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cirrhosis and portal hypertension

P Aiden McCormick, Dermot E Malone, James R Docherty, Clifford Kiat, Brian T Christopher, Jun Liong Chin
OBJECTIVES: One of the striking features of splenic imaging is variable heterogeneous gyriform arterial enhancement on dynamic computed tomography (CT). We speculated that these patterns of arterial enhancement may reflect changes in splenic micro-circulation related to changes in portal venous pressure. PATIENTS AND METHODS: To test this hypothesis, we evaluated arterial phase CT scans performed before and after liver transplantation (n=91), as this is the most effective way of alleviating portal hypertension...
October 16, 2018: European Journal of Gastroenterology & Hepatology
Tatyana R Beketova, Lucy Bailey, Eric L Crowell, Emilio P Supsupin, Ore-Ofe O Adesina
A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection...
October 9, 2018: Ophthalmic Plastic and Reconstructive Surgery
Octavia Bane, Steven Peti, Mathilde Wagner, Stefanie Hectors, Hadrien Dyvorne, Michael Markl, Bachir Taouli
BACKGROUND: The test-retest/interobserver repeatability and diagnostic value of 4D flow MRI in liver disease is underreported. PURPOSE: To determine the reproducibility/repeatability of flow quantification in abdominal vessels using a spiral 4D flow MRI sequence; to assess the value of 4D flow parameters in diagnosing cirrhosis and degree of portal hypertension. STUDY TYPE: Prospective. SUBJECTS: Fifty-two patients with chronic liver disease...
October 14, 2018: Journal of Magnetic Resonance Imaging: JMRI
J G Abraldes, J Trebicka, N Chalasani, G D'Amico, D Rockey, V Shah, J Bosch, G Garcia-Tsao
Portal hypertension is the main driver of cirrhosis decompensation, the main determinant of death in patients with cirrhosis. Portal hypertension results initially from increased intrahepatic vascular resistance. Later, increased inflow from splanchnic vasodilation and increased cardiac output lead to a further increase in portal pressure. Reducing portal pressure in cirrhosis results in better outcomes. Removing the cause of cirrhosis might improve portal pressure. However, this is a slow process and patients may continue to be at risk of decompensation...
October 15, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Mohammed AbdAllah Salman, Doaa Ahmed Mansour, Hany Armia Balamoun, Mohamed Yehia Elbarmelgi, Kareem Essam Eldin Hadad, Mohammad ElSherbiny Abo Taleb, Ahmed Salman
OBJECTIVE: Emergency surgery is a risk factor for mortality in cirrhotic patients. Portal hypertension is an essential feature of decompensated cirrhosis. This study aimed to assess the value of portal venous pressure (PVP) measurement in prediction of 1-month mortality in cirrhotic patients undergoing emergency laparotomy. METHODS: This prospective study included 121 adults with liver cirrhosis subjected to an emergency laparotomy. Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score were used for preoperative patient evaluation...
October 10, 2018: Asian Journal of Surgery
Carlos Moctezuma-Velazquez, Francesca Saffioti, Stephanie Tasayco-Huaman, Stefania Casu, Andrew Mason, Davide Roccarina, Victor Vargas, Jan-Erick Nilsson, Emmanuel Tsochatzis, Salvador Augustin, Aldo J Montano-Loza, Annalisa Berzigotti, Douglas Thorburn, Joan Genesca, Juan Gonzalez Abraldes
BACKGROUND: Baveno-VI guidelines recommend that patients with compensated cirrhosis with liver stiffness by transient elastography (LSM-TE) <20 kPa and platelets >150,000/mm3 do not need an esophagogastroduodenoscopy (EGD) to screen for varices, since the risk of having varices needing treatment (VNT) is <5%. It remains uncertain if this tool can be used in patients with cholestatic liver diseases (ChLDs): primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)...
October 12, 2018: American Journal of Gastroenterology
Carlos Ferre Aracil, Laura Núñez Gómez, Luis Téllez Villajos, Agustín Albillos Martínez
INTRODUCTION: Epistaxis in cirrhotic patients is a common issue. However, the literature published to date is very scarce. MATERIAL AND METHODS: Retrospective case series of patients with cirrhosis who presented with a significant epistaxis, between 2006 and 2016. RESULTS: Data were collected from 39 cirrhotic patients with a mean age of 61.4 (±14) years, 75% of which were males. The main comorbidities were hypertension (33%) and diabetes mellitus (26%)...
October 9, 2018: Gastroenterología y Hepatología
Gyorgy Baffy
Gut microbiota is the largest collection of commensal microorganisms in the human body, engaged in reciprocal cellular and molecular interactions with the liver. This mutually beneficial relationship may break down and result in dysbiosis, associated with disease phenotypes. Altered composition and function of gut microbiota has been implicated in the pathobiology of nonalcoholic fatty liver disease (NAFLD), a prevalent condition linked to obesity, insulin resistance, and endothelial dysfunction. NAFLD may progress to cirrhosis and portal hypertension, which is the result of increased intrahepatic vascular resistance and altered splanchnic circulation...
