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Variceal bleeding

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https://www.readbyqxmd.com/read/28530783/a-rare-case-of-obscure-gastrointestinal-bleeding-small-bowel-varices-flowing-into-the-inferior-epigastric-vein
#1
Akira Hoshiai, Junya Tsurukiri, Yasuhiro Sumi
Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28523485/report-of-mesocaval-shunt-in-the-management-of-variceal-hemorrhage-following-gastric-bypass-surgery
#2
Anurag Shrimal, Ranjan Sudan, Gaurav Chaubal, Ahmad Zaaroura, Kitza Williams, Kadiyala Ravindra
Gastrointestinal bleeding following Roux-en- Y gastric bypass (RYGB) is rare. We report an unusual cause of upper gastrointestinal bleeding following RYGB that was complicated by porto- splenic vein thrombosis. A 35- year- old woman was successfully treated by mesocaval surgical shunt for recurrent variceal hemorrhage in the excluded stomach following RYGB.
May 18, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28515596/balloon-occluded-retrograde-transvenous-obliteration-for-bleeding-gastric-varices-eyes-see-what-the-mind-knows
#3
Pushpinder S Khera, Lee Myungsu, Choi Joonsung
Approximately one in six patients with portal hypertension who develop varices at sites of portosystemic venous collaterals has gastric varices due to hepatofugal flow into the gastric veins. Bleeding from gastric varices, though less common, has a higher mortality and morbidity compared to bleeding esophageal varices, which are easier to manage endoscopically. The efferent channel for gastric varices is mostly the gastrorenal shunt (GRS) which opens into the left renal vein. Balloon-occluded transvenous obliteration (BRTO) involves accessing the GRS with an aim to temporarily occlude its outflow using a balloon catheter and at the same time injecting sclerosant mixture within the varix so as to cause its thrombosis and thereby obliteration...
January 2017: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/28504002/development-and-evaluation-of-a-novel-score-for-prediction-of-large-oesophageal-varices-in-patients-with-hepatitis-c-virus-induced-liver-cirrhosis
#4
K Farid, M M Omran, R E Farag, M M Arafa, T M Emran
OBJECTIVE: Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis. METHODS: A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices...
May 15, 2017: British Journal of Biomedical Science
https://www.readbyqxmd.com/read/28501971/electrolyte-and-acid-base-disturbances-in-end-stage-liver-disease-a-physiopathological-approach
#5
REVIEW
José Víctor Jiménez, Diego Luis Carrillo-Pérez, Rodrigo Rosado-Canto, Ignacio García-Juárez, Aldo Torre, David Kershenobich, Eduardo Carrillo-Maravilla
Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination...
May 13, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28501536/multicenter-external-validation-of-risk-stratification-criteria-for-patients-with-variceal-bleeding
#6
Irene Conejo, Maria Anna Guardascione, Puneeta Tandon, Alba Cachero, Josep Castellote, Juan G Abraldes, Lucio Amitrano, Joan Genescà, Salvador Augustin
BACKGROUND & AIMS: Early placement of a transjugular intrahepatic porto-systemic shunts (TIPS) is considered the treatment of choice for patients with acute variceal bleeding (AVB) and cirrhosis who have a high risk of death (Child-Pugh class B with active bleeding at endoscopy or Child-Pugh class C). It has been proposed that patients of Child-Pugh class B, even with active bleeding, should not be considered high risk. Alternative criteria have been proposed for identification of high-risk patients, such as Child-Pugh class C with plasma level of creatinine of 1 mg/dl or more (ChildC-C1) and a model for end-stage liver disease (MELD) score of 19 or more...
May 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28500570/narrow-band-imaging-can-increase-the-visibility-of-fibrin-caps-after-bleeding-of-esophageal-varices-a-case-with-extensive-esophageal-candidiasis
#7
Yoshihiro Furuichi, Yoshitaka Kasai, Hirohito Takeuchi, Yuu Yoshimasu, Takashi Kawai, Katsutoshi Sugimoto, Yoshiyuki Kobayashi, Ikuo Nakamura, Takao Itoi
A 58-year-old man with hepatitis B cirrhosis noticed black stools and underwent an endoscopy at a community hospital. The presence of esophageal varices (EVs) was confirmed, but the bleeding point was not found. He was referred to our institution and underwent a second endoscopy. Extensive white patches of esophageal candidiasis were visible on endoscopy by white-light imaging (WLI), but it was difficult to find the fibrin cap of the EVs. This was easier under narrow-band imaging (NBI), however, as the color turned red from absorption by hemoglobin adhered to it...
