New Approaches to the Management of Portal Hypertension and Variceal Haemorrhage

1983 ◽  
pp. 268-280 ◽  
Author(s):  
D. Westaby ◽  
B. Macdougall ◽  
R. Williams
Keyword(s):  
Portal Hypertension ◽  
Variceal Haemorrhage ◽  
New Approaches

New approaches in the pharmacologic treatment of portal hypertension

1993 ◽  
Vol 17 ◽  
pp. S41-S45 ◽  
Author(s):  
Jaime Bosch ◽  
Juan C. García-Pagán ◽  
Faust Feu ◽  
Angelo Luca ◽  
Mercedes Fernández ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Pharmacologic Treatment ◽  
New Approaches

Portal hypertension and variceal haemorrhage

The Lancet ◽  
1997 ◽  
Vol 350 (9086) ◽  
pp. 1235-1239 ◽  
Author(s):  
Adrian J Stanley ◽  
Peter C Hayes
Keyword(s):  
Portal Hypertension ◽  
Variceal Haemorrhage

Hepatic disease

2018 ◽  
Author(s):  
Ashleigh Williams ◽  
John Christie
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Liver Failure ◽  
Hepatorenal Syndrome ◽  
Anaesthetic Management ◽  
Hepatic Disease ◽  
Portosystemic Shunt ◽  
Variceal Haemorrhage ◽  
Chronic Liver Failure ◽  
Intrahepatic Portosystemic Shunt

This chapter describes the anaesthetic management of the patient with liver disease and its sequelae. Acute liver failure and chronic liver failure are discussed, together with their anaesthetic implications on coagulation and drug metabolism. Major sequelae of liver disease are discussed, including portal hypertension, varices, and hepatorenal syndrome. The preoperative investigation and optimization, treatment, and anaesthetic management of the patient with liver failure are described. The investigation and management of post-operative liver dysfunction are described. The anaesthetic management of acute oesophageal variceal haemorrhage and transjugular intrahepatic portosystemic shunt (TIPSS) are described.

scholarly journals Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030038 ◽  
Author(s):  
Sizhe Wan ◽  
Chenkai Huang ◽  
Xuan Zhu
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Observational Study ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Clinical Effects ◽  
Variceal Haemorrhage ◽  
Randomised Controlled

BackgroundStatins may improve outcomes in patients with cirrhosis. We performed a systematic review and meta-analysis to evaluate the effect of statins on patients with cirrhosis and related complications, especially portal hypertension and variceal haemorrhage.MethodsStudies were searched in the PubMed, Embase and Cochrane library databases up to February 2019. The outcomes of interest were associations between statin use and improvement in portal hypertension (reduction >20% of baseline or <12 mm Hg) and the risk of variceal haemorrhage. The relative risk (RR) with a 95% CI was pooled and calculated using a random effects model. Subgroup analyses were performed based on the characteristics of the studies.ResultsEight studies (seven randomised controlled trials (RCTs) and one observational study) with 3195 patients were included. The pooled RR for reduction in portal hypertension was 1.91 (95% CI, 1.04 to 3.52; I2=63%) in six RCTs. On subgroup analysis of studies that used statin for 1 month, the RR was 2.01 (95% CI, 1.31 to 3.10; I2=0%); the pooled RR for studies that used statins for 3 months was 3.76 (95% CI, 0.36 to 39.77; I2=75%); the pooled RR for studies that used non-selective beta-blockers in the control group was 1.42 (95% CI, 0.82 to 2.45; I2=64%); the pooled RR for studies that used a drug that was not reported in the control group was 4.21 (95% CI, 1.52 to 11.70; I2=0%); the pooled RR for studies that used simvastatin was 2.20 (95% CI, 0.92 to 5.29; I2=69%); RR for study using atorvastatin was 1.82 (95% CI, 1.00 to 3.30). For the risk of a variceal haemorrhage, the RR based on an observational study was 0.47 (95% CI, 0.23 to 0.94); in two RCTs, the pooled RR was 0.88 (95% CI, 0.52 to 1.50; I2=0%). Overall, the summed RR was 0.64 (95% CI, 0.42 to 0.99; I2=6%).ConclusionStatins may improve hypertension and decrease the risk of variceal haemorrhage according to our assessment. However, further and larger RCTs are needed to confirm this conclusion.

