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Critical Care hepatology

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https://www.readbyqxmd.com/read/27747458/acute-on-chronic-liver-failure
#1
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27061311/competency-based-medical-education-in-gastrointestinal-motility
#2
R Yadlapati, R N Keswani, J E Pandolfino
Traditional apprenticeship-based medical education methods focusing on subjective evaluations and case-volume requirements do not reliably produce clinicians that provide high-quality care in unsupervised practice. Consequently, training approaches are shifting towards competency based medical education, which incorporates robust assessment methods and credible standards of physician proficiency. However, current gastroenterology and hepatology training in the US continues to utilize procedural volume and global impressions without standardized criteria as markers of competence...
October 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/26959806/intensive-care-management-of-patients-with-liver-disease-proceedings-of-a-single-topic-conference-sponsored-by-the-brazilian-society-of-hepatology
#3
Paulo Lisboa Bittencourt, Carlos Terra, Edison Roberto Parise, Alberto Queiroz Farias, Vincent Arroyo, Javier Fernandez, Gustavo Pereira, Luiz Marcelo Maubouisson, Guilherme Marques Andrade, Fernando Gomes de Barros Costa, Liana Codes, Antônio Ricardo Andrade, Angelo Matos, André Torres, Fernanda Couto, Ivan Zyngier
Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation...
December 2015: Arquivos de Gastroenterologia
https://www.readbyqxmd.com/read/26778768/-evaluation-and-treatment-of-the-critically-ill-cirrhotic-patient
#4
Javier Fernández, Carles Aracil, Elsa Solà, Germán Soriano, Maria Cinta Cardona, Susanna Coll, Joan Genescà, Manoli Hombrados, Rosa Morillas, Marta Martín-Llahí, Albert Pardo, Jordi Sánchez, Victor Vargas, Xavier Xiol, Pere Ginès
Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units...
November 2016: Gastroenterología y Hepatología
https://www.readbyqxmd.com/read/26776157/the-calm-before-the-storm-a-report-from-the-international-liver-cancer-association-congress-2015-part-2
#5
Giuseppe Cabibbo, Maria Reig, Gennaro Gadaleta-Caldarola, Giovanni Galati, Giuseppe Lombardi, GianCarlo Mazza, Luca Marzi, Carlo Saitta, Jean-Charles Nault, Rodolfo Sacco
International Liver Cancer Association Congress 2015, Paris, France, 4-6 September 2015 Since its creation 9 years ago, in 2007, the International Liver Cancer Association has focused on the multidisciplinary approach to liver cancer due to advances in hepatology science and care worldwide. In its 2015 annual conference, held on 4-6 September in Paris, France, the most recent progresses in the basic biology, management and treatment of liver cancer have been presented. This report, divided into two parts, introduces and critically reviews some of the most intriguing topics discussed at the meeting...
February 2016: Future Oncology
https://www.readbyqxmd.com/read/26775918/the-calm-before-the-storm-a-report-from-the-international-liver-cancer-association-congress-2015-part-1
#6
Giuseppe Cabibbo, Maria Reig, Gennaro Gadaleta-Caldarola, Giovanni Galati, Giuseppe Lombardi, GianCarlo Mazza, Luca Marzi, Carlo Saitta, Jean-Charles Nault, Rodolfo Sacco
International Liver Cancer Association Congress 2015, Paris, France, 4-6 September 2015 Since its creation 9 years ago, in 2007, the International Liver Cancer Association has focused on the multidisciplinary approach to liver cancer due to advances in hepatology science and care worldwide. In its 2015 annual conference, held on 4-6 September in Paris, France, the most recent progresses in the basic biology, management and treatment of liver cancer have been presented. This report, divided into two parts, introduces and critically reviews some of the most intriguing topics discussed at the meeting...
February 2016: Future Oncology
https://www.readbyqxmd.com/read/26762655/patterns-of-service-utilisation-within-australian-hepatology-clinics-high-prevalence-of-advanced-liver-disease
#7
N A El-Atem, K Wojcik, L Horsfall, K M Irvine, T Johnson, S M McPhail, E E Powell
BACKGROUND: Liver diseases in Australia are estimated to affect 6 million people with a societal cost of $51 billion annually. Information about utilisation of specialist hepatology care is critical in informing policy makers about the requirements for delivery of hepatology-related healthcare. AIMS: This study examined the aetiology and severity of liver disease seen in a tertiary hospital hepatology clinic, as well as the resource utilisation patterns. METHODS: A longitudinal cohort study included consecutive patients booked in hepatology outpatient clinics during a 3-month period...
