cirrhotics listed for liver transplantation with refractory ascites undergoing large volume paracentesis (LVP). Methods: Patients with cirrhosis and refractory ascites, with an indication to start NSBB in primary prophylaxis for variceal bleeding, were enrolled...
2018: Gastroenterology Research and Practice
Marta Carneiro de Moura, Shiyi Chen, Binita M Kamath, Vicky Lee Ng, Simon C Ling
BACKGROUND AND AIMS: The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors. METHODS: We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015...
May 30, 2018: Journal of Pediatric Gastroenterology and Nutrition
Saman Salim, Olle Ekberg, Johan Elf, Moncef Zarrouk, Anders Gottsäter, Stefan Acosta
Background/aim Mesenteric venous thrombosis is a rare lethal disease. The main aim of the present study was to evaluate clinical efficacy and safety of direct oral anticoagulants and vitamin K antagonists in mesenteric venous thrombosis patients. Methods Retrospective study of 102 mesenteric venous thrombosis patients treated between 2004 and 2017 at a center with a conservative medical first approach. Median clinical follow-up was 4 years. Results Computed tomography showed successful recanalization of thrombosis in 71% of patients on vitamin K antagonists and 69% of patients on direct oral anticoagulants ( p = 0...
January 1, 2018: Phlebology
Li Wan, Hongjing Wang, Ke Xu, Lingyun Yang
Spontaneous rupture of a vulvar hematoma during delivery is a relatively uncommon event and may cause excessive hemorrhage. Exact identification of anatomic structures and bleeding points is challenging. We herein present a case involving a pregnant woman at 39 weeks' gestation with a large vulvar hematoma that spontaneously ruptured during the second stage of labor, likely due to rupture of varices in the vulva or vagina. It was difficult to accurately expose and suture the deep bleeding points. The estimated blood loss volume was 1591 mL, and the hemoglobin concentration dropped from 132 g/L before delivery to 84 g/L after delivery...
January 1, 2018: Journal of International Medical Research
Reena C Jha, Satinderpal Singh Khera, Amit Dinesh Kalaria
OBJECTIVE: The purpose of this article is to review the classic and uncommon imaging findings of portal vein thrombosis (PVT) (acute, chronic, congenital, and septic thrombus) as visualized on multiple modalities, with an emphasis on MRI findings. Additional aims are to understand the imaging of obliterative portal venopathy and its clinical significance, appreciate morphologic changes of the biliary system that may accompany PVT, and recognize changes in liver enhancement patterns seen with PVT related to the hepatic arterial buffer response...
May 24, 2018: AJR. American Journal of Roentgenology
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