October 12, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Ivana Nikolic, Lai-Ming Yung, Peiran Yang, Rajeev Malhotra, Samuel D Paskin-Flerlage, Teresa Dinter, Geoffrey A Bocobo, Kathleen E Tumelty, Anthony J Faugno, Luca Troncone, Megan E McNeil, Xiuli Huang, Kathryn R Coser, Carol S C Lai, Paul D Upton, Marie Jose Goumans, Roham T Zamanian, C Gregory Elliott, Arthur Lee, Wei Zheng, Stephen P Berasi, Christine Huard, Nicholas W Morrell, Raymond T Chung, Richard W Channick, Kari E Roberts, Paul B Yu
RATIONALE: Bone Morphogenetic Protein 9 (BMP9) is a circulating endothelial quiescence factor with protective effects in pulmonary arterial hypertension (PAH). Loss-of-function mutations in BMP9, its receptors and downstream effectors have been reported in heritable PAH. OBJECTIVES: We sought to determine how an acquired deficiency of BMP9 signaling might contribute to PAH. METHODS AND RESULTS: Plasma levels of BMP9 and antagonist soluble Endoglin (sEng) were measured in Group 1 PAH, Group 2 and 3 pulmonary hypertension (PH), and in patients with severe liver disease without PAH...
October 12, 2018: American Journal of Respiratory and Critical Care Medicine
Deepika Polineni, Annalisa V Piccorelli, William B Hannah, Sarah N Dalrymple, Rhonda G Pace, Peter R Durie, Simon C Ling, Michael R Knowles, Jaclyn R Stonebraker
Previous reports of lung function in cystic fibrosis (CF) patients with liver disease have shown worse, similar, or even better forced expiratory volume in 1 second (FEV1), compared to CF patients without liver disease. Varying definitions of CF liver disease likely contribute to these inconsistent relationships reported between CF lung function and liver disease. We retrospectively evaluated spirometric data in 179 subjects (62% male; 58% Phe508del homozygous) with severe CF liver disease (CFLD; defined by presence of portal hypertension due to cirrhosis)...
2018: PloS One
Josephine Cool, Russell Rosenblatt, Sonal Kumar, Catherine Lucero, Brett Fortune, Carl Crawford, Arun Jesudian
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is increasingly common in cirrhotics, but its impact on mortality and outcomes is unclear. Studies evaluating PVT have been limited by small sample size. This study analyzes the trend of the prevalence of PVT and its associated mortality in hospitalized decompensated cirrhotics. METHODS: The Nationwide Inpatient Sample, the largest nationally-representative database of hospital discharges, was queried from 1998-2014...
October 11, 2018: Journal of Gastroenterology and Hepatology
Abdisamad M Ibrahim, Bishal Bhandari, Paolo K Soriano, Zafar Quader, John Z Gao, Dmitry Shuster, Chaitanya K Mamillapalli
BACKGROUND Sarcoidosis is a systemic disease that can affect any organ, including the liver. It is manifested by the presence of non-caseating granulomas within involved organs, most commonly the pulmonary, lymphatic, and hepatic system. Unlike pulmonary or lymphatic involvement, hepatic involvement is usually asymptomatic and it is underdiagnosed. Here, we report a case of a patient with a history of pulmonary sarcoidosis who developed hepatic sarcoidosis. CASE REPORT 68-year-old female with pulmonary sarcoidosis with a 2-week history of severe abdominal pain and epigastric tenderness presented to our center...
October 11, 2018: American Journal of Case Reports
Clément Lejealle, Valérie Paradis, Onorina Bruno, Emmanuelle de Raucourt, Claire Francoz, Olivier Soubrane, Didier Lebrec, Pierre Bedossa, Dominique Valla, Hervé Mal, Valérie Vilgrain, François Durand, Pierre-Emmanuel Rautou
BACKGROUND: s: Hepatopulmonary syndrome (HPS) is characterized by an arterial oxygenation defect - defined by an increased alveolar-arterial oxygen gradient - induced by pulmonay vascular dilatations in the context of liver disease. The pathogenesis of HPS is poorly understood. Morphological changes associated with HPS are unknown. This study aimed at describing imaging and pathology changes associated with HPS. METHODS: We performed a case-control study in candidates for transplant with suspicion of cirrhosis...
