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Variceal hemorrhage

Jia Zhu, Xingshun Qi, Haonan Yu, Chunping Su, Xiaozhong Guo
BACKGROUND AND AIM: Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices. METHODS: All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed...
March 22, 2018: Expert Review of Gastroenterology & Hepatology
Janesh Lakhoo, Senthil S Gunasekaran, R Peter Lokken, Andrew J Lipnik, Charles E Ray, James T Bui, Ron C Gaba
BACKGROUND AND STUDY AIMS: There are currently limited data available summarizing the clinical outcomes and safety of transjugular intrahepatic portosystemic shunts (TIPS) in cases of advanced chronic kidney disease (CKD). The study aimed to assess efficacy and safety of TIPS in patients with advanced CKD. PATIENTS AND METHODS: Seventeen patients (M :F 8 :9, age 55 years, MELD 24) with grade 4-5 CKD who underwent TIPS for ascites (n = 7) or varices (n = 10) were analyzed...
April 2017: Acta Gastro-enterologica Belgica
Sofia Simona Jakab, Guadalupe Garcia-Tsao
Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. Variceal hemorrhage is a life-threatening complication of cirrhosis and is one of the clinical complications that defines cirrhosis decompensation. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented...
March 15, 2018: Clinical Gastroenterology and Hepatology
Andrzej B Szczepanik, Konrad Pielaciński, Anna M Oses-Szczepanik, Sławomir Huszcza, Andrzej Misiak, Wojciech P Dąbrowski, Sławomir Gajda
INTRODUCTION: Bleeding from esophageal varices is a serious clinical condition in hemophilia patients due to congenital deficiency or lack of clotting factors VIII (in hemophilia A) and IX (in hemophilia B), decreased clotting factor II, VII, IX, X synthesis in the course of chronic liver disease and hipersplenic thrombocytopenia. The aim of this study was to assess the efficacy and safety of endoscopic sclerotherapy in acute esophageal variceal bleeding and in secondary prophylaxis of hemorrhage...
February 28, 2018: Polski Przeglad Chirurgiczny
Clara Elisa Frare de Avelar Teixeira, Angélica de Fátima de Assunção Braga, Franklin Sarmento da Silva Braga, Vanessa Henriques Carvalho, Rafael Miranda da Costa, Giselle Ioná Teixeira Brighenti
INTRODUCTION: Klippel-Trenaunay syndrome is a rare congenital vascular disease characterized by cutaneous hemangiomas, varicosities, and limb asymmetry, which may evolve with coagulation disorders and hemorrhage as more frequent complications in pregnant patients. Pregnancy is not advised in women with this syndrome due to increased obstetric risk. CASE REPORT: Female patient, 29 years old, 99kg, 167cm, BMI 35.4kg.m-2 , physical status ASA III, with 27 weeks of gestational age and diagnosis of Klippel-Trenaunay syndrome...
March 2, 2018: Revista Brasileira de Anestesiologia
Lili Ma, Xiaoquan Huang, Jingjing Lian, Jian Wang, Shiyao Chen
BACKGROUND AND AIM: Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices. PATIENTS AND METHODS: A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016...
March 2, 2018: European Journal of Gastroenterology & Hepatology
Bolin Niu, Brian Kim, Berkeley N Limketkai, Jing Sun, Zhiping Li, Tinsay Woreta, Po-Hung Chen
BACKGROUND AND AIM: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis and is associated with significant morbidity and mortality. In this study, we examined the clinical characteristics and risk factors associated with mortality in hospitalized patients presenting with SBP. METHODS: The Nationwide Inpatient Sample was queried for all hospitalizations involving SBP from 2006 to 2014 using the International Classification of Disease-9-CM Code...
February 26, 2018: Digestive Diseases and Sciences
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
Ji Chang-Xue, Li Ying, Ju Shuai, Qiang Jin-Wei
OBJECTIVE: To evaluate the application value of percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal hemorrhage in patients with schistosomiasis cirrhosis. METHODS: Sixteen schistosomiasis cirrhosis patients (12 males and 4 females) with portal hypertension complicated with esophageal and upper gastrointestinal hemorrhage were selected as the investigation subjects, all the patients had been treated by esophageal vein ligation and sclerotherapy, but with bleeding again post-operation...
March 27, 2017: Zhongguo Xue Xi Chong Bing Fang Zhi za Zhi, Chinese Journal of Schistosomiasis Control
Luis Téllez, Enrique Rodríguez-Santiago, Agustín Albillos
Fontan-associated liver disease is a hepatic disorder arising from hemodynamic changes and systemic venous congestion following Fontan surgery. The histological changes produced in the liver are similar but not equivalent to those seen in other forms of cardiac liver disease. While the natural history of this form of liver disease is not well established, over time many Fontan patients develop portal hypertension-related complications such as ascites, variceal hemorrhage or encephalopathy. Fontan survivors also show an increased risk of hepatocellular carcinoma...
