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cirrhosis and portal hypertension

Mohammad Golriz, Omid Ghamarnejad, Elias Khajeh, Mohammadsadegh Sabagh, Markus Mieth, Katrin Hoffmann, Alexis Ulrich, Thilo Hackert, Karl Heinz Weiss, Peter Schirmacher, Markus W Büchler, Arianeb Mehrabi
Background: It is a novel idea that platelet counts may be associated with postoperative outcome following liver surgery. This may help in planning an extended hepatectomy (EH), which is a surgical procedure with high morbidity and mortality. Aim: The aim of this study was to evaluate the predictive potential of platelet counts on the outcome of EH in patients without portal hypertension, splenomegaly, or cirrhosis. Methods: A series of 213 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2016...
2018: Canadian Journal of Gastroenterology & Hepatology
Yasir Al-Azzawi, Lidia Spaho, Mohammed Mahmoud, Joan Kheder, Anne Foley, David Cave
Background: The features of the portal hypertension enteropathy (PHE) vary from mild mucosal changes to varices with or without bleeding. The prevalence and the development are not fully understood. Aim: Our aim is to examine the prevalence and the different manifestations of PHE using video capsule endoscopy (VCE). Methods: It is a single center retrospective study of patients with cirrhosis, who had VCE. Based on the published literature, we divided the PHE lesions into vascular lesions and mucosal lesions...
2018: International Journal of Hepatology
Razan M Bader, Maureen M Jonas, Paul D Mitchell, Shanna Wiggins, Christine K Lee
BACKGROUND: Hepatic steatosis is a common manifestation of CF-related liver disease(CFLD). Controlled attenuation parameter(CAP) measurement during transient elastography(TE) semiquantifies liver steatosis. We examined the relationship between CAP and CFLD severity, clinical factors and liver stiffness measurements(LSM). METHODS: This is a cross-sectional study of CF patients seen for outpatient care between January 2013-March 2014. CFLD severity was categorized as no CFLD, CFLD without portal hypertension(PHTN) and CFLD with PHTN, based on published criteria...
November 30, 2018: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
Yan Song, Weizhi Li, Hui Xue, Litao Ruan
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is the method of choice for the treatment of portal hypertension. The Tei index is the most sensitive indicator of myocardial function. DESIGN: This study enrolled 31 patients with cirrhosis who underwent TIPS and were followed up over a median period of 34 months (range 2-60 months). Baseline Meld score and the changes in the Tei index within 1 month after TIPS and their potential relationship with prognosis were evaluated...
December 1, 2018: Echocardiography
Maria Angeles Aller, Natalia Arias, Javier Blanco-Rivero, Gloria Balfagón, Jaime Arias
We propose that the circulatory impairments produced, in both portal hypertension and liver cirrhosis, to a certain degree resemble those characterizing prenatal life in the fetus. In fact, the left-right circulatory syndrome is common in cirrhotic patients and in the fetus. Thus, in patients with portal hypertension and chronic liver failure, the re-expression of a blood circulation comparable to fetal circulation is associated with the development of similar amniotic functions, i.e., ascites production and placenta functions, and portal vascular enteropathy...
November 29, 2018: Current Research in Translational Medicine
Rohini Krishna, Samuel O Igbinedion, Richie Diaz, Nazneen Hussain, Moheb Boktor
With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed...
2018: Case Reports in Gastrointestinal Medicine
Nicolas M Intagliata, Jessica P E Davis, Stephen H Caldwell
Achieving hemostasis, preventing and treating thrombosis, and laboratory measurement of the hemostatic pathways constitute the core elements of managing the critically ill patient with liver failure. Uncontrolled bleeding in acutely decompensated cirrhosis and acute-on-chronic liver failure is probably the most familiar clinical challenge to intensivists. Bleeding in these patients can be broadly divided into pressure-driven (portal hypertension-related) bleeding with only limited dependence on hemostatic pathways and intractable mucosal/wound bleeding, which is much more directly related to a severely disturbed hemostatic system with imbalances in the coagulation cascade and the fibrinolytic system...
