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cirrhosis and portal hypertension

Chiao-Lin Chuang, Ching-Chih Chang, Shao-Jung Hsu, Hui-Chun Huang, Fa-Yauh Lee, Ling-Ju Huang, Shou-Dong Lee
Hepatorenal syndrome (HRS), a severe complication of advanced cirrhosis, is defined as hypo-perfusion of kidneys resulting from intense renal vasoconstriction in response to generalized systemic arterial vasodilatation. Nevertheless, the mechanisms were barely investigated. Cumulative studies demonstrated renal vasodilatation in portal hypertensive and compensated cirrhotic rats. Previously, we identified that blunted renal vascular reactivity of portal hypertensive rats was reversed following lipopolysaccharide (LPS)...
August 10, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
Victoria Young, Shankar Rajeswaran
Interventional radiology's role in the management of portal hypertension in the pediatric population differs from the management of adult portal hypertension. In the pediatric population, portal hypertension is frequently secondary to thrombosis and cavernous transformation of the extrahepatic portion of the portal vein. Transjugular intrahepatic portosystemic shunt can be utilized to manage portal hypertension in children with intrinsic liver disease that results in cirrhosis and portal hypertension, and is often used as a bridge to transplant...
August 2018: Seminars in Interventional Radiology
Jacob Kibrit, Ruben Khan, Barbara H Jung, Sean Koppe
The development of portal hypertension in a patient with cirrhosis portends a poor prognosis. Untreated or progressive portal hypertension has serious clinical outcomes, which are often fatal. It is important to recognize portal hypertension early to delay progression and to treat complications of portal hypertension as they arise. This review will focus on the clinical assessment and management of portal hypertension.
August 2018: Seminars in Interventional Radiology
Victorine B Nzana, Anusha Rohit, Deepu George, Madhusudan Vijayan, Milly Mathew, Sundar Sankaran, Palaniappan Nagarajan, Georgi Abraham
A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal...
April 2018: Indian Journal of Medical Microbiology
J Q Li, Y Lu, Y L Qiu, J S Wang
Objective: To summarize and review the clinical and genetic features of neonatal sclerosing cholangitis (NSC) caused by DCDC2 variations. Methods: Whole exome sequencing was performed to identify DCDC2 variants in two Chinese siblings with NSC who were diagnosed in Children's Hospital of Fudan University in May 2017. Clinical, laboratory and genetic data of the two cases were summarized. Key words of "DCDC2" "neonatal sclerosing cholangitis" were searched in Chinese databases and PubMed for articles published until April 2018, and all the relevant literature were reviewed...
August 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Suraj D Serai, Andrew T Trout, Alexander Miethke, Eric Diaz, Stavra A Xanthakos, Jonathan R Dillman
Chronic injury to the liver leads to inflammation and hepatocyte necrosis, which when untreated can lead to myofibroblast activation and fibrogenesis with deposition of fibrous tissue. Over time, liver fibrosis can accumulate and lead to cirrhosis and end-stage liver disease with associated portal hypertension and liver failure. Detection and accurate measurement of the severity of liver fibrosis are important for assessing disease severity and progression, directing patient management, and establishing prognosis...
August 2018: Pediatric Radiology
Elsaid Wasfy, Galal Elkassas, Sally Elnawasany, Kariman Elkasrawy, Sherief Abd-Elsalam, Shaimaa Soliman, Rehab Badawi
Background& Aims: Esophageal varices (EV) are a major complication of portal hypertension in cirrhotic patients. Screening is essential for all patients with cirrhosis. Performing non-invasive methods for screening is a cost-effective and time-saving measure. The aim of this work is to evaluate whether insulin resistance (IR) assessed by HOMA-IR score can predict the presence of EV or not. METHODS: This cross-sectional study was carried out on sixty Egyptian cirrhotic HCV patients divided into 3 groups: Group I: 20 cirrhotic patients without esophageal varices, Group II: 20 cirrhotic patients, with small esophageal varices and Group III: 20 cirrhotic patients with large esophageal varices...
