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ICU GI

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117 papers 25 to 100 followers
https://www.readbyqxmd.com/read/28847548/cholestatic-alterations-in-the-critically-ill-some-new-light-on-an-old-problem
#1
REVIEW
Marc Jenniskens, Lies Langouche, Greet Van den Berghe
Liver dysfunction and jaundice are traditionally viewed as late features of sepsis and other critical illnesses and are associated with a complicated ICU stay. However, study results suggest that cholestatic alterations occur early in the course of critical illnesses, perceived only as minor abnormalities in routinely used biochemical liver tests. Inflammation-induced alterations in the transport of bile acids (BAs) appear to drive BAs and bilirubin toward the systemic circulation. Ongoing BA synthesis with an, at least partial, loss of feedback inhibition further contributes to elevated circulating BAs and bilirubin...
August 26, 2017: Chest
https://www.readbyqxmd.com/read/28759468/the-evaluation-of-critically-ill-transplant-patients-with-infectious-diarrhea
#2
Diana F Florescu
PURPOSE OF REVIEW: The review summarizes the epidemiology, risk factors, clinical presentation, diagnosis and management of the most important etiologic agents of infectious diarrhea in critically ill transplant recipients. RECENT FINDINGS: Diarrhea, frequently caused by infectious pathogens, can cause significant morbidity and mortality in transplant recipients. Diarrhea can lead to severe dehydration, acute renal failure, medication toxicity, rejection, graft-versus-host disease and impairs patients' quality of life...
October 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28770495/fecal-microbiota-transplantation-beyond-clostridium-difficile
#3
REVIEW
Braden Millan, Michael Laffin, Karen Madsen
PURPOSE OF REVIEW: Fecal microbiota transplantation (FMT) has been established as standard of care in the treatment of antibiotic refractory Clostridium difficile infection (RCDI). This review examines the current evidence that exists to support the use of FMT in the treatment of human disease beyond C. difficile infection. RECENT FINDINGS: Beneficial effects of FMT have been described in case series or small prospective trials on a wide spectrum of conditions, including inflammatory bowel disease, functional gastrointestinal disorders, non-alcoholic steatohepatitis, alcoholic hepatitis, hepatic encephalopathy, and neuropsychiatric conditions, and in limiting antibiotic-resistant bacterial infections...
September 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28417882/easl-clinical-practical-guidelines-on-the-management-of-acute-fulminant-liver-failure
#4
Julia Wendon,, Juan Cordoba, Anil Dhawan, Fin Stolze Larsen, Michael Manns, Didier Samuel, Kenneth J Simpson, Ilan Yaron, Mauro Bernardi
The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome, characterised by an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy...
May 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28794797/acute-mesenteric-ischemia-guidelines-of-the-world-society-of-emergency-surgery
#5
REVIEW
Miklosh Bala, Jeffry Kashuk, Ernest E Moore, Yoram Kluger, Walter Biffl, Carlos Augusto Gomes, Offir Ben-Ishay, Chen Rubinstein, Zsolt J Balogh, Ian Civil, Federico Coccolini, Ari Leppaniemi, Andrew Peitzman, Luca Ansaloni, Michael Sugrue, Massimo Sartelli, Salomone Di Saverio, Gustavo P Fraga, Fausto Catena
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28321156/current-knowledge-on-the-laboratory-diagnosis-of-clostridium-difficile-infection
#6
REVIEW
Adrián Martínez-Meléndez, Adrián Camacho-Ortiz, Rayo Morfin-Otero, Héctor Jesús Maldonado-Garza, Licet Villarreal-Treviño, Elvira Garza-González
Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from self-limited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients...
March 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28373761/gastrointestinal-bleeding-in-patients-on-novel-oral-anticoagulants-risk-prevention-and-management
#7
REVIEW
Ka-Shing Cheung, Wai K Leung
Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b...
March 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28780148/intraabdominal-hypertension-abdominal-compartment-syndrome-and-the-open-abdomen
#8
REVIEW
William Kirke Rogers, Luis Garcia
Abdominal compartment syndrome (ACS) is the end point of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion in the abdomen (such as ascites or a hematoma) leads to pathologically increased pressure. This results in so-called intraabdominal hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality...