April 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/26660679/rates-of-treatment-eligibility-in-follow-up-of-patients-with-chronic-hepatitis-b-chb-across-various-clinical-settings-who-were-initially-ineligible-at-presentation
#8
Lindsay A Uribe, Nghia Nguyen, Lily Kim, Huy N Trinh, Christopher Wong, Clifford Wong, Long H Nguyen, Mindie H Nguyen
BACKGROUND AND AIMS: Chronic hepatitis B (CHB) is a major cause of cirrhosis and end-stage liver disease. Not all patients with CHB require antiviral treatment but long-term monitoring is critical to identify patients who would benefit from antiviral therapy. CHB patients followed in various clinical settings may differ in disease characteristics and rates of treatment eligibility in long-term follow-up. METHODS: We conducted a retrospective cohort study of 359 consecutive treatment-naive, treatment-ineligible CHB patients (228 from community GI clinics; 73 from university hepatology clinic; 58 from primary care clinic)...
February 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/25755504/hepatitis-e-and-acute-on-chronic-liver-failure
#9
REVIEW
Ashish Kumar, Vivek A Saraswat
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis (AVH) globally. It causes large scale epidemics of AVH across the low- and middle income countries in Asia and Africa, and also causes sporadic cases of AVH in the same geographical region. AVH due to HEV is usually an acute, self-limiting illness, similar in clinical presentation to AVH caused by hepatitis A virus (HAV). When HEV causes AVH in patients of chronic liver disease it may worsen rapidly to a syndrome called acute-on-chronic liver failure (ACLF) leading to very high mortality...
September 2013: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/25730177/vibration-controlled-transient-elastography-a-practical-approach-to-the-noninvasive-assessment-of-liver-fibrosis
#10
REVIEW
Elliot B Tapper, Nezam H Afdhal
PURPOSE OF REVIEW: Therapeutic advances for hepatitis C and the increasing prevalence on nonalcoholic fatty liver disease are reshaping the diagnostic approach to disease staging in clinical hepatology. Well tolerated, inexpensive and reliable alternatives to liver biopsy are a critical need for clinicians and patients alike. RECENT FINDINGS: Vibration-controlled transient elastography (VCTE, also known as 'transient elastography') is a robust, point-of-care tool for the noninvasive assessment of liver fibrosis...
May 2015: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/25419906/pharmacological-treatment-of-children-with-gastro-oesophageal-reflux
#11
REVIEW
Mark Tighe, Nadeem A Afzal, Amanda Bevan, Andrew Hayen, Alasdair Munro, R Mark Beattie
BACKGROUND: Gastro-oesophageal reflux (GOR) is a common disorder, characterised by regurgitation of gastric contents into the oesophagus. GOR is a very common presentation in infancy in both primary and secondary care settings. GOR can affect approximately 50% of infants younger than three months old (Nelson 1997). The natural history of GOR in infancy is generally that of a functional, self-limiting condition that improves with age; < 5% of children with vomiting or regurgitation continue to have symptoms after infancy (Martin 2002)...
2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/25392842/small-for-size-liver-remnant-following-resection-prevention-and-management
#12
REVIEW
Rony Eshkenazy, Yael Dreznik, Eylon Lahat, Barak Bar Zakai, Alex Zendel, Arie Ariche
In the latest decades an important change was registered in liver surgery, however the management of liver cirrhosis or small size hepatic remnant still remains a challenge. Currently post-hepatectomy liver failure (PLF) is the major cause of death after liver resection often associated with sepsis and ischemia-reperfusion injury (IRI). ''Small-for-size'' syndrome (SFSS) and PFL have similar mechanism presenting reduction of liver mass and portal hyper flow beyond a certain threshold. Few methods are described to prevent both syndromes, in the preoperative, perioperative and postoperative stages...
October 2014: Hepatobiliary Surgery and Nutrition
https://www.readbyqxmd.com/read/25334553/assessing-mortality-in-the-medical-intensive-care-unit-of-interfacility-transferred-micu-patients
#13
Nirav Patel, Niusha Damaghi, Michael Stephen
Outcomes/Quality Control Posters IISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: The purpose of this study was to asses outcomes in patients in an academic MICU that were transferred from an outside hospital MICU. Transferring a patient to a tertiary care MICU is costly and the risks of the transfer may outweigh the benefits. This study assessed mortality of transferred patients. Furthermore, it assesses if patients have met their primary purpose post transfer, whether it was an improvement in their condition, or if the patients received an organ transplantation (Liver/ kidney)...