May 12, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28498107/ultrasound-assisted-thrombolysis-of-an-occluded-transjugular-portosystemic-shunt
#8
Nicholas Hilliard, Teik Choon See, Nadeem Shaida
Transjugular intrahepatic portosystemic shunt (TIPS) insertion is commonly performed for refractory ascites or variceal bleeding. However, TIPS dysfunction can be seen in both early and late settings, with shunt thrombosis a particular problem. Treatment of shunt dysfunction commonly involves angioplasty and re-lining, with or without embolectomy, mechanical thrombectomy, or thrombolysis. Ultrasound-assisted thrombolysis has been shown to be successful for treatment of pulmonary embolism, deep vein thrombosis, and peripheral arterial thromboembolism, but has not been described before for TIPS occlusion...
May 12, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28495438/african-americans-have-a-lower-prevalence-of-portal-vein-thrombosis-at-the-time-of-liver-transplantation
#9
Dmitri Bezinover, Ethan Reeder, Faisal Aziz, Fuat Saner, Patrick McQuillan, Zakiyah Kadry, Thomas Riley, Dmitri Guvakov, Piotr K Janicki
BACKGROUND: Perioperative vascular thrombotic events in patients undergoing liver transplantation (LT) are associated with significant morbidity and mortality. METHODS: In this retrospective UNOS database analysis, we evaluated the prevalence of portal vein thrombosis (PVT) and factors contributing to PVT development in different ethnic groups. RESULTS: Of the 47 953 LT performed between 2002 and 2015, we identified 3642 cases of PVT. African Americans (AA) had a significantly lower prevalence of PVT compared to other ethnic groups (p = 0...
May 8, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28494539/-current-status-and-perspectives-of-diagnosis-and-treatment-of-complications-related-to-liver-cirrhosis
#10
Y M Nan
Liver cirrhosis is the severe period of chronic liver diseases, especially decompensated liver cirrhosis and its complications, such as ascites, esophagogastric variceal bleeding, hepatic encephalopathy, acute kidney injury, and hepatocellular carcinoma, which greatly affect patients' quality of life and even threaten their lives. Early prevention and treatment of the causes of development and progression and pathogenic mechanism may slow down or reverse liver cirrhosis and its severe complications. Once the disease progresses to portal hypertension and related complications, it is very important to select preventive measures for acute exacerbation of different complications, as well as the methods and timing for treatment in acute stage, which may help to save patients' lives and improve their prognosis...
April 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28494001/partial-spleen-embolization-reduces-the-risk-of-portal-hypertension-induced-upper-gastrointestinal-bleeding-in-patients-not-eligible-for-tips-implantation
#11
Matthias Buechter, Alisan Kahraman, Paul Manka, Guido Gerken, Alexander Dechêne, Ali Canbay, Axel Wetter, Lale Umutlu, Jens M Theysohn
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting...
2017: PloS One
https://www.readbyqxmd.com/read/28492370/non-invasive-diagnosis-of-esophageal-varices-after-baveno-vi
#12
REVIEW
Carlos Moctezuma Velázquez, Juan G Abraldes
A major complication of portal hypertension in patients with cirrhosis is the development of esophageal varices with the associated risk of variceal bleeding. Hence, the Baveno consensus on portal hypertension in its first five editions had recommended surveillance with periodic upper endoscopies in these patients to identify in a timely fashion the development of esophageal varices and initiate a primary prophylaxis strategy in those at a high risk of bleeding. For the first time, the Sixth Baveno Consensus on Portal Hypertension (Baveno VI) recommended using non-invasive tools to rule out the presence of varices with a high risk of bleeding...
May 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/28491877/nodular-regenerative-hyperplasia-a-case-of-rare-prognosis
#13
Mindy Lee, Manhal Izzy, Ashwin Akki, Kathryn Tanaka, Harmit Kalia
Introduction: Nodular regenerative hyperplasia (NRH) is a known etiology of noncirrhotic portal hypertension. Cases of biopsy-proven NRH in human immunodeficiency virus (HIV)-positive patients have been described. While these patients often have normal synthetic liver function, several reports described disease progression to liver failure. Case: We here present a 26-year-old woman with history of congenital HIV on antiretroviral therapy complicated by Pneumocystis carinii pneumonia at age 14. CD4 counts have been >300 with undetectable viral load...
January 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28491181/tips-performed-in-a-patient-with-complete-portal-vein-thrombosis
#14
Ashwani Kumar Sharma, David Charles Kaufman
Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements have led to improved TIPS outcomes that have encouraged an expanded application. Complete portal vein thrombosis has come a long way from being a contraindication to an indication for TIPS procedure...