October 2018: Seminars in Respiratory and Critical Care Medicine
Kapil Rajwani, Brett E Fortune, Robert S Brown
Gastrointestinal (GI) bleeding and ascites are two significant clinical events that frequently present in critically ill patients with chronic liver failure or decompensated cirrhosis. GI bleeding in patients with cirrhosis, particularly portal hypertensive-associated bleeding, carries a high short-term mortality (15-25%) and requires early initiation of a vasoactive agent and antibiotics as well as timely endoscopic management. Conservative transfusion strategies and adequate airway protection are also imperative to assist in bleeding control...
October 2018: Seminars in Respiratory and Critical Care Medicine
Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber
Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common...
October 2018: Seminars in Respiratory and Critical Care Medicine
Edoardo G Giannini, Mattia Crespi, Mariagiulia Demarzo, Giorgia Bodini, Manuele Furnari, Elisa Marabotto, Francesco Torre, Patrizia Zentilin, Vincenzo Savarino
BACKGROUND: The outcome of patients with chronic hepatitis C virus infection (HCV) and advanced, compensated liver disease after sustained virological response (SVR) to direct-acting antivirals (DAAs) has not yet been completely depicted. We aimed to assess the clinical, biochemical, and instrumental outcome of patients with advanced, compensated chronic HCV-related liver disease with DAAs-induced SVR to DAAs and who had at least 1-year follow-up. MATERIALS AND METHODS: Fifty-two patients with cirrhosis (n=27) and fibrosis stage F3 (n=25) followed-up for a median of 60 weeks after successful DAAs treatment were included...
November 26, 2018: European Journal of Clinical Investigation
D Bhattacharjee, S Vracar, R A Round, P G Nightingale, J A Williams, G V Gkoutos, I M Stratton, R Parker, S D Luzio, G A Roberts, J Webber, S Ghosh, S E Manley
AIMS: To investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease. METHODS: HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. The median (interquartile range) Model for End Stage Liver Disease score for the study cohort was calculated as 12 (9-17; normal <6)...
November 26, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
P Rigaud, J Traclet, V Cottin
INTRODUCTION: Schistosomiasis associated pulmonary arterial hypertension belongs to group 1 of the pulmonary hypertension classification and should be considered in any patient with pulmonary hypertension returning from an endemic area. CASE REPORT: A 17-year-old patient was hospitalized for pulmonary hypertension detected during the initial assessment of viral hepatitis B-related cirrhosis with portal hypertension. The initial assessment established the diagnosis of pulmonary hypertension secondary to viral hepatitis B-cirrhosis...
November 22, 2018: Revue des Maladies Respiratoires
J M Seguí-Ripoll, P Zapater-Hernández, A Candela-Gomis, L Compañ-Catalá, R Francés-Guarinos, A Payá-Romá, A Compañ-Rosique, J Such-Ronda
BACKGROUND: Double common bile duct ligation plus section in rats is used as a model for bacterial translocation, a phenomenon that has been correlated with the degree of liver damage. This study analyzes whether a simpler variant of the technique is also a valid model to study bacterial translocation. METHODS: Fifty-six male Sprague Dawley rats underwent one of three surgical interventions: a) proximal double ligation and section of the common bile duct; b) proximal simple ligation of the bile duct; and c) sham operation...
November 14, 2018: American Journal of Surgery
Shuet Fong Neong, Emma O Billington, Stephen E Congly
Healthy sexual function is important to maintain a good quality of life but is frequently impaired in patients with cirrhosis. The degree of sexual dysfunction appears to be linked with the degree of hepatic dysfunction. In men, sexual dysfunction can be related to the hyperestrogenism of portal hypertension and/or to decreased testosterone resulting from testicular dysfunction. In women, suppression of the hypothalamic-pituitary-gonadal axis appears to be a principal contributor, with no significant effect of portal hypertension...
