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Variceal hemorrhage

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https://www.readbyqxmd.com/read/29317268/combination-of-albumin-bilrubin-grade-and-platelet-to-predict-compensated-patient-with-hepatocellular-carcinoma-who-do-not-require-endoscopic-screening-for-esophageal-varices
#1
Ping-Hsien Chen, Wei-Yao Hsieh, Chien-Wei Su, Ming-Chih Hou, Yen-Po Wang, I-Fang Hsin, Tsung-Chieh Yang, Wei-Chih Liao, Han-Chieh Lin, Fa-Yauh Lee, Jaw-Ching Wu
BACKGROUND: s & Aims: There is no consensus for screening high-risk esophageal varices (HRV) in patients with hepatocellular carcinoma (HCC). Here, we aimed to investigate the prevalence and risk factors of HRV in HCC patients and to assess the combination of albumin-bilirubin grade and platelet count (ALBI-PLT score) for predicting compensated patients who do not need unnecessary endoscopic screening for HRV. METHODS: The ALBI-PLT score was calculated by adding ALBI grade and point of platelet count (1 point if platelet count >150,000 /mm3 and 2 points if ≦150,000 /mm3)...
January 6, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29290508/the-emergency-medicine-evaluation-and-management-of-the-patient-with-cirrhosis
#2
REVIEW
Brit Long, Alex Koyfman
BACKGROUND: Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider. OBJECTIVE OF THE REVIEW: Provide an evidence-based update for the resuscitation of decompensating cirrhotic patients and an overview of cirrhosis complications...
December 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29283964/the-american-association-for-the-surgery-of-trauma-uniform-grading-of-hemorrhagic-emergency-general-surgery-diseases
#3
Gail T Tominaga, Carlos V R Brown, John T Schulz, Ronald R Barbosa, Suresh Agarwal, Nathaniel McQuay, Garth Utter, Marie Crandall
Consistent grading of Emergency General Surgery (EGS) diseases is important for comparison of outcomes and development of EGS registries. The American Association for the Surgery of Trauma (AAST) Patient Assessment Committee has previously determined common EGS diseases and developed a grading system for measuring anatomic severity of 16 inflammatory/infectious EGS diseases. The specific aim of this project was to develop a uniform grading template for hemorrhagic EGS diseases managed by acute care surgeons and apply the template to common hemorrhagic EGS diseases...
December 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29282637/changing-epidemiology-of-upper-gastrointestinal-hemorrhage-in-the-last-decade-a-nationwide-analysis
#4
Brandon A Wuerth, Don C Rockey
BACKGROUND: Upper gastrointestinal hemorrhage (UGIH) is common and carries substantial mortality requiring frequent hospitalizations. AIM: To investigate trends in etiology and outcome of UGIH in hospitalized patients in the USA. METHODS: Retrospective, observational cohort study of the Nationwide Inpatient Sample from 2002 to 2012 was carried out. UGIH was identified in hospitalizations with a principle ICD-9-CM diagnosis of UGIH or secondary diagnosis of UGIH with a principal diagnosis of hematemesis, blood in stool, or gastrointestinal bleeding...
December 27, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29238587/bacterial-infections-in-acute-variceal-hemorrhage-despite-antibiotics-a-multicenter-study-of-predictors-and-clinical-impact
#5
Stephen Lee, Lynora Saxinger, Mang Ma, Verónica Prado, Joaquin Fernández, Deepali Kumar, Juan Gonzalez-Abraldes, Adam Keough, Ravin Bastiampillai, Michelle Carbonneau, Javier Fernandez, Puneeta Tandon
Background and aims: Current guidelines recommend antibiotic prophylaxis in all patients presenting with cirrhosis and acute variceal hemorrhage (AVH). We aimed to evaluate the characteristics and clinical impact of "early" infections (developing within 14 days) of AVH in a real-world setting. Methods: We analyzed retrospective data from a cohort of 371 adult patients with cirrhosis and AVH all of whom had received antibiotic prophylaxis (74% men; mean age 56 years), admitted to tertiary care hospitals in Edmonton, Alberta, Canada, and Barcelona, Spain...