October 1, 2014: Chest
https://www.readbyqxmd.com/read/24740498/nutrition-algorithms-and-bedside-nutrient-delivery-practices-in-pediatric-intensive-care-units-an-international-multicenter-cohort-study
#14
MULTICENTER STUDY
Enid E Martinez, Lori J Bechard, Nilesh M Mehta
BACKGROUND: Enteral nutrition (EN) delivery is associated with improved outcomes in critically ill patients. We aimed to describe EN practices, including details of algorithms and individual bedside practices, in pediatric intensive care units (PICUs). METHODS: Available EN algorithm details from 31 international PICUs were obtained. Daily nutrient intake data from 524 mechanically ventilated patients, 1 month to 18 years old, were prospectively documented, including EN delivery, adjunct therapies, and energy prescription...
June 2014: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/24662844/health-services-and-policy-research-in-hepatology
#15
REVIEW
Jayant A Talwalkar
PURPOSE OF REVIEW: This article examines recent health services and policy research studies in hepatology and liver transplantation. RECENT FINDINGS: Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location...
May 2014: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/24102514/bcsh-bsbmt-guideline-diagnosis-and-management-of-veno-occlusive-disease-sinusoidal-obstruction-syndrome-following-haematopoietic-stem-cell-transplantation
#16
Fiona L Dignan, Robert F Wynn, Nedim Hadzic, John Karani, Alberto Quaglia, Antonio Pagliuca, Paul Veys, Michael N Potter
DIAGNOSIS: It is recommended that the diagnosis of veno-occlusive disease (sinusoidal obstruction syndrome) [VOD (SOS)] be based primarily on established clinical criteria (modified Seattle or Baltimore criteria) (1A). Ultrasound imaging may be helpful in the exclusion of other disorders in patients with suspected VOD (SOS) (1C). It is recommended that liver biopsy be reserved for patients in whom the diagnosis of VOD (SOS) is unclear and there is a need to exclude other diagnoses (1C)...
November 2013: British Journal of Haematology
https://www.readbyqxmd.com/read/24073089/access-to-care-for-vulnerable-veterans-with-hepatitis-c-a-hybrid-conceptual-framework-and-a-case-study-to-guide-translation
#17
Catherine Rongey, Steven Asch, Sara J Knight
The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients...
December 2011: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/23967610/-a-bibliometric-investigation-to-research-fronts-of-major-sub-specialties-in-internal-medicine
#18
Lei Cui, Xi-Bin Shen, Li Fang, Xian-Wei Pan, Xiu-Mei Zhong, Xue Gong, Ying Yang
OBJECTIVE: To outline the research fronts of ten major sub-specialties in internal medicine. METHODS: Based on their impact factor scores and the proportion of the journals of 10 subspecialties (endocrinology & metabolism, cardiac & cardiovascular systems, hematology, infectious diseases, nephrology, gastroenterology & hepatology, respiratory system, rheumatology, critical care medicine, clinical neurology) in Journal Citation Report (JCR), and careful consulation of expert clinicians, we identified 50 journals...
February 2013: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/23843097/identifying-practice-gaps-to-optimize-medical-care-for-patients-with-nonalcoholic-fatty-liver-disease
#19
Amanda C Wieland, Matthew Quallick, Aimee Truesdale, Pamela Mettler, Kiran M Bambha
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. Primary care providers (PCPs), in contrast to gastroenterology/hepatology (GI/Hep) providers, are the first medical contact for the majority of patients with, or at risk for, NAFLD. PCP awareness of and facility with NAFLD is critical for management of these patients. AIM: The purpose of this study was to assess understanding and practice patterns of PCPs and non-GI/Hep subspecialty providers with respect to the diagnosis and management of NAFLD...
October 2013: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/23788321/growth-and-development-of-a-new-subspecialty-pediatric-hepatology
#20
William F Balistreri
Several major forces converged to catalyze the formal emergence of a body of knowledge and an organized focus on disorders of the liver in early life. Attendant to the development of a focused clinical subspecialty the pace of patient- and laboratory-based research in the field quickened in parallel to decipher the consequences of genetic or metabolic aberrations on immature liver structure and function. The key research observations that catalyzed the emergence and subsequent rapid growth of Pediatric Hepatology include: (1) an understanding of the dynamic events occurring during hepatobiliary development and the importance of these physiologic variables that occur during liver maturation; (2) the recognition of the unique nature of inherited and acquired liver diseases that affect infants and children-such as biliary atresia and Reye's syndrome; and (3) redefinition of the once obscure inherited intrahepatic cholestatic diseases of the liver, which, in turn, provided insight into normal and abnormal hepatobiliary physiology...
August 2013: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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