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Cirrhotic ascites

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https://www.readbyqxmd.com/read/28792999/clinical-features-of-refractory-ascites-in-outpatients
#1
Wanda Regina Caly, Rodrigo Martins Abreu, Bernardo Bitelman, Flair José Carrilho, Suzane Kioko Ono
OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month...
July 2017: Clinics
https://www.readbyqxmd.com/read/28751810/effectiveness-of-tolvaptan-monotherapy-and-low-dose-furosemide-tolvaptan-combination-therapy-for-hepatoprotection-and-diuresis-in-a-rat-cirrhotic-model
#2
Norikazu Tanabe, Taro Takami, Koichi Fujisawa, Toshihiko Matsumoto, Naoki Yamamoto, Isao Sakaida
Spironolactone and furosemide, which are used to treat ascites associated with decompensated cirrhosis, are ineffective in treating refractory ascites. Hence, combination therapy with tolvaptan, a vasopressin V2 receptor antagonist, has been approved in Japan. Tolvaptan monotherapy and combination therapy with furosemide inhibit fibrosis in cardiac remodeling; hence, we examined these therapies in a rat cirrhotic model, including their usefulness in inhibiting hepatic fibrosis. In the present study, we used a model of hepatic fibrosis induced by a choline-deficient l-amino-acid-defined diet + diethylnitrosamine...
July 2017: Journal of Clinical Biochemistry and Nutrition
https://www.readbyqxmd.com/read/28744162/validity-of-an-automated-algorithm-using-diagnosis-and-procedure-codes-to-identify-decompensated-cirrhosis-using-electronic-health-records
#3
Mei Lu, Wadih Chacra, David Rabin, Loralee B Rupp, Sheri Trudeau, Jia Li, Stuart C Gordon
Viral hepatitis-induced cirrhosis can progress to decompensated cirrhosis. Clinical decompensation represents a milestone event for the patient with cirrhosis, yet there remains uncertainty regarding precisely how to define this important phenomenon. With the development of broader treatment options for cirrhotic hepatitis patients, efficient identification of liver status before evolving to decompensated cirrhosis could be life-saving, but research on the topic has been limited by inconsistencies across studies, populations, and case-confirmation methods...
2017: Clinical Epidemiology
https://www.readbyqxmd.com/read/28737869/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-1-pathophysiology-diagnostic-evaluation-hospitalization-criteria-treatment-nutritional-management
#4
REVIEW
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamsch, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Álvarez
Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of pediatric patients with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to its diagnostic and therapeutic aspects, and preventive care...
August 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28726361/risk-of-spontaneous-fungal-peritonitis-sfp-in-hospitalized-cirrhotic-patients-with-ascites-a-systematic-review-of-observational-studies-and-meta-analysis
#5
Marco Fiore, Paolo Chiodini, Vincenzo Pota, Pasquale Sansone, Maria B Passavanti, Sebastiano Leone, Caterina Aurilio, Maria C Pace
INTRODUCTION: Spontaneous Fungal Peritonitis (SFP) is an infection of ascitic fluid occurring in cirrhotic patients. SFP prevalence varies from 0 to 41% of patients with spontaneous peritonitis (SP) and a positive ascitic fluid culture. Cirrhotic patients with SFP who fail to show improvement with empirical antibiotic therapy, before the identification of the fungal pathogen, have high mortality (89.5-100%). Although the weight of the disease is so dramatic, more recent guidelines on infections in cirrhosis do not consider SFP management...
July 20, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28688177/renal-vein-dilation-predicts-the-poor-outcome-in-patients-with-refractory-cirrhotic-ascites
#6
Naoki Matsumoto, Masahiro Ogawa, Mariko Kumagawa, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Shunichi Matsuoka, Mitsuhiko Moriyama, Hirotoshi Fujikawa
BACKGROUND & AIMS: Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra-abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites. METHODS: Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non-contrast computed tomography...
July 8, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28688141/incidence-predictive-factors-and-impacts-of-acute-kidney-injury-in-cirrhotic-patients-hospitalized-for-cellulitis
#7
Ana Garcia Garcia de Paredes, Luis Tellez, Miguel Angel Rodriguez-Gandia, Javier Martinez, Enrique Rodriguez De Santiago, Lara Aguilera Castro, Francisco Gea, Agustín Albillos
BACKGROUND & AIMS: Cellulitis is a common infection in patients with cirrhosis but its impact on progression of liver disease has been hardly addressed. This study examines the incidence of acute kidney injury (AKI), predictive factors, and its impacts on mortalilty in cirrhotic patients hospitalized for cellulitis. METHODS: Retrospective data from cirrhotic patients hospitalized for cellulitis over the period January 2006 to September 2015 were analyzed. AKI was defined according to revised criteria of the International Club of Ascites...
