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Portal hypertension

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https://www.readbyqxmd.com/read/28445299/endoscopic-ultrasonography-predicts-early-esophageal-variceal-bleeding-in-liver-cirrhosis-a-case-report
#1
Changjun Men, Guoliang Zhang
RATIONALE: Bleeding esophageal and gastric varices constitute a serious complication in liver cirrhosis. Previous studies have shown that endoscopic ultrasonography (EUS) can be used to predict early esophageal variceal bleeding in liver cirrhosis. PATIENT CONCERNS: We report a case of a 46-year-old man with hepatitis B liver cirrhosis (CTP score, 5; Child-Pugh class, A) who was admitted to our hospital due to a decreased appetite lasting 1 week. DIAGNOSIS: He was initially diagnosed with decompensated hepatitis B cirrhosis; an abdominal computed tomography (CT) scan indicated a diagnosis of liver cirrhosis and portal hypertension (PHT)...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28445104/endoscopic-ultrasound-guided-direct-portal-pressure-measurement-using-a-digital-pressure-wire-with-real-time-remote-display-a-survival-study
#2
Allison R Schulman, Christopher C Thompson, Marvin Ryou
BACKGROUND: Portal hypertension is necessary for the development of most clinical complications of cirrhosis. We recently reported a novel, endoscopic ultrasound (EUS)-guided technique for direct portal pressure measurements using a digital pressure wire. AIMS: The aims of this study were to (1) evaluate safety in an animal survival model and (2) compare direct portal vein (PV) versus transhepatic access of a first-order venule. MATERIALS AND METHODS: Yorkshire pigs, weighing 40-55 kg...
April 26, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28442120/american-gastroenterological-association-institute-technical-review-on-the-role-of-elastography-in-chronic-liver-diseases
#3
Siddharth Singh, Andrew J Muir, Douglas T Dieterich, Yngve T Falck-Ytter
Chronic liver diseases (CLDs), due to chronic hepatitis C; hepatitis B; nonalcoholic fatty liver diseases (NAFLD); and alcoholic liver disease, are a leading cause of morbidity and mortality globally. Early identification of patients with cirrhosis at high risk of progression to liver-related complications may facilitate timely care and improve outcomes. With risks and misclassification associated with invasive tests, such as liver biopsy, noninvasive imaging modalities for liver fibrosis assessment have gained popularity...
May 2017: Gastroenterology
https://www.readbyqxmd.com/read/28439483/whipple-s-disease-manifested-as-recurrent-ascites
#4
Ali Aamar, Kamraan Madhani, Muhammad S Anwar, Prabhdeep Singh, Joel Garsten
Whipple's disease commonly presents as chronic diarrhea and abdominal pain. Ascites is an uncommon presentation of Whipple's disease. Here, we report a rare case of a 47-year-old male who presented with diarrhea and abdominal distention for three months. The physical examination was significant for ascites. Serum albumin was low and serum-to-ascites albumin gradient was < 1.1 g/dl. This suggested that ascites was less likely to be present due to portal hypertension. Enteroscopy showed erythematous duodenum and jejunum; biopsy was suggestive of periodic acid-Schiff stain (PAS) positive macrophages consistent with Whipple's disease...
March 21, 2017: Curēus
https://www.readbyqxmd.com/read/28437324/noncirrhotic-portal-fibrosis-in-pediatric-population
#5
Vikrant Sood, Bikrant B Lal, Rajeev Khanna, Dinesh Rawat, Chhagan Bihari, Seema Alam
OBJECTIVES: Noncirrhotic portal fibrosis (NCPF) has been classically described as a disease of young to middle age with limited literature regarding its occurrence, onset, or clinical presentation in children. We hereby present a series of 19 patients diagnosed and managed as NCPF in pediatric age group. METHODS: A retrospective review of all the patients presenting to the pediatric hepatology department (age <18 years) and diagnosed as NCPF was done and data were evaluated...
May 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28434422/patient-web-portals-and-patient-provider-relationships-a-summary-perspective
#6
Hannah D Caldwell, Neil B Minkoff, Kalyani Murthy
OBJECTIVES: Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic...