June 2017: Radiology case reports
https://www.readbyqxmd.com/read/28489830/-clinical-and-laboratory-characteristics-of-patients-with-pulmonary-hypertension-and-pulmonary-vascular-complications-hospitalized-at-the-instituto-nacional-de-salud-del-ni%C3%A3-o
#15
Alexis Jose Ormeño Julca, Carlos Melchor Alvarez Murillo, Pedro Miguel Amoretti Alvino, Angel Aladino Florian Florian, Rosa Aurora Castro Johanson, Maria Danisa Celi Perez, Olga Rocío Huamán Prado
The hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHN) are distinct pulmonary vascular complications of portal hypertension (PHT) and are associated with increased morbidity and mortality. OBJECTIVES: To describe the clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño. MATERIALS AND METHODS: We included patients with HTP hospitalized from January 2012 to June 2013 and that during its evolution progressed with SHP or HTPP...
January 2017: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
https://www.readbyqxmd.com/read/28488730/octreotide-associated-neutropenia
#16
Stacy S Tse, Troy Kish
Drug-induced neutropenia and agranulocytosis are rare adverse events but can be fatal. Neutropenia can be induced by a myriad of drugs from almost every pharmacologic class. Octreotide is a somatostatin analogue that has been used to treat variceal bleeding, acromegaly, and severe diarrhea associated with metastatic tumors, and to reduce symptoms in the setting of malignant bowel obstruction and pseudo-obstruction. The most common adverse effects associated with octreotide include pain at the injection site and gastrointestinal effects such as loose stools, cramping, and nausea; neutropenia is not currently listed as an adverse effect of the drug...
May 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28488370/patients-with-cirrhosis-who-have-coronary-artery-disease-treated-with-cardiac-stents-have-high-rates-of-gastrointestinal-bleeding-but-no-increased-mortality
#17
T Krill, G Brown, R A Weideman, D J Cipher, S J Spechler, E Brilakis, L A Feagins
BACKGROUND: Patients with coronary artery disease (CAD) treated with stents require dual antiplatelet therapy (DAPT). For cirrhotics, who often have varices and coagulopathy, it is not clear if the risk of gastrointestinal bleeding (GIB) should preclude use of DAPT. AIM: To compare GIB and mortality rates in cirrhotics with CAD treated medically or with stents. METHODS: Using institutional databases, we identified patients with cirrhosis and CAD treated with stents or medical therapy between January 2000-September 2015...
May 9, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28488102/transjugular-intrahepatic-portosystemic-shunt-for-portal-hypertension-in-hepatocellular-carcinoma-with-portal-vein-tumor-thrombus
#18
Bin Qiu, Kai Li, Xiaoqun Dong, Fu-Quan Liu
PURPOSE: In patients with hepatocellular carcinoma (HCC), limited therapeutic options are available for portal hypertension resulted from portal vein tumor thrombus (PVTT). We aimed to determine safety and efficacy of TIPS for treatment of symptomatic portal hypertension in HCC with PVTT. METHODS: We evaluated clinical characteristics of 95 patients with HCC and PVTT out of 992 patients who underwent TIPS. The primary endpoints included success rate, procedural mortality, serious complications, decrease in portosystemic pressure gradient, and symptom relief...
May 9, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28487619/one-step-minilaparotomy-assisted-transmesenteric-portal-vein-recanalization-combined-with-transjugular-intrahepatic-portosystemic-shunt-placement-a-novel-surgical-proposal-in-pediatrics
#19
Gloria Pelizzo, Pietro Quaretti, Lorenzo Paolo Moramarco, Riccardo Corti, Marcello Maestri, Giulio Iacob, Valeria Calcaterra
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric (MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma (PC). A 16-year-old girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC...
April 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28483304/short-term-safety-and-efficacy-of-balloon-occluded-retrograde-transvenous-obliteration-using-ethanolamine-oleate-results-of-a-prospective-multicenter-single-arm-trial
#20
Masao Kobayakawa, Shigehiro Kokubu, Shozo Hirota, Jun Koizumi, Norifumi Nishida, Taku Yasumoto, Satoshi Mochida, Hisashi Hidaka, Noriko Tanaka, Tsuyoshi Tajima
PURPOSE: To evaluate 90-day outcomes after balloon-occluded retrograde transvenous obliteration (BRTO) with ethanolamine oleate (EO) in patients with gastric varices (GVs). MATERIALS AND METHODS: An 8-site prospective single-arm clinical trial was conducted. Patients who had endoscopically confirmed GVs with a gastrorenal shunt were eligible for the study. Overnight BRTO was performed, and efficacy was evaluated by endoscopy and contrast-enhanced computed tomography (CT)...
May 5, 2017: Journal of Vascular and Interventional Radiology: JVIR
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