July 8, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28663673/spontaneous-bacterial-peritonitis-by-burkholderia-cepacia-complex-a-rare-difficult-to-treat-infection-in-decompensated-cirrhotic-patients
#8
Sunil Taneja, Pramod Kumar, Vikas Gautam, Ajay Duseja, Virendra Singh, Radha K Dhiman, Yogesh Chawla
INTRODUCTION: Burkholderia cepacia complex (Bcc) is non-fermenting Gram-negative bacillus and has been rarely reported to cause spontaneous bacterial peritonitis (SBP) in decompensated cirrhosis. OBJECTIVE: This study was done to evaluate the clinical presentation of cirrhotic patients with SBP due to Bcc and to determine its impact on clinical outcome. METHODS: This is a retrospective, observational study conducted during the period from 1st January 2013 through 31st March 2015...
June 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/28661458/adipokines-in-liver-cirrhosis
#9
REVIEW
Christa Buechler, Elisabeth M Haberl, Lisa Rein-Fischboeck, Charalampos Aslanidis
Liver fibrosis can progress to cirrhosis, which is considered a serious disease. The Child-Pugh score and the model of end-stage liver disease score have been established to assess residual liver function in patients with liver cirrhosis. The development of portal hypertension contributes to ascites, variceal bleeding and further complications in these patients. A transjugular intrahepatic portosystemic shunt (TIPS) is used to lower portal pressure, which represents a major improvement in the treatment of patients...
June 29, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28660157/comment-on-ascitic-fluid-analysis-in-the-differential-diagnosis-of-ascites-focus-on-cirrhotic-ascites
#10
Furqan Ahmed
No abstract text is available yet for this article.
June 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28647833/the-evaluation-of-the-right-inferior-phrenic-artery-diameter-in-cirrhotic-patients
#11
Kaan Esen, Yuksel Balci, Sermin Tok, Enver Ucbilek, Engin Kara, Omer Kaya
PURPOSE: The purpose of this study is to evaluate the relationship between right inferior phrenic artery diameter and portal hypertension in cirrhotic patients. METHODS: CT examinations of 38 patients with chronic liver disease (patient group) and 40 patients without any liver disease (control group) were evaluated. The right inferior phrenic artery diameter of the patient and control group were measured. CT findings of portal hypertension, which were accepted as ascites, collaterals, splenomegaly and portal vein diameter greater than 13 mm, were determined and scored in the patient group...
June 24, 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/28645737/alfapump%C3%A2-system-vs-large-volume-paracentesis-for-refractory-ascites-a-multicenter-randomized-controlled-study
#12
Christophe Bureau, Danielle Adebayo, Mael Chalret de Rieu, Laure Elkrief, Dominique Valla, Markus Peck-Radosavljevic, Anne McCune, Victor Vargas, Macarena Simon-Talero, Juan Cordoba, Paolo Angeli, Silvia Rosi, Stewart MacDonald, Massimo Malago, Maria Stepanova, Zobair M Younossi, Claudia Trepte, Randall Watson, Oleg Borisenko, Sun Sun, Neil Inhaber, Rajiv Jalan
BACKGROUND AND AIMS: Patients with refractory ascites (RA) require repeated large volume paracenteses (LVP), which involves frequent hospital visits and is associated with a poor quality-of-life. This study assessed safety and efficacy of an automated, low-flow pump (alfapump® [AP]) compared with LVP standard of care [SoC]. METHODS: A randomized controlled trial, in seven centers, with six month patient observation was conducted. Primary outcome was time to first LVP...
June 21, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28634518/role-of-albumin-in-cirrhosis-from-a-hospitalist-s-perspective
#13
REVIEW
Saqib Walayat, Daniel Martin, Jaymon Patel, Umair Ahmed, Muhammad N Asghar, Aparna U Pai, Sonu Dhillon
Albumin, a negatively charged globular protein encoded on chromosome 4, is one of the most abundant proteins in the plasma and accounts for approximately 75% of plasma oncotic pressure. The role of albumin in the management of various disease states has shown to be beneficial historically. Low serum albumin is a predictor of mortality and poor outcomes. In cirrhotics undergoing paracentesis, albumin infusion prevents rapid re-accumulation of ascitic fluid while simultaneously decreasing the risk of post-paracentesis related circulatory dysfunction...
January 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28614081/spontaneous-fungal-peritonitis-a-rare-but-severe-complication-of-liver-cirrhosis
#14
Marta Gravito-Soares, Elisa Gravito-Soares, Sandra Lopes, Graça Ribeiro, Pedro Figueiredo
INTRODUCTION AND AIM: Spontaneous bacterial peritonitis is the most common infectious complication in cirrhosis. Spontaneous fungal peritonitis is rare and remains unknown. In this work, spontaneous fungal peritonitis as well as risk factors and prognosis are characterized. PATIENTS AND METHODS: A retrospective case-control study of 253 consecutive admissions by peritonitis in cirrhotic patients was carried out between 2006 and 2015. Comparison of patients with spontaneous fungal peritonitis (cases) and spontaneous bacterial peritonitis with positive microbiologic ascitic fluid culture (controls) was performed...