August 3, 2018: Endocrine, Metabolic & Immune Disorders Drug Targets
Abdurrahman Sahin, Hakan Artas, Nurettin Tunc, Mehmet Yalniz, Ibrahim Halil Bahcecioglu
Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child⁻Turcotte⁻Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores...
August 2, 2018: Journal of Clinical Medicine
Virginia Hernández-Gea, Anna Baiges, Fanny Turon, Juan Carlos Garcia-Pagán
Idiopathic portal hypertension (IPH) is a rare disorder characterized by clinical portal hypertension in the absence of a recognizable cause such as cirrhosis. Laboratory tests often reveal a preserved liver function with anemia, leukopenia, and thrombocytopenia due to splenomegaly. Imaging studies reveal signs of portal hypertension whereas liver stiffness and portal pressure values are usually normal or slightly elevated. Liver biopsy is considered mandatory in order to rule out other causes of portal hypertension, mainly cirrhosis...
July 31, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
R Todd Stravitz
Patients with advanced liver disease have traditionally been considered at risk for bleeding complications. However, although bleeding in patients with cirrhosis frequently occurs due to complications of portal hypertension, research performed within the last 15 years has increasingly shown that hemostasis in patients with liver failure generally achieves a state of "rebalance", whereby compensatory systems restore a relatively neutral or even slightly pro-thrombotic state. Much recent clinical and in vitro research has, in fact, shown over-compensation, such that patients with acute and stable chronic liver failure may have a thrombotic tendency, which may participate in the progression of liver disease and cause systemic and portal thrombosis...
July 31, 2018: Hepatology International
George Boon-Bee Goh, Philip R Schauer, Arthur J McCullough
With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery...
July 28, 2018: World Journal of Gastroenterology: WJG
Guadalupe Garcia-Tsao, Michael Fuchs, Mitchell Shiffman, Brian B Borg, Nikolaos Pyrsopoulos, Kirti Shetty, Juan F Gallegos-Orozco, K Rajender Reddy, Eyob Feyssa, Jean L Chan, Mason Yamashita, James M Robinson, Alfred P Spada, David T Hagerty, Jaime Bosch
BACKGROUND AND RATIONALE: Caspases play a central role in apoptosis, inflammation and fibrosis. They produce hemodynamically-active, pro-inflammatory microparticles that cause intrahepatic inflammation, vasoconstriction and extrahepatic splanchnic vasodilation. Emricasan is a pan-caspase inhibitor that lowers portal hypertension (PH) and improves survival in murine models of cirrhosis. This exploratory study assessed whether emricasan lowers PH in patients with compensated cirrhosis. This multicenter, open-label study enrolled 23 subjects with compensated cirrhosis and PH (HVPG >5 mmHg)...
July 31, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Tae Hyung Kim, Han Ah Lee, Yeon Seok Seo, Yoo Ra Lee, Sun Young Yim, Young Sun Lee, Sang Jun Suh, Young Kul Jung, Ji Hoon Kim, Hyunggin An, Hyung Joon Yim, Jong Eun Yeon, Kwan Soo Byun, Soon Ho Um
BACKGROUND & AIMS: For appropriate management of acute kidney injury (AKI) in cirrhotic patients, accurate differentiation of the types of AKI, prerenal azotemia (PRA), hepatorenal syndrome (HRS) and acute tubular necrosis (ATN) is very important. Urine N-acetyl-β-D-glucosaminidase (NAG) has been proposed as a good tubular injury marker in many studies, but its efficacy in cirrhosis is unclear. This study was performed to evaluate the usefulness of urine NAG in patients with decompensated cirrhosis...
July 30, 2018: Journal of Gastroenterology and Hepatology
Amrendra Kumar Mandal, Mukesh Sharma Paudel, Sudhamshu Kc, Sitaram Chaudhary, Bidhan Nidhi Paudel, Nandu Silwal Poudyal, Barun Shrestha, Binod Karki, Suresh Thapa, Dibas Khadka, Rajan Kanth, Paritosh Kafle
INTRODUCTION: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. METHODS: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017...
