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Ascites in cirrhosis

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https://www.readbyqxmd.com/read/28925475/percutaneous-implant-of-denver-peritoneo-venous-shunt-for-treatment-of-refractory-ascites-a-single-center-retrospective-study
#1
M Piccirillo, L Rinaldi, M Leongito, A Amore, A Crispo, V Granata, P Aprea, F Izzo
OBJECTIVE: Refractory ascites is defined as a lack of response to high doses of diuretics or the development of diuretic related side effects, which compel the patient to discontinue the diuretic treatment. Current therapeutic strategies include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunts (TIPS). Peritoneovenous shunt (Denver shunt) should be considered for patients with refractory ascites who are not candidates for paracentesis or TIPS. This study presents our case series in the implant of Denver peritoneovenous shunt...
August 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28919607/impact-of-adrenocortical-insufficiency-on-clinical-parameters-in-haemodynamically-stable-cirrhotic-patients-with-ascites
#2
H Ahmed, M R Karim, R K Paul, M Chowdhury, M S Alam, A Saha, F Rahman, M A Rouf
Cirrhosis has many complications regardless of the aetiology. Complications include splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatocellular carcinoma and also linked to abnormalities in the endocrine system, including abnormal sex hormone metabolism, thyroid disease, osteoporosis, and, most recently identified, adrenal insufficiency. This prospective cohort study was done to evaluate the impact of adrenocortical insufficiency on clinical parameters in haemodynamically stable cirrhotic patients with ascites and had been performed at the inpatient of GHPD Department, BIRDEM, Dhaka, Bangladesh from April 2011 to March 2012...
July 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/28919595/a-case-of-hepatorenal-syndrome-and-abdominal-compartment-syndrome-with-high-renal-congestion
#3
Hiroteru Kamimura, Takayuki Watanabe, Tomoyuki Sugano, Nao Nakajima, Junji Yokoyama, Kenya Kamimura, Atsunori Tsuchiya, Masaaki Takamura, Hirokazu Kawai, Takashi Kato, Gen Watanabe, Satoshi Yamagiwa, Shuji Terai
BACKGROUND Hepatorenal syndrome (HRS) is a reversible renal impairment that occurs in patients with acute liver failure and advanced liver cirrhosis. HRS is due to a renal vasoconstriction that results from extreme vasodilatation. It is therefore a functional disorder, not associated with structural kidney damage. On the other hand, end-stage liver diseases are often complicated by massive ascites. Massive ascites may cause abdominal compartment syndrome (ACS), which includes impairment of renal blood flow, but there are no reports indicating that kidney lesions caused by ACS may pathologically contribute to end-stage liver diseases...
September 18, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28910501/serum-cystatin-c-level-is-an-excellent-predictor-of-mortality-in-patients-with-cirrhotic-ascites
#4
Yeon Seok Seo, Soo Young Park, Moon Young Kim, Sang Gyune Kim, Jun Yong Park, Hyung Joon Yim, Byoung Kuk Jang, Seung Ha Park, Ji Hoon Kim, Ki Tae Suk, Jin Dong Kim, Tae Yeob Kim, Eun Young Cho, Jun Sung Lee, Soung Won Jung, Jae Young Jang, Hyonggin An, Won Young Tak, Soon Koo Baik, Jae Seok Hwang, Young Seok Kim, Joo Hyun Sohn, Soon Ho Um
BACKGROUND/AIMS: Although serum cystatin C level is considered a more accurate marker of renal function in patients with liver cirrhosis, its prognostic efficacy remains uncertain. This study aimed to evaluate the prognostic efficacy of serum cystatin C level in patients with cirrhotic ascites. METHODS: Patients with cirrhotic ascites from 15 hospitals were prospectively enrolled between September 2009 and March 2013. Cox regression analyses were performed to identify independent predictive factors of mortality and development of type 1 hepatorenal syndrome (HRS-1)...
September 14, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28910191/lysophosphatidic-acid-is-a-biomarker-for-peritoneal-carcinomatosis-of-gastric-cancer-and-correlates-with-poor-prognosis
#5
Ruolan Zeng, Bin Li, Junhui Huang, Meizuo Zhong, Li Li, Chaojun Duan, Shan Zeng, Jin Huang, Wei Liu, Jingchen Lu, Youhong Tang, Lingming Zhou, Yiping Liu, Jianhuang Li, Zhengxi He, Quan Wang, Youyi Dai
BACKGROUND: Peritoneal carcinomatosis (PC) is an important cause of morbidity and mortality among patients with gastric cancer. Thus, it is important to identify an ideal biomarker for PC. METHODS: Plasma and ascites samples were collected from gastric cancer patients with PC and a control group. Lysophosphatidic acid (LPA) levels were tested and analyzed. RESULTS: The plasma LPA levels of gastric cancer patients with PC were significantly higher than those in gastric cancer patients after radical resection (p = 0...