September 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28611511/first-quarter-century-of-laparoscopic-liver-resection
#15
REVIEW
Zenichi Morise, Go Wakabayashi
The beginnings of laparoscopic liver resection (LLR) were at the start of the 1990s, with the initial reports being published in 1991 and 1992. These were followed by reports of left lateral sectionectomy in 1996. In the years following, the procedures of LLR were expanded to hemi-hepatectomy, sectionectomy, segmentectomy and partial resection of posterosuperior segments, as well as the parenchymal preserving limited anatomical resection and modified anatomical (extended and/or combining limited) resection procedures...
May 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28603226/infections-in-patients-affected-by-liver-cirrhosis-an-update
#16
Tiziana Ascione, Giusy Di Flumeri, Giovanni Boccia, Francesco De Caro
Patients with liver cirrhosis present an increased incidence of infections. The main cause has been founded in alterations of the enteric flora and of the intestinal barrier probably due to portal hypertension, in addition to a reticulo-endothelial system dysfunction. Furthermore, those living with cirrhosis can report a high predisposition to sepsis and septic shock, due to the excessive response of pro-inflammatory cytokines and a complessive hemodynamic derangement. By the analysis in the experimental model of the cirrhotic rat, it was demonstrated that radio-labelled Escherichia coli given by the oral route resulted in the location of the bacteria in the gut, the ascitic fluid and mesenteric lymph nodes, a phenomenon known as bacterial translocation...
June 1, 2017: Le Infezioni in Medicina
https://www.readbyqxmd.com/read/28593001/teaching-echoscopy-for-the-early-diagnosis-of-ascites-in-cirrhosis-assessment-of-an-objective-structured-clinical-examination-osce
#17
Salmi Andrea, Lanzani Giovanna, Campagnola Pietro, Frulloni Luca
INTRODUCTION: We assessed the efficacy of a brief, 8-h teaching program, using an objective structured clinical examination (OSCE) for the use of a pocket ultrasound device (echoscope) focused on bed side diagnosis of subclinical ascites in chronic liver disease. PATIENTS AND METHODS: Ten cirrhotic patients, five with subclinical ascites and five without, were selected during ultrasound examination performed with a high performance equipment for screening of hepatocellular carcinoma...
June 2017: Journal of Ultrasound
https://www.readbyqxmd.com/read/28588180/impact-of-adrenocortical-insufficiency-on-biochemical-parameters-in-haemodynamically-stable-cirrhotic-patients-with-ascites
#18
H Ahmed, M R Karim, R K Paul, M Chowdhury, M S Alam, F Rahman, M A Rouf
Cirrhosis has many complications regardless of the aetiology. Among them, adrenal insufficiency is recently identified entity. A prospective cohort study was done to evaluate the biochemical impact of adrenocortical insufficiency in haemodynamically stable, non-septic, cirrhotic patients with ascites and had been performed at the inpatient of GHPD department, BIRDEM, Dhaka from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months...
April 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/28579346/combined-spontaneous-bacterial-empyema-and-peritonitis-in-cirrhotic-patients-with-ascites-and-hepatic-hydrothorax
#19
Anwar Mohamed, Mohammed Atef, Ayman Alsebaey, Mahmoud Musa Elhabshy, Mohsen Salama
BACKGROUND AND STUDY AIMS: Spontaneous bacterial empyema (SBEM) is an underestimated condition in patients with ascites and hepatic hydrothorax with a high mortality. This study aimed to find whether spontaneous bacterial peritonitis (SBP) is a prerequisite for SBEM. PATIENTS AND METHODS: 3000 HCV-related cirrhotic patients with ascites and hydrothorax were screened for the presence of SBP (ascitic fluid neutrophils >250/mm(3)) and SBEM (positive pleural fluid culture and neutrophils >250/mm(3) or negative pleural fluid culture and neutrophils >500/mm(3) with no evidence of pneumonia/parapneumonic effusion on chest radiograph or CT)...
June 2017: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
https://www.readbyqxmd.com/read/28533907/novel-treatment-options-for-portal-hypertension
#20
Philipp Schwabl, Wim Laleman
Portal hypertension is most frequently associated with cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. As such, clinically significant portal hypertension forms the prelude to decompensation and impacts significantly on the prognosis of patients with liver cirrhosis. At present, non-selective β-blockers, vasopressin analogues and somatostatin analogues are the mainstay of treatment but these strategies are far from satisfactory and only target splanchnic hyperemia...
May 2017: Gastroenterology Report
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