December 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/29234547/testicular-cancer-presenting-as-gastric-variceal-hemorrhage
#6
Carlos Eduardo Salazar-Mejía, David Hernández-Barajas, Edio Llerena-Hernández, José Luis González-Vela, María Inés Contreras-Salcido, Adriana González-Gutiérrez, Omar David Borjas-Almaguer, Luis Alberto Pérez-Arredondo, Blanca Otilia Wimer-Castillo
Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35. The symptomatology caused by this tumor varies according to the site of metastasis. We present the case of a 26-year-old male who arrived to the emergency department with hematemesis. He had no previous medical history. On arrival, we noted enlargement of the left scrotal sac. There was also a mass in the left scrotum which provoked displacement of the penis and right testis. The serum alpha-fetoprotein level was 17,090 ng/mL, lactate dehydrogenase was 1480 U/L, and human chorionic gonadotropin was 287...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/29224657/cta-as-an-adjuvant-tool-for-acute-intra-abdominal-or-gastrointestinal-bleeding
#7
REVIEW
Mitchell Storace, Jonathan G Martin, Jay Shah, Zachary Bercu
Hematemesis and acute postsurgical upper gastrointestinal hemorrhage are common emergent on-call consultations for the interventional radiologist. Upper GI bleleding (UGIB) is a relatively frequent problem. The incidence and mortality vary among patient populations, but studies have shown an overall incidence ranging from 36-172 cases per 100,000 adults per year, with a mortality rate of 5%-14%. The incidence is significantly higher in men. Peptic ulcer disease is the predominant etiology, responsible for 28%-59% of UGIB...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29183764/clinical-outcome-of-portal-vein-thrombosis-in-patients-with-digestive-cancers-a-large-ageo-multicenter-study
#8
Hélène Regnault, Sheik Emambux, Thierry Lecomte, Solene Doat, Marion Dhooge, Marie Besson, Olivier Dubreuil, Frederic Moryoussef, Christine Silvain, Jean-Baptiste Bachet, David Tougeron
INTRODUCTION: Management of portal vein thrombosis (PVT) in cancer patients remains discussed. AIMS: The objective of this multicenter retrospective study was to investigate the management and outcome of PVT in patients with digestive cancers other than hepatocellular carcinoma (HCC). METHOD: Main inclusion criteria were trunk or branch PVT in patients with locally advanced or metastatic digestive cancers. Predictive factors of bleeding and overall survival (OS) were evaluated in univariate and multivariate analysis...
November 16, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/29162665/the-beneficial-effects-of-curcumin-in-cirrhotic-rats-with-portal-hypertension
#9
Shao-Jung Hsu, Jing-Yi Lee, Te-Yueh Lin, Yu-Hsin Hsieh, Hui-Chun Huang, Fa-Yauh Lee, Han-Chieh Lin, Ming-Chih Hou, Shou-Dong Lee
In liver cirrhosis with portal hypertension, the uneven distribution of vasoactive substances leads to increased intrahepatic vascular resistance and splanchnic vasodilatation. Angiogenesis also induces increased portal inflow and portosystemic collaterals. The collaterals may induce lethal complications such as gastroesophageal variceal hemorrhage, but the therapeutic effect of vasoconstrictors is still suboptimal due to poor collateral vasoresponsivenss. Curcumin has aroused much attention for its anti-fibrosis, vasoactive and anti-angiogenesis actions...
November 21, 2017: Bioscience Reports
https://www.readbyqxmd.com/read/29161702/favorable-effects-of-endoscopic-ligation-combined-with-drugs-on-rebleeding-and-mortality-in-cirrhotic-patients-a-network-meta-analysis
#10
Liang Shi, Xueping Zhang, Jianye Li, Xibo Bai
BACKGROUND: To assess the effects of combination therapies (endoscopic plus drug[s], drug combinations) on variceal/any-cause rebleeding and mortality among cirrhotic patients with one previous episode of variceal hemorrhage. SUMMARY: We searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. We included 26 randomized controlled trials involving 2,536 adults using OR to measure the effects. Endoscopic variceal ligation (EVL) plus nadolol ranked first for reducing recurrent bleeds...
November 21, 2017: Digestive Diseases
https://www.readbyqxmd.com/read/29154015/albumin-bilirubin-grade-versus-meld-score-for-predicting-survival-after-transjugular-intrahepatic-portosystemic-shunt-tips-creation
#11
J Ronald, Q Wang, S S Choi, P V Suhocki, M D Hall, T P Smith, C Y Kim
OBJECTIVES: The purpose of this study was to compare the albumin-bilirubin (ALBI) grade and model for end-stage liver disease (MELD) scores for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: A retrospective study of pre-procedure ALBI and MELD scores was performed in 197 patients who underwent TIPS from 2005 to 2012. There were 140 men and 57 women, with a mean age of 56±11 (SD) (range: 19-90years)...
November 16, 2017: Diagnostic and Interventional Imaging
https://www.readbyqxmd.com/read/29134968/-weekend-effect-in-patients-with-upper-gastrointestinal-hemorrhage-a-systematic-review-and-meta-analysis
#12
REVIEW
Ashutosh Gupta, Rajender Agarwal, Ashwin N Ananthakrishnan
OBJECTIVES: "Weekend effect" refers to worse outcomes among patients presenting to the hospital on weekends or holidays. We performed a systematic review and meta-analysis of observational studies assessing the impact of the "weekend effect" in patients with upper gastrointestinal hemorrhage (UGIH). METHODS: We searched key bibliographic databases using keywords and MeSH terms related to gastrointestinal hemorrhage and "weekend effect". Our primary analysis evaluated mortality in patients with UGIH who were hospitalized on the weekend or after-hours compared with a weekday...
November 14, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29117668/outcomes-of-patients-treated-with-sengstaken-blakemore-tube-for-uncontrolled-variceal-hemorrhage
#13
Ja Yun Choi, Yun Won Jo, Sang Soo Lee, Wan Soo Kim, Hye Won Oh, Cha Young Kim, Eun Young Yun, Jin Joo Kim, Jae Min Lee, Hong Jun Kim, Hyun Jin Kim, Tae Hyo Kim, Woon Tae Jung, Ok Jae Lee, Rock Bum Kim
Background/Aims: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. Methods: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29110128/endoscopic-treatments-for-portal-hypertension
#14
REVIEW
Gin-Ho Lo
Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding...
