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Cirrhotic liver failure

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https://www.readbyqxmd.com/read/28921803/the-pathophysiology-of-arterial-vasodilatation-and-hyperdynamic-circulation-in-cirrhosis
#1
Søren Møller, Flemming Bendtsen
Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension result in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction, and renal dysfunction as part of a cardiorenal syndrome...
September 16, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28901345/-acute-alcoholic-hepatitis
#2
Gianni Testino, Emanuele Scafato, Valentino Patussi
Chronic alcohol related liver disease is characterized by a cascade of events defined as follows: steatosis, steatohepatitis/steatofibrosi, cirrhosis and hepatocellular carcinoma. On one of these histologic patterns may overlap acute alcoholic hepatitis (AAE) (mild, moderate, severe). Severe AAE can cause a severe clinical picture: jaundice with a duration of less than three months, jaundice in the first decompensation event, serum bilirubin higher than 5 mg/dL, ratio AST/ALT >2:1, AST less than 500 IU/L ALT <300 IU/L, neutrophil leukocytosis and increased GGT...
September 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28900784/liver-involvement-in-urea-cycle-disorders-a-review-of-the-literature
#3
REVIEW
Adrien Bigot, Michel C Tchan, Benjamin Thoreau, Hélène Blasco, François Maillot
Urea cycle disorders (UCDs) are inborn errors of metabolism of the nitrogen detoxification pathway and encompass six principal enzymatic deficiencies. The aging of UCD patients leads to a better knowledge of the long-term natural history of the condition and to the reporting of previously unnoticed manifestations. Despite historical evidence of liver involvement in UCDs, little attention has been paid to this organ until recently. Hence, we reviewed the available scientific evidence on acute and chronic liver dysfunction and liver carcinogenesis in UCDs and discuss their pathophysiology...
September 12, 2017: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/28851249/bacterial-pneumonia-in-patients-with-liver-cirrhosis-with-or-without-hiv-co-infection-a-possible-definition-of-antibiotic-prophylaxis-associated-pneumonia-apap
#4
Gianluca Cuomo, Giuseppina Brancaccio, Gianfranca Stornaiuolo, Daniela Manno, Giuseppe L Gaeta, Cristina Mussini, Massimo Puoti, Giovanni B Gaeta
Introducion: Bacterial infections frequently complicate liver cirrhosis. The aim of this study was to identify risk factors and clinical impact of bacterial pneumonia in patients with cirrhosis. MATERIALS AND METHODS: Bacterial infection prevalence study: consecutive patients with cirrhosis were enroled over a six-month period in 13 Italian centres. Pneumonia and other infections were diagnosed by standard methods. Pneumonia study: cirrhotic patients with pneumonia were enroled for an additional six-month period and HIV-positive patients were included...
August 29, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28845103/bacterial-translocation-markers-in-liver-cirrhosis
#5
REVIEW
Alexandra Alexopoulou, Danai Agiasotelli, Larisa E Vasilieva, Spyros P Dourakis
Bacterial translocation (BT) is an important mechanism in the development of infection in liver cirrhosis. The migration and colonization of bacteria and/or bacterial products from the bowel to mesenteric lymph nodes is a controlled process in healthy persons. Increased intestinal permeability, bacterial overgrowth and defect of gut-associated lymphatic tissue promote impaired BT in cirrhotics. We reviewed the reports on markers used for the evaluation of BT published between 1987 and 2016. We focused on the clinical consequences of BT in cirrhosis, as indicated by the values of the BT markers...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/28844314/acute-kidney-injury-in-acute-on-chronic-liver-failure-where-does-hepatorenal-syndrome-fit
#6
REVIEW
Andrew Davenport, Mohammed Faisal Sheikh, Edmund Lamb, Banwari Agarwal, Rajiv Jalan
Renal dysfunction occurs in 25% to 50% of patients with cirrhosis admitted to the hospital with an acute episode of hepatic decompensation and may be due to underlying chronic kidney disease, an acute deterioration, or both. An acute deterioration in renal function in cirrhotic patients is now collectively referred to as acute kidney injury (AKI), which has been subclassified into different grades of severity that identify prognostic groups. Acute-on-chronic liver failure is characterized by acute hepatic and/or extrahepatic organ failure driven by a dysregulated immune response and systemic inflammatory response...
August 23, 2017: Kidney International
https://www.readbyqxmd.com/read/28843665/balanced-haemostasis-with-both-hypo-and-hyper-coagulable-features-in-critically-ill-patients-with-acute-on-chronic-liver-failure
#7
Caleb Fisher, Vishal C Patel, Sidsel Hyldgaard Stoy, Arjuna Singanayagam, Jelle Adelmeijer, Julia Wendon, Debbie L Shawcross, Ton Lisman, William Bernal
BACKGROUND: Cirrhotic patients have complex haemostatic abnormalities. Current evidence suggests stable cirrhotic (SC) patients have a "re-balanced" haemostatic state. However, limited data exists in acute decompensated (AD) or acute on chronic liver failure (ACLF) patients. METHODS: We utilised thrombin generation analysis, fibrinolysis assessment, and evaluation of haemostatic parameters to assess haemostasis in liver disease of progressive severity. RESULTS: The study cohorts were comprised of: SC, n=8; AD n=44; ACLF, n=17; and Healthy Control (HC), n=35...