January 2018: JNMA; Journal of the Nepal Medical Association
P Königshofer, K Brusilovskaya, P Schwabl, T Reiberger
Chronic liver diseases ultimately lead to cirrhosis and portal hypertension (PHT). Indeed, PHT is a major cause for severe complications, while medical treatment is limited to non-selective betablockers. Sophisticated animal models are needed to investigate novel treatment options for different etiologies of liver disease, effective anti-fibrotic agents as well as vasoactive drugs against PHT. In this review, we present some of the most common animal models of liver disease and PHT - including pre-hepatic, intra-hepatic and post-hepatic PHT in rodents...
July 25, 2018: Biochimica et Biophysica Acta
Dinesh Mani Tripathi, Marina Vilaseca, Erica Lafoz, Hector Garcia-Caldero, Gabriela Viegas Haute, Anabel Fernández-Iglesias, Jarbas Rodrigues de Oliveira, Juan Carlos Garcia-Pagan, Jaime Bosch, Jordi Gracia-Sancho
BACKGROUND & AIMS: Cirrhosis and its clinical consequences can be aggravated by bacterial infections, ultimately leading to the development of acute on chronic liver failure (ACLF), characterized by acute decompensation, organ failure, and high mortality within 28 days. Little is known about cellular and molecular mechanisms of ACLF in patients with cirrhosis, so no therapeutic options are available. We developed a sepsis-associated pre-clinical model of ACLF to facilitate studies of pathogenesis and evaluate the protective effects of simvastatin...
July 25, 2018: Gastroenterology
Kartik S Jhaveri, Hooman Hosseini-Nik, Nima Sadoughi, Harry Janssen, Jordan J Feld, Sandra Fischer, Ravi Menezes, Angela C Cheung
OBJECTIVES: To develop and internally validate MR elastography (MRE) quantified liver stiffness (LS) cut-off values for distinguishing early/moderate fibrosis from cirrhosis in primary sclerosing cholangitis (PSC) against non-invasive fibrosis test of vibration-controlled transient elastography (VCTE). METHODS: Sixty-seven patients were enrolled prospectively at a tertiary care centre to undergo MRE and VCTE. MRE-quantified LS was calculated using three region-of-interest (ROI) methods: Trace, Average and Maximum...
July 26, 2018: European Radiology
Chang Lae Kim, Taehong Kim, Won Hyuk Lee, Joo Wan Seo, Seung Ha Park, Joon Hyuk Choi, Nae Yun Heo
Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy...
July 25, 2018: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
Tawfik Khoury, Muhammad Massarwa, Wadi Hazou, Saleh Daher, David Hakimian, Ariel A Benson, Toni Ashqar, Mahmud Mahamid, Shaul Yaari
PURPOSE: Portal vein thrombosis (PVT) is a common condition in cirrhotic patients and mostly attributed to portal hypertension. The objective of our study was to examine the association of PVT with hepatocellular carcinoma (HCC) in cirrhotic patients. METHODS: A retrospective study was performed to identify cirrhotic patients with thrombosis of the portal system. Clinical and laboratory characteristics were collected and analyzed. RESULTS: Thirty-nine patients were identified...
July 25, 2018: Journal of Gastrointestinal Cancer
Filippo Schepis, Laura Turco, Marcello Bianchini, Erica Villa
Cirrhosis represents the end stage of chronic liver disease and its transition from a compensated to a decompensated status is mainly driven by portal hypertension and systemic inflammation. Although relevant modifications in the evaluation of the coagulative balance in cirrhosis across its natural history have occurred and alterations in routine indices of hemostasis have lost their role as indicators of the hemorrhagic risk of patients with liver cirrhosis, these are still perceived as prone to bleed when admitted to invasive procedures...
August 2018: Seminars in Liver Disease
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