November 23, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Khurram Mazhar
Nonalcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease in the United States. The NAFLD subtype, nonalcoholic steatohepatitis, represents a progressive form of the disease that can lead to cirrhosis, portal hypertension, and hepatocellular carcinoma. NAFLD is a diagnosis of exclusion and is strongly related to obesity and the metabolic syndrome. Although there has been an explosion of exciting therapeutic avenues for NAFLD in recent years, the bedrock of management continues to be lifestyle modification, weight loss, and optimization of metabolic risk factors...
January 2019: Medical Clinics of North America
Asmaa Elzeftawy, Loai Mansour, Abdelrahman Kobtan, Heba Mourad, Ferial El-Kalla
BACKGROUND/AIMS: The development of esophageal varices (EV) and resultant bleeding are the most critical complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV. To find a non-invasive method for diagnosis of EV and to predict the bleeding risk is appealing and would decrease the cost and discomfort of upper endoscopy. The aim of our study was to evaluate the blood ammonia level as a predictor of the presence of EV and of a high risk of bleeding...
November 21, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Yongliang Sun, Xu Lan, Chen Shao, Tailing Wang, Zhiying Yang
BACKGROUND AND AIM: Idiopathic portal hypertension (IPH) refers to a relatively rare condition characterized by intrahepatic portal hypertension in the absence of underlying disease such as liver cirrhosis. METHODS: We retrospectively reviewed 338 patients with IPH that were diagnosed at the pathological consultation center of our hospital. RESULTS: The ratio of male to female patients was 1:1. Mean age at onset was 35.1 ± 16.5 years; male patients on average were 12 years younger than female patients at onset...
November 21, 2018: Journal of Gastroenterology and Hepatology
Dou-Sheng Bai, Wen-Yu Shao, Chi Zhang, Ping Chen, Sheng-Jie Jin, Guo-Qing Jiang
BACKGROUND/AIMS: Splenectomy is regarded as an effective curative treatment for thrombocytopenia caused by hypersplenism in patients with cirrhosis. However, in clinical practice, thrombocytopenia is not resolved by splenectomy in all patients. This study aimed to evaluate the adverse factors responsible for platelet (PLT) counts below the normal lower limit following laparoscopic splenectomy and azygoportal disconnection (LSD). MATERIALS AND METHODS: We retrospectively evaluated the outcomes of 123 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism, who underwent LSD and who had PLT counts <125×109/L (non-normal group) or ≥125×109/L (normal group) at the postoperative month (POM) 3, between April 2014 and March 2017...
November 20, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Maria Rosa Bella, Meritxell Casas, Mercedes Vergara, Enric Brullet, Félix Junquera, Eva Martínez-Bauer, Mireia Miquel, Jordi Sánchez-Delgado, Blai Dalmau, Rafael Campo, Xavier Calvet
INTRODUCTION: Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG...
November 17, 2018: Gastroenterología y Hepatología
Xiaolong Qi, Weimin An, Fuquan Liu, Ruizhao Qi, Lei Wang, Yanna Liu, Chuan Liu, Yi Xiang, Jialiang Hui, Zhao Liu, Xingshun Qi, Changchun Liu, Baogang Peng, Huiguo Ding, Yongping Yang, Xiaoshun He, Jinlin Hou, Jie Tian, Zhiwei Li
Purpose To develop and validate a computational model for estimating hepatic venous pressure gradient (HVPG) based on CT angiographic images, termed virtual HVPG, to enable the noninvasive diagnosis of portal hypertension in patients with cirrhosis. Materials and Methods In this prospective multicenter diagnostic trial ( identifier: NCT02842697), 102 consecutive eligible participants (mean age, 47 years [range, 21-75 years]; 68 men with a mean age of 44 years [range, 21-73 years] and 34 women with a mean age of 52 years [range, 24-75 years]) were recruited from three high-volume liver centers between August 2016 and April 2017...
November 20, 2018: Radiology
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