August 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28841541/use-of-the-liver-maximum-function-capacity-test-limax-for-the-management-of-liver-resection-in-cirrhosis-a-case-of-hypopharyngeal-cancer-liver-metastasis
#8
S Cammann, F Oldhafer, K I Ringe, W Ramackers, K Timrott, M Kleine, J Klempnauer, F Lehner, H Bektas, F W R Vondran
INTRODUCTION: The presence of liver cirrhosis goes along with a higher chance for the need of liver resection. As established laboratory parameters often underestimate the degree of cirrhosis this is associated with an increased risk for postoperative liver failure due to the preoperatively impaired liver function. Known liver function tests are unlikely to be performed in daily use because of high cost or expenditure of time. Liver maximum function capacity test (LiMAx) provides a novel tool for measurement of liver function and references for the safety of liver resection...
August 10, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28839312/short-term-outcomes-after-hepatic-resection-perspective-from-a-developing-country
#9
Saleema Begum, Muhammad Rizwan Khan
OBJECTIVE: To review the early outcomes of hepatic resection at our hospital. METHODS: This study was conducted at the Aga Khan University Hospital, Karachi, from January 2008 to December 2015, and comprised patients who underwent hepatic resection. We analysed the pathology, magnitude of hepatic resection and short-term outcomes in the patients. Mean and standard deviations were used to describe categorical data whereas frequencies and proportions to describe quantitative data...
August 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28811718/chronic-liver-failure-consortium-acute-on-chronic-liver-failure-and-acute-decompensation-scores-predict-mortality-in-brazilian-cirrhotic-patients
#10
Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Ângelo Zambam de Mattos
AIM: To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients. METHODS: This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF)...
July 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28810889/dehydroepiandrosterone-sulfate-and-dehydroepiandrosterone-sulfate-cortisol-ratio-in-cirrhotic-patients-with-septic-shock-another-sign-of-hepatoadrenal-syndrome
#11
Ming-Hung Tsai, Hui-Chun Huang, Yun-Shing Peng, Yung-Chang Chen, Ya-Chung Tian, Chih-Wei Yang, Jau-Min Lien, Ji-Tseng Fang, Cheng-Shyong Wu, Sen-Yung Hsieh, Fa-Yauh Lee
BACKGROUND: Cirrhotic patients are susceptible to sepsis and critical illness-related corticosteroid insufficiency (CIRCI). Dehydroepiandrosterone sulfate (DHEAS) is a corticotropin-dependent adrenal androgen, which has immunostimulating and antiglucocorticoid effects. Considering the synchronized synthesis of cortisol and DHEAS and their opposing effects to each other, investigators have proposed measuring these two hormones as a ratio. Severe sepsis has been associated with low DHEAS, especially relative to high cortisol...
August 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28809733/circulating-levels-of-pentraxin-3-ptx3-in-patients-with-liver-cirrhosis
#12
Janaína L Narciso-Schiavon, Jéssica G Pereira, Telma Erotides Silva, Emília T O Bansho, Edelton F Morato, José T Pinheiro, Letícia Muraro-Wildner, Maria Luiza Bazzo, Esther Buzaglo Dantas-Corrêa, Leonardo L Schiavon
BACKGROUND: Despite the circulating levels of PTX3 were related to the severity of various diseases, there are no studies investigating its role in patients with liver cirrhosis. We aimed to study PTX3 levels in patients with liver cirrhosis. MATERIAL AND METHODS: A prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis, 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil...
August 8, 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28808210/acute-on-chronic-liver-failure-recent-update
#13
Azeem Alam, Ka Chun Suen, Daqing Ma
Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria and management pathways...
January 19, 2017: Journal of Biomedical Research
https://www.readbyqxmd.com/read/28808200/acute-on-chronic-liver-failure-recent-update
#14
Azeem Alam, Ka Chun Suen, Daqing Ma
Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria and management pathways...
July 13, 2017: Journal of Biomedical Research
https://www.readbyqxmd.com/read/28802877/declining-mortality-in-critically-ill-patients-with-cirrhosis-in-australia-and-new-zealand-between-2000-and-2015
#15
Avik Majumdar, Michael Bailey, William M Kemp, Rinaldo Bellomo, Stuart K Roberts, David Pilcher
BACKGROUND AND AIMS: Few studies have described the outcomes of patients with cirrhosis receiving intensive care unit (ICU) admission at a population level. We aimed to describe trends in the mortality of such patients in Australia and New Zealand (ANZ), and to investigate the relationship with associated organ failures. METHODS: We studied patients admitted to 172 ICUs on a non-elective basis, with and without cirrhosis between January 1(st) 2000 and December 31(st) 2015 as recorded by the ANZ Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database...