September 14, 2017: Genetic Testing and Molecular Biomarkers
https://www.readbyqxmd.com/read/28902040/long-term-rifaximin-therapy-as-a-primary-prevention-of-hepatorenal-syndrome
#6
El-Sayed Ibrahim, Ayman Alsebaey, Hassan Zaghla, Sabry Moawad Abdelmageed, Khalid Gameel, Eman Abdelsameea
BACKGROUND: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis, with poor survival. Rifaximin is a gut-selective broad-spectrum antibiotic. AIM: The aim of this study was to evaluate the role of rifaximin as a primary prevention of HRS. PATIENTS AND METHODS: Eighty patients with liver cirrhosis and ascites were enrolled. They were randomized into two groups: control (n=40) and rifaximin group (n=40). Baseline liver function tests, renal function tests, complete blood count, international normalized ratio, urine analysis, and abdominal ultrasonography were carried out...
September 8, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28895701/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-2-electrolyte-disturbances-nonelectrolyte-disturbances-therapeutic-options
#7
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamscha, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Alvarez
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 a pediatric patient 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 diagnostic and therapeutic aspects, and preventive care...
October 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28892178/review-article-the-diagnostic-approach-and-current-management-of-chylous-ascites
#8
REVIEW
B Lizaola, A Bonder, H D Trivedi, E B Tapper, A Cardenas
BACKGROUND: Chylous ascites is rare, accounting for less than 1% of cases. An appropriate and stepwise approach to its diagnosis and management is of key importance. AIM: To review the current diagnostic approach and management of chylous ascites. METHODS: A literature search was conducted using PubMed using the key words 'chylous', 'ascites', 'cirrhosis', 'pathophysiology', 'nutritional therapy', 'paracentesis", "transjugular intrahepatic portosystemic shunt" and "TIPSS'...
September 11, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28877719/absolute-quantification-of-microparticles-by-flow-cytometry-in-ascites-of-patients-with-decompensated-cirrhosis-a-cohort-study
#9
Cornelius Engelmann, Katrin Splith, Sandra Krohn, Adam Herber, Albrecht Boehlig, Stephan Boehm, Johann Pratschke, Thomas Berg, Moritz Schmelzle
BACKGROUND: Microparticles (MPs) are small (<1 μm) cell membrane-derived vesicles that are formed in response to cellular activation or early stages of apoptosis. Increased plasma MP levels have been associated with liver disease severity. Here we investigated the clinical impact of ascites MPs in patients with decompensated liver cirrhosis. METHODS: Ascites and blood samples of 163 patients with cirrhosis (ascites n = 163, blood n = 31) were collected between February 2011 and December 2012...
September 6, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28876707/-initial-management-of-new-onset-ascites-in-patient-with-cirrhosis
#10
Léon Finci, Stéphane Mouraux, Judith Knuchel, Laurent Bochatay
Ascites is the most frequent complication of cirrhosis and represents a significant change for the patient because the impact on mortality and quality of life is important. The management of a patient with initial onset of ascites includes a full history, a clinical exam and complementary analysis. This systematic approach allows an etiologic diagnosis. The aim of this article is to review the etiologies encountered in the initial onset of ascites in patient suffering from cirrhosis, to help the diagnosis and start initial management...
September 6, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28864370/pro-brain-natriuretic-peptide-and-troponin-t-hypersensitivity-levels-correlate-with-the-severity-of-liver-dysfunction-in-liver-cirrhosis
#11
Jiancheng Zhao, Sai Li, Linan Ren, Xiaozhong Guo, Xingshun Qi
BACKGROUND: Increased pro-brain natriuretic peptide (pro-BNP) or troponin T-hypersensitivity (TnT-HSST) levels are common in liver cirrhosis. We conducted a retrospective observational study aimed to evaluate the correlation of pro-BNP and TnT-HSST levels with the clinical characteristics, laboratory data and in-hospital outcomes of patients with liver cirrhosis. MATERIALS AND METHODS: We selected cirrhotic patients admitted to our hospital between January 2011 and June 2014...
August 2017: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/28853729/predictors-of-early-readmission-in-patients-with-cirrhosis-after-the-resolution-of-bacterial-infections
#12
Salvatore Piano, Filippo Morando, Giovanni Carretta, Marta Tonon, Elia Vettore, Silvia Rosi, Marialuisa Stanco, Chiara Pilutti, Antonietta Romano, Alessandra Brocca, Antonietta Sticca, Daniele Donato, Paolo Angeli
OBJECTIVES: In patients with cirrhosis, infections represent a frequent trigger for complications, increasing frequency of hospitalizations and mortality rate. This study aimed to identify predictors of early readmission (30 days) and of mid-term mortality (6 months) in patients with liver cirrhosis discharged after a hospitalization for bacterial and/or fungal infection. METHODS: A total of 199 patients with cirrhosis discharged after an admission for a bacterial and/or fungal infection were included in the study and followed up for a least 6 months...