March 1, 2018: Annals of Hepatology
Brian M Fung, Amir Kalani, James H Tabibian
No abstract text is available yet for this article.
February 6, 2018: Clinical Gastroenterology and Hepatology
Francisca Cisneros Farrar
Acute gastrointestinal bleeding is a common problem found in critically ill patients that can range from self-limited bleeding to a hemorrhaging emergency. Patients can quickly develop shock and altered mental status when they develop hemodynamic instability. Therefore, it is essential that the frontline critical care nurse develop self-efficacy for management of these disorders. This article overviews standards of practice for the management of upper and lower acute gastrointestinal bleeding. Common bleeding disorders are reviewed with expanded focus on peptic ulcer, acute variceal hemorrhage, colonic diverticular bleeding, and angiodysplasias, which are commonly found in the critical care setting...
March 2018: Critical Care Nursing Clinics of North America
Jihyun Kwon, Youngil Koh, Su Jong Yu, Jung-Hwan Yoon
INTRODUCTION: Portal vein thrombosis (PVT) is a well-known complication in patients with liver cirrhosis (LC). The aim of this study is to investigate the outcomes of cirrhotic patients with PVT treated with low-molecular-weight heparin (LMWH). METHOD: Ninety-one LC patients with PVT were treated with dalteparin or enoxaparin for six months. Patients with major bleeding during the last three months, severe thrombocytopenia, or impaired renal function were excluded...
February 1, 2018: Thrombosis Research
Hui-Chun Huang, Shao-Jung Hsu, Ching-Chih Chang, Ming-Hung Tsai, Fa-Yauh Lee, Ming-Chih Hou, Shou-Dong Lee
Critical illness is accompanied by hypothalamic-pituitary-adrenal axis activation, but adrenal insufficiency characterized by inadequate glucocorticoid synthesis is common in critically ill cirrhotic patients, the 'hepato-adrenal syndrome'. Adrenal cortex also synthesizes androgen (dehydroepiandrosterone, DHEA). DHEA maintains microcirculation by enhancing vascular endothelial nitric oxide synthase (eNOS) activity. In critical patients of other disease entities, a shift of adrenal steroidogenesis away from androgens towards glucocorticoid has been noted, arousing interests in androgen replacement in critical settings...
February 1, 2018: Shock
Xiuli Yin, Xiaofei Lei, Changqing Xu, Jing Yang, Yingying Zhao, Kun Li
RATIONALE: Esophageal variceal bleeding caused by portal hypertension is massive and life-threatening to those patients with decompensated liver cirrhosis. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively stop bleeding. But the process of puncture may lead to bile duct injury and even form fistulas between the hepatic artery and bile duct. PATIENT CONCERNS: The case report illustrated a 52-year-old Chinese female patient who underwent TIPS...
December 2017: Medicine (Baltimore)
Filippo Schepis, Francesco Vizzutti, Guadalupe Garcia-Tsao, Guido Marzocchi, Luigi Rega, Nicola De Maria, Tommaso Di Maira, Stefano Gitto, Cristian Caporali, Stefano Colopi, Mario De Santis, Umberto Arena, Antonio Rampoldi, Aldo Airoldi, Alessandro Cannavale, Fabrizio Fanelli, Cristina Mosconi, Matteo Renzulli, Roberto Agazzi, Roberto Nani, Pietro Quaretti, Ilaria Fiorina, Lorenzo Moramarco, Roberto Miraglia, Angelo Luca, Raffaele Bruno, Stefano Fagiuoli, Rita Golfieri, Pietro Torricelli, Fabrizio Di Benedetto, Luca Saverio Belli, Federico Banchelli, Giacomo Laffi, Fabio Marra, Erica Villa
BACKGROUND & AIMS: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time...
January 25, 2018: Clinical Gastroenterology and Hepatology
Xiuyan Wu, Wei Xuan, Lei Song
Portal hypertension can lead to ectopic varices, which occur most frequently in the rectum. Rectal variceal bleeding in patients with portal hypertension is rare but can be life-threatening if not diagnosed and treated in a timely manner. However, no specific treatment guidelines have been established for rectal variceal bleeding. We herein report a case involving a woman with portal hypertension due to autoimmune liver disease who was successfully treated with a transjugular intrahepatic portosystemic stent shunt and variceal embolization...
January 1, 2018: Journal of International Medical Research
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
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
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
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