August 9, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28779790/management-of-renal-dysfunction-in-patients-with-liver-cirrhosis-role-of-pretransplantation-hemodialysis-and-outcomes-after-liver-transplantation
#16
REVIEW
Ashok Thorat, Long-Bin Jeng
Patients with end-stage liver disease (ESLD) who develop hepatorenal syndrome (HRS) have very high mortality rates. For patients with HRS type I, median survival without specific therapy is only 2 weeks. Due to worsening clinical condition in such patients secondary to uremia and hepatic disease, some form of renal replacement therapy (RRT), either intermittent hemodialysis IHD or continuous veno-venous hemodialysis (CVVHD), must be instituted. However, the literature regarding the survival benefits of the hemodialysis for the worsening renal failure in liver cirrhotic patients remains limited...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28767684/application-of-chronic-liver-failure-sequential-organ-failure-assessment-score-for-the-predication-of-mortality-after-esophageal-variceal-hemorrhage-post-endoscopic-ligation
#17
Ming-Wun Wong, Ming-Jen Chen, Huan-Lin Chen, Yu-Chi Kuo, I-Tsung Lin, Chia-Hsien Wu, Yuan-Kai Lee, Chun-Han Cheng, Ming-Jong Bair
BACKGROUND: Esophageal variceal hemorrhage (EVH) is one of the high mortality complications in cirrhotic patients. Endoscopic variceal ligation (EVL) is currently the standard therapy for EVH. However, some patients have expired during hospitalization or survived shortly after management. AIM: To evaluate hospital and 6-week mortality by receiver operating characteristic (ROC) curve of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score compared to a model for end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP) class...
2017: PloS One
https://www.readbyqxmd.com/read/28765697/eight-week-ledipasvir-sofosbuvir-in-non-cirrhotic-treatment-na%C3%A3-ve-hepatitis-c-genotype-1-patients-with-hepatitis-c-virus-rna-6-million-single-center-real-world-effectiveness-and-safety
#18
Nyan L Latt, Beshoy T Yanny, Derenik Gharibian, Rita Gevorkyan, Amandeep K Sahota
AIM: To evaluate sustained viral response (SVR) of 8-wk ledipasvir/sofosbuvir therapy among non-cirrhotic, genotype-1 hepatitis C virus (HCV) patients with RNA < 6 million IU/mL. METHODS: We performed a retrospective cohort study to examine SVR rates, predictors of treatment failure and safety analysis of 8-wk ledipasvir/sofosbuvir (LDV/SOF) therapy among non-cirrhotic, genotype 1 HCV patients with viral load < 6 million IU/mL. Primary outcome was an achievement of SVR at 12 wk after treatment...
July 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28761907/feasibility-and-reproducibility-of-liver-surface-nodularity-quantification-for-the-assessment-of-liver-cirrhosis-using-ct-and-mri
#19
Grace C Lo, Cecilia Besa, Michael J King, Martin Kang, Ashley Stueck, Swan Thung, Mathilde Wagner, Andrew D Smith, Bachir Taouli
PURPOSE: To assess intra-observer, inter-observer and inter-modality (CT vs. MRI) reproducibility of liver surface nodularity (LSN) scores measured with software used for detection of liver fibrosis. METHODS: This IRB-approved retrospective study included patients with both abdominal CT and MRI within 6 months of histopathologic sampling. Two independent observers used post-processing software to quantify LSN scores on axial non-contrast CT (NCT), axial contrast-enhanced CT (CECT), axial T2-weighted (T2W) HASTE, and axial and coronal post-gadoxetic acid T1-weighted (T1W) images obtained during the hepatobiliary phase (HBP)...
2017: European Journal of Radiology Open
https://www.readbyqxmd.com/read/28746121/development-of-a-prognostic-nomogram-for-cirrhotic-patients-with-upper-gastrointestinal-bleeding
#20
Yu-Jie Zhou, Ji-Na Zheng, Yi-Fan Zhou, Yi-Jing Han, Tian-Tian Zou, Wen-Yue Liu, Martin Braddock, Ke-Qing Shi, Xiao-Dong Wang, Ming-Hua Zheng
BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) is a complication with a high mortality rate in critically ill patients presenting with cirrhosis. Today, there exist few accurate scoring models specifically designed for mortality risk assessment in critically ill cirrhotic patients with upper gastrointestinal bleeding (CICGIB). Our aim was to develop and evaluate a novel nomogram-based model specific for CICGIB. PATIENTS AND METHODS: Overall, 540 consecutive CICGIB patients were enrolled...
October 2017: European Journal of Gastroenterology & Hepatology
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