August 29, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28845103/bacterial-translocation-markers-in-liver-cirrhosis
#13
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/28842296/clinical-outcomes-of-patients-undergoing-antiviral-therapy-while-awaiting-liver-transplantation
#14
Juan Manuel Pascasio, Carmen Vinaixa, María Teresa Ferrer, Jordi Colmenero, Angel Rubin, Lluis Castells, María Luisa Manzano, Sara Lorente, Milagros Testillano, Xavier Xiol, Esther Molina, Luisa González-Diéguez, Elena Otón, Sonia Pascual, Begoña Santos, José Ignacio Herrero, Magdalena Salcedo, José Luis Montero, Gloria Sánchez-Antolín, Isidoro Narváez, Flor Nogueras, Álvaro Giráldez, Martín Prieto, Xavier Forns, María-Carlota Londoño
BACKGROUND & AIMS: Antiviral therapy against hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy and the clinical outcomes delisted patients. METHODS: Observational, multicenter and retrospective analysis of prospectively collected data of HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 hospitals in Spain...
August 22, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28839517/serum-cholinesterase-a-predictive-biomarker-of-hepatic-reserves-in-chronic-hepatitis-d
#15
Minaam Abbas, Zaigham Abbas
AIM: To determine the predictive performance of cholinesterase compared to existing prognostic models in evaluating liver function in patients with chronic hepatitis D. METHODS: In an observational, cross-sectional and retrospective study, consecutive patients with hepatitis D cirrhosis were evaluated. Demographic, clinical and laboratory parameters were recorded. Serum cholinesterase levels were correlated with existing scoring models for chronic liver disease and Liver function tests...
August 8, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28839438/efficacy-of-tolvaptan-for-the-patients-with-advanced-hepatocellular-carcinoma
#16
Masayuki Miyazaki, Masayoshi Yada, Kosuke Tanaka, Takeshi Senjyu, Takeshi Goya, Kenta Motomura, Motoyuki Kohjima, Masaki Kato, Akihide Masumoto, Kazuhiro Kotoh
AIM: To investigate the factors influenced the efficacy of tolvaptan (TLV) in liver cirrhosis. METHODS: We retrospectively enrolled 61 consecutive patients with refractory hepatic ascites. All of them had been treated with furosemide and spironolactone before admission, and treated with TLV for 7 d in our hospital. The effect of TLV was defined by the rate of body weight loss, and the factors that influenced TLV efficacy were analyzed using multiple regression. RESULTS: Coexistent hepatocellular carcinoma (HCC) was the only significant predictive variable that attenuated the efficacy of TLV...
August 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28836115/management-of-ascites-and-hepatorenal-syndrome
#17
REVIEW
Salvatore Piano, Marta Tonon, Paolo Angeli
Ascites represents the most common decompensating event in patients with liver cirrhosis. The appearance of ascites is strongly related to portal hypertension, which leads to splanchnic arterial vasodilation, reduction of the effective circulating volume, activation of endogenous vasoconstrictor systems, and avid sodium and water retention in the kidneys. Bacterial translocation further worsens hemodynamic alterations of patients with cirrhosis and ascites. The first-line treatment of uncomplicated ascites is a moderate sodium-restricted diet combined with diuretic treatment...
August 23, 2017: Hepatology International
https://www.readbyqxmd.com/read/28796076/factors-affecting-mortality-and-resource-use-for-hospitalized-patients-with-cirrhosis-a-population-based-study
#18
Phunchai Charatcharoenwitthaya, Ngamphol Soonthornworasiri, Khemajira Karaketklang, Kittiyod Poovorawan, Wirichada Pan-Ngum, Watcharasak Chotiyaputta, Tawesak Tanwandee, Kamthorn Phaosawasdi
Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis.Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28792999/clinical-features-of-refractory-ascites-in-outpatients
#19
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/28789767/-primary-membranous-nephropathy-presenting-as-relapsing-ascites
#20
Kristine Lindhard, Martin Egefjord, Otto Clemmesen
Ascites is common in patients with liver cirrhosis. It may present as a clinical manifestation in nephrotic syndrome in adults, typically with heart- or liver disease together with other oedema. We describe a 64-year-old male patient - with no liver or heart disease - with relapsing ascites and no other oedema, who was surprisingly diagnosed with primary membranous nephropathy (MN), and the autoantibody anti-PLA2R was positive. Through immunotherapy the ascites disappeared. Anti-PLA2R and anti-TSHD7A can be used in the diagnosis (primary/secondary MN) and may play a role in the treatment and prognosis...
July 24, 2017: Ugeskrift for Laeger
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