scholarly journals Pregnancy with extrahepatic portal venous hypertension

2021 ◽  
Vol 10 (5) ◽  
pp. 2085
Author(s):  
Shilpa Nabapure ◽  
Sapna I. S. ◽  
Balumuri Pooja Sai
Keyword(s):  
Portal Hypertension ◽  
Fetal Outcome ◽  
Venous Hypertension ◽  
Variceal Haemorrhage ◽  
Hemodynamic Changes ◽  
Hepatic Decompensation ◽  
Hypertension Portal ◽  
Life Threatening ◽  
Portal Venous Hypertension ◽  
Increasing Risk

We are reporting a case of pregnancy with extrahepatic portal venous hypertension. Portal hypertension in pregnancy is an uncommon event. It presents a challenge to the obstetrician in management as physiological hemodynamic changes associated with pregnancy worsen with portal hypertension. Thus, increasing risk of life threatening complications like variceal haemorrhage and hepatic decompensation to many folds during pregnancy. Management requires knowledge of effects of portal hypertension on maternal and fetal outcome and vice-versa.

scholarly journals Variceal pressure is a strong predictor of variceal haemorrhage in patients with cirrhosis as well as in patients with non-cirrhotic portal hypertension

Gut ◽  
1999 ◽  
Vol 45 (4) ◽  
pp. 618-621 ◽  
Author(s):  
E A El Atti ◽  
F Nevens ◽  
K Bogaerts ◽  
G Verbeke ◽  
J Fevery
Keyword(s):  
Portal Hypertension ◽  
Strong Predictor ◽  
Variceal Haemorrhage

scholarly journals Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience

2021 ◽  
Vol 10 (4) ◽  
pp. 785
Author(s):  
Sarah-Louise Gillespie ◽  
Norma C. McAvoy ◽  
Diana E. Yung ◽  
Alexander Robertson ◽  
John N. Plevris ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Tertiary Care ◽  
Gastric Varices ◽  
Oesophageal Varices ◽  
Thrombin Injection ◽  
Variceal Haemorrhage ◽  
Tertiary Care Centre ◽  
Endoscopic Injection ◽  
Ectopic Varices ◽  
Significant Difference

Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre. This was a retrospective observational study. Patients with portal hypertension who received endoscopic injection of recombinant thrombin were identified and data collected on haemostasis and rebleeding rates, complications and mortality. Patients were grouped by indication for thrombin injection: gastric/oesophageal/ectopic varices and endoscopic band ligation (EBL)-induced ulceration. 155 patients (96M/59F, mean age 58.3 years) received endoscopic thrombin injection. Mean volume of thrombin injected at index endoscopy was 9.5 ml/2375IU. Initial haemostasis was achieved in 144 patients (92.9%). Rebleeding occurred in a total of 53 patients (36.8%) divided as follows: early rebleeding (<5 days from index endoscopy)—26 patients (18%); rebleeding within 30 days—42 patients (29.1%); delayed rebleeding (> 30 days)—11 patients (7.6%). There was statistically significant difference in rate of initial haemostasis between Child-Pugh A/B patients vs Child-Pugh C (p = 0.046). There was no significant difference in rebleeding rates between different indication groups (p = 0.78), by presence of cirrhosis or by Child-Pugh Score. All-cause mortality at 6 weeks was 18.7%; 1-year mortality 37.4% (median follow-up 48 months). There was no significant difference in mortality between groups (p = 0.37). No significant adverse events or complications were reported. Thrombin is effective and safe for gastric varices and other portal-hypertension-related bleeding including oesophageal varices, ulcers secondary to EBL and ectopic varices.

Beyond autism: Challenging unexamined assumptions about social motivation in typical development

2019 ◽  
Vol 42 ◽  
Author(s):  
Karen Bartsch ◽  
David Estes
Keyword(s):  
Social Interest ◽  
Social Motivation ◽  
Typical Development ◽  
Typically Developing ◽  
New Approaches

Abstract In challenging the assumption of autistic social uninterest, Jaswal & Akhtar have opened the door to scrutinizing similar unexamined assumptions embedded in other literatures, such as those on children's typically developing behaviors regarding others’ minds and morals. Extending skeptical analysis to other areas may reveal new approaches for evaluating competing claims regarding social interest in autistic individuals.

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