August 2, 2017: Chest
https://www.readbyqxmd.com/read/28693567/protocol-based-invasive-intracranial-pressure-monitoring-in-acute-liver-failure-feasibility-safety-and-impact-on-management
#9
Venkatakrishna Rajajee, Robert J Fontana, Anthony J Courey, Parag G Patil
BACKGROUND: Acute liver failure (ALF) may result in elevated intracranial pressure (ICP). While invasive ICP monitoring (IICPM) may have a role in ALF management, these patients are typically coagulopathic and at risk for intracranial hemorrhage (ICH). Contemporary ICP monitoring techniques and coagulopathy reversal strategies may be associated with a lower risk of hemorrhage. Our objective was to evaluate the safety, feasibility, impact on clinical management and outcomes associated with protocol-directed use of IICPM in ALF...
July 11, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28579346/combined-spontaneous-bacterial-empyema-and-peritonitis-in-cirrhotic-patients-with-ascites-and-hepatic-hydrothorax
#10
Anwar Mohamed, Mohammed Atef, Ayman Alsebaey, Mahmoud Musa Elhabshy, Mohsen Salama
BACKGROUND AND STUDY AIMS: Spontaneous bacterial empyema (SBEM) is an underestimated condition in patients with ascites and hepatic hydrothorax with a high mortality. This study aimed to find whether spontaneous bacterial peritonitis (SBP) is a prerequisite for SBEM. PATIENTS AND METHODS: 3000 HCV-related cirrhotic patients with ascites and hydrothorax were screened for the presence of SBP (ascitic fluid neutrophils >250/mm(3)) and SBEM (positive pleural fluid culture and neutrophils >250/mm(3) or negative pleural fluid culture and neutrophils >500/mm(3) with no evidence of pneumonia/parapneumonic effusion on chest radiograph or CT)...
June 2017: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
https://www.readbyqxmd.com/read/28443154/drug-induced-liver-injury-do-we-know-everything
#11
REVIEW
Tamara Alempijevic, Simon Zec, Tomica Milosavljevic
Interest in drug-induced liver injury (DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating the current state of the art, the latest scientific findings, controversies, and guidelines, this review will attempt to answer the question: Do we know everything? Since the first descriptions of hepatotoxicity over 70 years ago, more than 1000 drugs have been identified to date, however, much of our knowledge of diagnostic and pathophysiologic principles remains unchanged...
April 8, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28515843/emerging-concepts-in-alcoholic-hepatitis
#12
REVIEW
Phoenix Fung, Nikolaos Pyrsopoulos
Severe alcoholic hepatitis is implicated as a costly, worldwide public health issue with high morbidity and mortality. The one-month survival for severe alcoholic hepatitis is low with mortality rates high as 30%-50%. Abstinence from alcohol is the recommended first-line treatment. Although corticosteroids remain as the current evidence based option for selected patients with discriminant function > 32, improvement of short-term survival rate may be the only benefit. Identification of individuals with risk factors for the development of severe alcoholic hepatitis may provide insight to the diverse clinical spectrum and prognosis of the disease...
April 28, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28262529/effects-of-combined-prokinetic-administration-on-gastric-emptying-in-critically-ill-patients
#13
Afshin Gholipour Baradari, Mohammad Reza Khajavi, Abolfazl Firouzian, Abbas Alipour, Hojatallah Daneshpour, Yunes Panahi, Amirhossein Sahebkar
BACKGROUND AND STUDY AIMS: Combination of prokinetic drugs with different mechanisms of action is frequently used when feeding intolerance is not improved with a single agent. In this study, we evaluated the effect of combined infusion of neostigmine and metoclopramide on gastric passage in critically ill patients in the intensive care unit (ICU). PATIENTS AND METHODS: This study is a randomized double-blind controlled trial in 90 patients between 20 and 60years of age who were under mechanical ventilation and had gastric residual volumes (GRVs) >120mL 3h after the last lavage...