November 7, 2017: Hepatology International
https://www.readbyqxmd.com/read/29075990/biology-of-portal-hypertension
#15
REVIEW
Matthew McConnell, Yasuko Iwakiri
Portal hypertension develops as a result of increased intrahepatic vascular resistance often caused by chronic liver disease that leads to structural distortion by fibrosis, microvascular thrombosis, dysfunction of liver sinusoidal endothelial cells (LSECs), and hepatic stellate cell (HSC) activation. While the basic mechanisms of LSEC and HSC dysregulation have been extensively studied, the role of microvascular thrombosis and platelet function in the pathogenesis of portal hypertension remains to be clearly characterized...
October 26, 2017: Hepatology International
https://www.readbyqxmd.com/read/29058164/hand-assisted-laparoscopic-hassab-s-procedure-for-esophagogastric-varices-with-portal-hypertension
#16
Takashi Kobayashi, Kohei Miura, Hirosuke Ishikawa, Daiki Soma, Zhengkun Zhang, Takuya Ando, Kizuki Yuza, Yuki Hirose, Tomohiro Katada, Kazuyasu Takizawa, Masayuki Nagahashi, Jun Sakata, Hitoshi Kameyama, Toshifumi Wakai
BACKGROUND: Laparoscopic surgery for patients with portal hypertension is considered to be contraindicated because of the high risk of massive intraoperative hemorrhaging. However, recent reports have shown hand-assisted laparoscopic surgery for devascularization and splenectomy to be a safe and effective method of treating esophagogastric varices with portal hypertension. The aim of this study is to evaluate the efficacy of hand-assisted laparoscopic devascularization and splenectomy (HALS Hassab's procedure) for the treatment of esophagogastric varices with portal hypertension...
October 23, 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/29052175/african-americans-with-cirrhosis-are-less-likely-to-receive-endoscopic-variceal-screening-within-one-year-of-cirrhosis-diagnosis
#17
Ann Robinson, Hesam Tavakoli, Benny Liu, Taft Bhuket, Ramsey Cheung, Robert J Wong
BACKGROUND: Esophageal variceal hemorrhage is a complication of cirrhosis that carries high mortality, and can be reduced with timely endoscopic variceal screening and treatment. AIM: We aim to evaluate overall rates of and disparities in receipt of endoscopic variceal screening among an ethnically diverse urban safety-net hospital. METHODS: All consecutive adults with cirrhosis (7/1/2014 to 12/31/2015) were retrospectively evaluated to determine the rates of receiving esophageal variceal screening within 6 months and within 1 year after cirrhosis diagnosis...
October 19, 2017: Journal of Racial and Ethnic Health Disparities
https://www.readbyqxmd.com/read/29043000/effect-of-entecavir-in-the-treatment-of-patients-with-hepatitis-b-virus-related-compensated-and-decompensated-cirrhosis
#18
Xiao-Dong Gai, Wei-Feng Wu
Chronic hepatitis B virus (CHB) infection is a burden on global healthcare and is associated with a higher risk of serious sequelae, including cirrhosis and hepatocellular carcinoma. The clinical application of entecavir as a treatment for CHB has produced positive outcomes, and so is an attractive form of pharmacological therapy. However, little data exists comparing the safety and efficacy of entecavir for the treatment of hepatitis B virus (HBV)-related compensated, and decompensated cirrhosis, respectively...
October 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28994870/predictive-scores-of-early-mortality-from-variceal-gastrointestinal-bleeding-in-cirrhotic-patients
#19
Leila Mouelhi, Hend Ayadi, Yosra Zaimi, Oussama Daboussi, Mohamed Salem, Radhouane Debbech, Fatma Houissa, Taoufik Najjar
INTRODUCTION: The variceal bleeding, main complication of portal hypertension during cirrhosis, is associated with high early mortality riskestimated between 15 and 20%. This highlights the necessity of predictive models that allow identifying high-risk patients raising the issue of amore aggressive therapeutic care. OBJECTIVE: To assess the performance of four scores for the prediction of cirrhotic patients' high early mortality risk due to digestive hemorrhageand to compare them to the Child-Pugh reference score...
November 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28983709/late-complications-of-biliary-atresia-hepatopulmonary-syndrome-and-portopulmonary-hypertension
#20
Frederick M Karrer, Bradley J Wallace, Arturo E Estrada
Children with biliary atresia (BA) following Kasai portoenterostomy have a high risk for portal hypertension, however, while variceal and hemorrhagic complications have been more commonly studied, less frequent but no less possibly devastating complications of hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPH) remain less well understood. HPS and PPH both occur in a setting of portal hypertension, however, paradoxically patients with HPS develop pulmonic vasculature dilation leading to shunting and hypoxia, while those with PPH develop an opposite progression of pulmonary vasoconstriction eventually leading to cor pulmonale and decompensation...
December 2017: Pediatric Surgery International
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