April 24, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28433982/acute-on-chronic-gastrointestinal-bleeding-a-unique-clinical-entity
#7
Don C Rockey, Adam C Hafemeister, Joan S Reisch
Gastrointestinal bleeding is defined in temporal-spatial terms-as acute or chronic, and/or by its location in the gastrointestinal tract. Here, we define a distinct type of bleeding, which we have coined 'acute on chronic' gastrointestinal bleeding. We prospectively identified all patients who underwent endoscopic evaluation for any form of gastrointestinal bleeding at a University Hospital. Acute on chronic bleeding was defined as the presence of new symptoms or signs of acute bleeding in the setting of chronic bleeding, documented as iron deficiency anemia...
April 21, 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/28433114/hepatic-features-of-wilson-disease
#8
Salih Boga, Aftab Ala, Michael L Schilsky
In Wilson disease (WD) defective AT7B function leads to biliary copper excretion and pathologic copper accumulation, particularly in liver and brain, where it induces cellular damage. Liver disease most often precedes neurologic or psychiatric manifestations. In most patients with neurologic or psychiatric symptoms there is some degree of liver disease at the time of disease presentation. Hepatic manifestations of WD can be extremely variable. Patients with clinically asymptomatic WD are often found by family screening or identified on routine laboratory testing...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28433104/wilson-disease-symptomatic-liver-therapy
#9
Jan Pfeiffenberger, Karl-Heinz Weiss, Wolfgang Stremmel
Wilson disease leads to symptomatic impairment of liver function or liver cirrhosis. Strict adherence to decoppering agents is essential in these patients. Secondary prevention of additional hepatic damage by avoidance of other toxic substances (e.g., alcohol, drugs) and sufficient calorie intake is recommended. Routine examinations in cirrhotic patients include screening for signs of portal hypertension (esophagus varices), development of ascites, and hepatic encephalopathy. Where varices are present, primary or secondary preventive interventions may include treatment with nonselective beta-blockers or variceal ligation, similar to the approach in patients with liver cirrhosis due to other etiologies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28433103/liver-transplantation-for-wilson-disease
#10
Ahsan Ahmad, Euriko Torrazza-Perez, Michael L Schilsky
Liver transplantation (LT) is a life-saving and curative treatment for Wilson disease (WD), providing restoration of function of the liver and mitigation of portal hypertension. Indications for LT in patients with WD include acute liver failure or end-stage liver disease not treatable by medical therapy. LT is also used to treat hepatocellular carcinoma when it develops in patients with WD when tumor resection is not feasible. LT solely for neurologic or psychiatric WD remains controversial. Living liver donation as well as cadaveric orthotopic and auxiliary LT are options for transplantation for WD...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28431779/propranolol
#11
Abdulrahman A Al-Majed, Ahmed H H Bakheit, Hatem A Abdel Aziz, Fahad M Alajmi, Haitham AlRabiah
Propranolol is a noncardioselective β-blocker. It is reported to have membrane-stabilizing properties, but it does not own intrinsic sympathomimetic activity. Propranolol hydrochloride is used to control hypertension, pheochromocytoma, myocardial infarction, cardiac arrhythmias, angina pectoris, and hypertrophic cardiomyopathy. It is also used to control symptoms of sympathetic overactivity in the management of hyperthyroidism, anxiety disorders, and tremor. Other indications cover the prophylaxis of migraine and of upper gastrointestinal bleeding in patients with portal hypertension...
2017: Profiles of Drug Substances, Excipients, and related Methodology
https://www.readbyqxmd.com/read/28430610/treatment-of-hepatocellular-carcinoma-with-portal-vein-tumor-thrombus-advances-and-challenges
#12
REVIEW
Jin-Fang Jiang, Yong-Cong Lao, Bao-Hong Yuan, Jun Yin, Xin Liu, Long Chen, Jian-Hong Zhong
Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents...
February 16, 2017: Oncotarget
https://www.readbyqxmd.com/read/28429043/transsplenic-endovascular-recanalization-and-stenting-of-a-completely-occluded-portal-vein-with-jejunal-variceal-embolization-in-a-pediatric-liver-transplant-recipient
#13
Jeffrey Forris Beecham Chick, Alexandria Jo, Narasimham Dasika, Wael E Saad, Ravi Nara Srinivasa
Portal vein thrombosis occurs in 1.4% of pediatric liver transplant candidates and 3.7% of liver transplant recipients. While portal vein recanalization without and with portal vein stenting has been described in adult transplant candidates and recipients, it has never been described in the pediatric transplant population. This report presents a pediatric liver transplant recipient with portal hypertension secondary to portal vein thrombosis successfully managed with transsplenic access and subsequent portal vein recanalization and stenting...