March 2017: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
https://www.readbyqxmd.com/read/28395782/colon-ischemia-right-sided-colon-involvement-has-a-different-presentation-etiology-and-worse-outcome-a-large-retrospective-cohort-study-in-histology-proven-patients
#14
REVIEW
Lotte B Ten Heggeler, Lisette J H van Dam, Alderina Bijlsma, Marijn C Visschedijk, Robert H Geelkerken, Maarten A C Meijssen, Jeroen J Kolkman
BACKGROUND: Colon ischemia (CI), is generally considered a non-occlusive mesenteric ischemia disorder that usually runs a benign course, but right-sided involvement (RCI) has been associated with worse outcome. The poor outcome of RCI has been associated with comorbidity, but more recently also with occlusions of the mesenteric arteries. We performed a retrospective analysis of a large cohort of CI-patients to assess differences in presentation, etiology, and comorbidity between right-sided colon ischemia (RCI) and non-right-sided colon ischemia (NRCI), and their relation to outcome...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395784/acute-mesenteric-ischemia-part-i-incidence-etiologies-and-how-to-improve-early-diagnosis
#15
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395790/serological-markers-for-human-intestinal-ischemia-a-systematic-review
#16
REVIEW
Joep P M Derikx, Dirk H S M Schellekens, Stefan Acosta
Early and accurate diagnosis of intestinal ischemia is important in order to provide rapid and correct treatment and reduce morbidity and mortality rates. Clinical signs and symptoms are often unspecific. This systemic review sums up literature regarding human plasma biomarkers for acute mesenteric ischemia reported during the last ten years. Classic, general markers, including lactate, white cell count, base excess, show poor diagnostic accuracy for intestinal ischemia. Preliminary results for ischemia-modified albumin are promising, which is also true for the inflammatory marker procalcitonin...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395792/vasculitis-of-the-mesenteric-circulation
#17
REVIEW
Matthew J Koster, Kenneth J Warrington
Vasculitis of the mesenteric circulation is an uncommon but life-threatening manifestation of systemic vasculitis. Initial symptoms are frequently non-specific and therefore patients often present to primary care physicians and gastroenterologists with abdominal pain or gastrointestinal bleeding. Given the severity of the conditions associated with mesenteric vasculitis, it is imperative to appropriately diagnose and initiate treatment of suspected cases. This review will focus on diseases commonly associated with vasculitis of the mesenteric vessels...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28341748/drug-induced-liver-injury-recent-advances-in-diagnosis-and-risk-assessment
#18
REVIEW
Gerd A Kullak-Ublick, Raul J Andrade, Michael Merz, Peter End, Andreas Benesic, Alexander L Gerbes, Guruprasad P Aithal
Idiosyncratic drug-induced liver injury (IDILI) is a rare but potentially severe adverse drug reaction that should be considered in patients who develop laboratory criteria for liver injury secondary to the administration of a potentially hepatotoxic drug. Although currently used liver parameters are sensitive in detecting DILI, they are neither specific nor able to predict the patient's subsequent clinical course. Genetic risk assessment is useful mainly due to its high negative predictive value, with several human leucocyte antigen alleles being associated with DILI...
June 2017: Gut
https://www.readbyqxmd.com/read/28105256/drug-induced-liver-injury-towards-early-prediction-and-risk-stratification
#19
REVIEW
Emanuel Raschi, Fabrizio De Ponti
Drug-induced liver injury (DILI) is a hot topic for clinicians, academia, drug companies and regulators, as shown by the steadily increasing number of publications and agents listed as causing liver damage (http://livertox.nih.gov/). As it was the case in the past decade with drug-induced QT prolongation/arrhythmia, there is an urgent unmet clinical need to develop tools for risk assessment and stratification in clinical practice and, in parallel, to improve prediction of pre-clinical models to support regulatory steps and facilitate early detection of liver-specific adverse drug events...
January 8, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28144392/vasopressin-use-in-critically-ill-cirrhosis-patients-with-catecholamine-resistant-septic-shock-the-cvicu-cohort
#20
Lukasz A Myc, Jonathan G Stine, Rinita Chakrapani, Alexandra Kadl, Curtis K Argo
AIM: To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholamine-refractory septic shock. METHODS: We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents...
January 18, 2017: World Journal of Hepatology
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