Chronic Liver Disease, Cirrhosis, and Complications: Part 1 (Portal Hypertension, Ascites, Spontaneous Bacterial Peritonitis (SBP), and Hepatorenal Syndrome (HRS))

2013 ◽  
pp. 483-495 ◽  
Author(s):  
Ross W. Shepherd
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Chronic Liver ◽  
Bacterial Peritonitis

Complications of chronic liver disease

2018 ◽  
Author(s):  
Naresh P Shanmugam ◽  
Dharam Basude
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Chronic Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Growth Failure ◽  
Hepatopulmonary Syndrome ◽  
Chronic Liver ◽  
Bacterial Peritonitis

The chapter on complications of chronic liver disease gives an overview of the definition, pathophysiology, diagnosis, and management of the various complications that accompany chronic liver disease. It includes among others, malnutrition and growth failure, hepatic encephalopathy, hepatopulmonary syndrome, hepatorenal syndrome, portal hypertension, and spontaneous bacterial peritonitis.

Targeting the gut-liver-immune axis to treat cirrhosis

Gut ◽  
2020 ◽  
pp. gutjnl-2020-320786 ◽  
Author(s):  
Thomas Henry Tranah ◽  
Lindsey A Edwards ◽  
Bernd Schnabl ◽  
Debbie Lindsay Shawcross
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Bacterial Infections ◽  
Hepatorenal Syndrome ◽  
Intestinal Barrier ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Barrier Dysfunction ◽  
Bacterial Peritonitis ◽  
Gut Barrier Function

Cirrhotic portal hypertension is characterised by development of the decompensating events of ascites, encephalopathy, portal hypertensive bleeding and hepatorenal syndrome, which arise in a setting of cirrhosis-associated immune dysfunction (CAID) and define morbidity and prognosis. CAID describes the dichotomous observations that systemic immune cells are primed and display an inflammatory phenotype, while failing to mount robust responses to pathogen challenge. Bacterial infections including spontaneous bacterial peritonitis are common complications of advanced chronic liver disease and can precipitate variceal haemorrhage, hepatorenal syndrome and acute-on-chronic liver failure; they frequently arise from gut-derived organisms and are closely linked with dysbiosis of the commensal intestinal microbiota in advanced chronic liver disease.Here, we review the links between cirrhotic dysbiosis, intestinal barrier dysfunction and deficits of host-microbiome compartmentalisation and mucosal immune homoeostasis that occur in settings of advanced chronic liver disease. We discuss established and emerging therapeutic strategies targeted at restoring intestinal eubiosis, augmenting gut barrier function and ameliorating the mucosal and systemic immune deficits that characterise and define the course of decompensated cirrhosis.

Elevated C-Reactive Protein and Spontaneous Bacterial Peritonitis in Children With Chronic Liver Disease and Ascites

2014 ◽  
Vol 58 (1) ◽  
pp. 96-98 ◽  
Author(s):  
Marcela Preto-Zamperlini ◽  
Sylvia Costa Lima Farhat ◽  
Maria Beatriz Moliterno Perondi ◽  
Adriana Pozzi Pestana ◽  
Patricia Salles Cunha ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Chronic Liver ◽  
C Reactive Protein ◽  
Bacterial Peritonitis ◽  
Reactive Protein

scholarly journals Evaluation of diagnostic accuracy of C-Reactive protein as a biomarker of spontaneous bacterial peritonitis in patients having decompensated chronic liver disease.

2021 ◽  
Vol 28 (10) ◽  
pp. 1438-1442
Author(s):  
Kapeel Raja ◽  
Rizwan Saeed Kiyani ◽  
Sadia Rehman ◽  
Abdul Rashid ◽  
Sanjay Kumar ◽  
...  
Keyword(s):  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Ascitic Fluid ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Chronic Liver ◽  
C Reactive Protein ◽  
Bacterial Peritonitis ◽  
Reactive Protein

Objective: The objective of this study was to evaluate the diagnostic accuracy of C Reactive Protein (CRP) in diagnosing spontaneous bacterial peritonitis (SBP) in patients with decompensated chronic liver disease. Study Design: Cross Sectional study. Setting: Department of Medicine Sheikh Khalifa Bin Zayed Hospital Rawalakot Azad Kashmir. Period:  Feb 2018 to Dec 2018. Material & Methods: One hundred subjects with decompensated liver disease were recruited in this study after fulfilling inclusion criteria. The patients’ medical record number, age and gender was recorded upon admission. Baseline investigations including complete blood count, urine examination and chest X ray were done. Abdominal ultrasound was performed for detecting the presence of ascitic fluid. SBP was diagnosed if > 250 mm3 neutrophils are detected in the ascitic fluid. Serum CRP was detected and reported in mg/L. Results: SBP was detected in 32.8% of the patients having decompensated chronic liver disease. CRP levels were > 29.5mg/L in 36% of the patients while in 64% patients the CRP levels were < 29.5mg/L. The sensitivity of CRP for the diagnosis of SBP was calculated as 83.61% while the specificity was calculated as 87.2%. A positive predictive value was estimated as 76.12% and a negative predictive value was 91.59% while the diagnostic accuracy was calculated as 86.02% from the given data. Conclusion: CRP is a reliable diagnostic biomarker for spontaneous bacterial peritonitis in subjects having complications of chronic liver disease.

scholarly journals To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

2017 ◽  
Vol 5 (8) ◽  
pp. 3654
Author(s):  
Rajendra Kumar Verma ◽  
Richa Giri ◽  
Mayuri Agarwal ◽  
Vaibhav Srivastava
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Hospital ◽  
Chronic Liver ◽  
Albumin Concentration ◽  
Bacterial Peritonitis ◽  
Presenting Symptoms ◽  
Group A ◽  
Group B

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl. 

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