October 4, 2018: Chest
Dou-Sheng Ba, Chi Zhang, Sheng-Jie Jin, Ping Chen, Guo-Qing Jiang
BACKGROUND/AIMS: In patients who survive the first esophageal variceal bleeding (EVB) resulting from portal hypertension, the probability of fatal esophageal variceal re-bleeding (EVR) is high. We have developed a sandwich-style sequential therapy combining laparoscopic splenectomy and azygoportal disconnection (LSD) with preoperative and postoperative endoscopic intervention (LSDE). The aim of the present study was to investigate whether LSDE is safe and effective and to evaluate whether the postoperative EVR rate for LSDE was lower than that for LSD without periodical postoperative endoscopic intervention (NLSDE)...
October 5, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Kuei-Chuan Lee, Wei-Fan Hsu, Yun-Cheng Hsieh, Che-Chang Chan, Ying-Ying Yang, Yi-Hsiang Huang, Ming-Chih Hou, Han-Chieh Lin
BACKGROUND: Liver fibrosis can progress to cirrhosis, hepatocellular carcinoma, or liver failure. Unfortunately, the antifibrotic agents are limited. Thrombin activates hepatic stellate cells (HSCs). Therefore, we investigated the effects of a direct thrombin inhibitor, dabigatran, on liver fibrosis. METHODS: Adult male Sprague-Dawley rats were injected intraperitoneally with thioacetamide (TAA, 200 mg/kg twice per week) for 8 or 12 weeks to induce liver fibrosis...
October 4, 2018: Digestive Diseases and Sciences
Peter Lykke Eriksen, Anne Luise Hartkopf-Mikkelsen, Peter Ott, Hendrik Vilstrup, Niels Kristian Aagaard
Background: Terlipressin is used as pharmacological treatment for variceal bleeding. The drug's physiological effect favours hyponatremia, and rapid changes in plasma sodium (PNa) may cause brain injury. Cirrhosis patients seem to be largely protected against this effect but patients without cirrhosis may not be so. Objective: The objective of this study was to examine whether terlipressin treatment of patients without cirrhosis leads to more serious fluctuations in PNa than in cirrhosis...
October 2018: United European Gastroenterology Journal
Dengke Teng, Hao Zuo, Lin Liu, Jinghui Dong, Lei Ding
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) procedure has played a vital role in management of portal hypertension. Thus, we aimed to investigate the natural history, long-term clinical outcome, predictors of survival in viral hepatitis related cirrhotic patients post-TIPS. METHOD: A total of 704 patients with complete followed-up data were enrolled, and clinical characteristics of patients were collected and analyzed. Kaplan-Meier method was used to calculate survival, and comparisons were made by log rank test...
October 1, 2018: Virology Journal
Wen Xu, Ping Liu, Yong-Ping Mu
Portal hypertension (PHT) is an important consequence of liver cirrhosis, which can lead to complications that adversely affect a patient's quality of life and survival, such as upper gastrointestinal bleeding, ascites, and portosystemic encephalopathy. In recent years, advances in molecular biology have led to major discoveries in the pathological processes of PHT, including the signaling pathways that may be involved: PI3K-AKT-mTOR, RhoA/Rho-kinase, JAK2/STAT3, and farnesoid X receptor. However, the pathogenesis of PHT is complex and there are numerous pathways involved...
September 26, 2018: World Journal of Clinical Cases
Elsaed H Ibrahim, Salah A Marzouk, Ahmed E Zeid, Sameh A Lashen, Tarek M Taher
BACKGROUND: Noninvasive methods have been established to detect clinically significant portal hypertension in liver cirrhosis with variable limitations. The von Willebrand factor (vEF) has been found to increase in liver cirrhosis. AIM: The aim of this study was to explore the vEF and VITRO (von Willebrand factor antigen/platelet ratio) score in the prediction of variceal bleeding in patients with portal hypertension. MATERIALS AND METHODS: Fifty patients with hepatitis C-related liver cirrhosis (25 patients with variceal bleeding and 25 without variceal bleeding) as well as 80 healthy controls were included...
October 2, 2018: European Journal of Gastroenterology & Hepatology
Raja Gr Edula, Sujit Muthukuru, Serban Moroianu, Yucai Wang, Vivek Lingiah, Phoenix Fung, Nikolaos T Pyrsopoulos
Background and Aims: To evaluate the prevalence and significance of elevated cancer antigen-125 (CA-125) levels in patients with cirrhosis being treated in a tertiary care liver center and its correlation with objective markers of disease severity. Methods: We retrospectively reviewed medical records of 172 adult patients with cirrhosis (due to any etiology) after obtaining CA-125 serum analysis. Demographics, etiology of cirrhosis, model of end-stage liver disease (MELD) score, Child's Turcotte-Pugh classification, albumin bilirubin (ALBI) score, degree of ascites, presence of esophageal varices, serum CA-125 level and various other parameters were collected...
September 28, 2018: Journal of Clinical and Translational Hepatology
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