April 20, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28427382/splenectomy-before-adult-liver-transplantation-a-retrospective-study
#14
LingXiang Kong, Ming Li, Lei Li, Li Jiang, Jiayin Yang, Lvnan Yan
BACKGROUND: A considerable number of patients with portal hypertension (PHT) have to undergo splenectomy because they do not meet the requirements for liver transplantation (LT) or cannot find a suitable liver donor. However, it is not known whether pre-transplantation splenectomy may create occult difficulties for patients who require LT in future. METHODS: We analyzed 1059 consecutive patients who underwent adult liver transplantation (ADLT). Patients with pre-transplantation splenectomy Sp(+) and without splenectomy Sp(-) were compared using a propensity score analysis to create the best match between groups...
April 20, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28425018/hepatocellular-carcinoma-and-liver-transplantation-changing-patterns-and-practices
#15
REVIEW
Nicole E Rich, Neehar D Parikh, Amit G Singal
Benefits of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) are well established. However, there is debate regarding optimal and equitable selection of patients best served by LT, particularly in the face of limited organ availability. Herein, we discuss topics regarding LT selection criteria for patients with HCC. Recent change in UNOS policy currently mandates a 6-month observation period prior to priority listing and institutes a cap of 34 MELD exception points for patients with HCC...
April 19, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28408920/endoscopic-assisted-linea-alba-reconstruction-new-technique-for-treatment-of-symptomatic-umbilical-trocar-and-or-epigastric-hernias-with-concomitant-rectus-abdominis-diastasis
#16
Ferdinand Köckerling, Marinos Damianos Botsinis, Christine Rohde, Wolfgang Reinpold, Christine Schug-Pass
BACKGROUND: Patients with symptomatic umbilical, trocar, and/or epigastric hernias and concomitant rectus abdominis diastasis represent a growing clinical problem. The optimal management of this complex hernia situation is the subject of debate in the literature. This paper reports the early results of an innovative surgical technique aimed at managing this hernia situation. METHODS: Endoscopic-assisted linea alba reconstruction (ELAR) with mesh augmentation is a surgical technique long known in the literature for its good outcome for incisional hernia repair (myofascial release, overlapping herniorrhaphy, Gibson's operation, shoelace repair, anterior rectus sheath repair, dynamic patch plasty) via a small access route...
2017: European Surgery: ACA: Acta Chirurgica Austriaca
https://www.readbyqxmd.com/read/28407511/clinical-and-cross-sectional-imaging-features-of-spontaneous-pancreatic-pseudocyst-portal-vein-fistula
#17
Francesco Alessandrino, Corinne Strickland, Amirkasra Mojtahed, Steven C Eberhardt, Koenraad J Mortele
PURPOSE: To evaluate clinical and imaging features of pancreatic pseudocyst-portal vein fistula (PPVF). METHODS: Patients with evidence of PPVF on CT/MRI were included. Clinical presentation, outcomes, imaging appearance of the portal vein were recorded. RESULTS: 75% of patients developed portal hypertension, 62% cavernous transformation of the portal vein and 25% portal biliopathy. PPVF presented on CT as fluid-attenuated portal vein, and on MRI as T2-weighted hyperintense fluid-filled portal vein...
April 1, 2017: Clinical Imaging
https://www.readbyqxmd.com/read/28406835/pediatric-portal-hypertension-a-review-for-primary-care
#18
Clarissa Barbon Vogel
Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options.
May 12, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28405718/-value-of-surgical-shunt-procedures-for-portal-hypertension
#19
F Rauchfuß, U Settmacher
No abstract text is available yet for this article.
April 12, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28402977/molecular-mechanisms-leading-to-splanchnic-vasodilation-in-liver-cirrhosis
#20
Marco Di Pascoli, David Sacerdoti, Patrizia Pontisso, Paolo Angeli, Massimo Bolognesi
In liver cirrhosis, portal hypertension is a consequence of enhanced intrahepatic vascular resistance and portal blood flow. Significant vasodilation in the arterial splanchnic district is crucial for an increase in portal flow. In this pathological condition, increased levels of circulating endogenous vasodilators, including nitric oxide, prostacyclin, carbon monoxide, epoxyeicosatrienoic acids, glucagon, endogenous cannabinoids, and adrenomedullin, and a decreased vascular response to vasoconstrictors are the main mechanisms underlying splanchnic vasodilation...
April 13, 2017: Journal of Vascular Research
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