scholarly journals Nodular Regenerative Hyperplasia

2017 ◽  
Vol 5 (1) ◽  
pp. 232470961769074
Author(s):  
Mindy Lee ◽  
Manhal Izzy ◽  
Ashwin Akki ◽  
Kathryn Tanaka ◽  
Harmit Kalia
Keyword(s):  
Portal Hypertension ◽  
Pneumocystis Carinii ◽  
Undetectable Viral Load ◽  
Gastric Varices ◽  
Nodular Regenerative Hyperplasia ◽  
Noncirrhotic Portal Hypertension ◽  
First Case ◽  
Bleeding Prophylaxis ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of

Introduction: Nodular regenerative hyperplasia (NRH) is a known etiology of noncirrhotic portal hypertension. Cases of biopsy-proven NRH in human immunodeficiency virus (HIV)–positive patients have been described. While these patients often have normal synthetic liver function, several reports described disease progression to liver failure. Case: We here present a 26-year-old woman with history of congenital HIV on antiretroviral therapy complicated by Pneumocystis carinii pneumonia at age 14. CD4 counts have been >300 with undetectable viral load. She was referred to our Hepatology service for evaluation of splenomegaly, elevated liver tests, and thrombocytopenia. On initial presentation, she reported easy bruising and gingival bleeding, and abdominal imaging showed evidence of portal hypertension without associated cirrhosis. Upper endoscopy was significant for large esophageal varices without bleeding stigmata. Liver biopsy showed minimal fibrosis around the portal areas without significant inflammation. The lobules showed focal zones of thin hepatocyte plates on reticulin stain with adjacent areas showing mild regenerative changes. The diagnosis of NRH was made and patient was placed on propranolol for variceal bleeding prophylaxis. Two years later, the patient presented with bleeding gastric varices warranting transjugular intrahepatic portosystemic shunt. Postprocedure course was complicated by mild encephalopathy. Subsequent magnetic resonance imaging showed a 1.7 × 1.3 cm lesion suggestive of hepatocellular carcinoma (HCC). The patient was deemed to be a candidate for liver transplantation, and she is now delisted due to ongoing pregnancy. Conclusion: This report describes the first case of HCC in an HIV patient with NRH. The possible association of NRH with HCC warrants further investigation.

scholarly journals Noncirrhotic Portal Hypertension due to Nodular Regenerative Hyperplasia Treated with Surgical Portacaval Shunt

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Lisa M. Louwers ◽  
Jared Bortman ◽  
Alan Koffron ◽  
Veslav Stecevic ◽  
Steven Cohn ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Lupus Erythematosus ◽  
Beta Blockers ◽  
Portacaval Shunt ◽  
Nodular Regenerative Hyperplasia ◽  
Noncirrhotic Portal Hypertension ◽  
Parenchymal Liver ◽  
Abdominal Mri ◽  
Synthetic Function ◽  
History Of

Nodular regenerative hyperplasia (NRH) is an uncommon condition, but an important cause of noncirrhotic intrahepatic portal hypertension (NCIPH), characterized by micronodules of regenerative hepatocytes throughout the liver without intervening fibrous septae. Herein, we present a case of a thirty-seven-year-old female with systemic lupus erythematosus (SLE) who was discovered to have significant esophageal varices on endoscopy for dyspepsia. Her labs revealed a slight elevation in the alkaline phosphatase and mild thrombocytopenia. Abdominal MRI revealed seven focal hepatic masses, splenomegaly, no ascites, and a patent portal vein. Ultrasound-guided core biopsy was reported as focal nodular hyperplasia. However, her varices persisted despite treatment with beta-blockers and four additional upper endoscopies with banding. She was subsequently referred for a surgical opinion. At that time, given her history of SLE, azathioprine use, and portal hypertension, suspicion for NRH was raised. Given her normal synthetic function and lack of parenchymal liver disease, the patient was offered surgical shunting. During shunt surgery, a liver wedge biopsy was also performed and this confirmed NRH. An upper endoscopy six weeks after shunting verified complete resolution of varices. Currently, fifteen months after surgery duplex ultrasonography demonstrates shunt patency and the patient is without recurrence of her portal hypertension.

scholarly journals First case report of acute cholangitis secondary to Cronobacter sakazakii

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Syeda Sahra ◽  
Abdullah Jahangir ◽  
Neville Mobarakai ◽  
Allison Glaser ◽  
Ahmad Jahangir ◽  
...  
Keyword(s):  
Acute Cholangitis ◽  
Tube Placement ◽  
Cronobacter Sakazakii ◽  
First Case ◽  
Shunt Procedure ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of ◽  
Cholecystostomy Tube ◽  
Percutaneous Cholecystostomy Tube ◽  
First Time

Abstract Introduction Cronobacter sakazakii is an opportunistic Gram-negative, rod-shaped bacterium which may be a causative agent of meningitis in premature infants and enterocolitis and bacteremia in neonates and adults. While there have been multiple cases of C. sakazakii infections, there have been no acute cholangitis cases reported in humans. Case presentation An 81-year-old male with a past medical history of basal cell carcinoma, alcoholic liver cirrhosis, transjugular intrahepatic portosystemic shunt procedure, complicated by staphylococcus bacteremia, pituitary tumor, glaucoma, and hypothyroidism presented to the emergency room with the complaint of diffuse and generalized 10/10 abdominal pain of 1 day’s duration. There was a concern for pancreatitis, acute cholangitis, and possible cholecystitis, and the patient underwent a percutaneous cholecystostomy tube placement. Blood cultures from admission and biliary fluid cultures both grew C. sakazakii. The patient was treated with a carbapenem and clinically improved. Conclusions The case study described a patient with multiple medical comorbidities that presented with C. sakazakii bacteremia and cholangitis. While this bacterium has been implicated in other infections, we believe this is the first time the bacteria is being documented to have caused acute cholangitis.

scholarly journals Beyond the scope and the glue: update on evaluation and management of gastric varices

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cyriac Abby Philips ◽  
Rizwan Ahamed ◽  
Sasidharan Rajesh ◽  
Tom George ◽  
Meera Mohanan ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Endovascular Procedures ◽  
Gastric Varices ◽  
Current Evidence ◽  
Ultrasound Guided ◽  
Algorithmic Approach ◽  
Evidence Based Treatments ◽  
Intrahepatic Portosystemic Shunt ◽  
Shed Light

Abstract Gastric varices are encountered less frequently than esophageal varices. Nonetheless, gastric variceal bleeding is more severe and associated with worse outcomes. Conventionally, gastric varices have been described based on the location and extent and endoscopic treatments offered based on these descriptions. With improved understanding of portal hypertension and the dynamic physiology of collateral circulation, gastric variceal classification has been refined to include inflow and outflow based hemodynamic pathways. These have led to an improvement in the management of gastric variceal disease through newer modalities of treatment such as endoscopic ultrasound-guided glue-coiling combination therapy and the emergence of highly effective endovascular treatments such as shunt and variceal complex embolization with or without transjugular intrahepatic portosystemic shunt (TIPS) placement in patients who are deemed ‘difficult’ to manage the traditional way. Furthermore, the decisions regarding TIPS and additional endovascular procedures in patients with gastric variceal bleeding have changed after the emergence of ‘portal hypertension theories’ of proximity, throughput, and recruitment. The hemodynamic classification, grounded on novel theories and its cognizance, can help in identifying patients at baseline, in whom conventional treatment could fail. In this exhaustive review, we discuss the conventional and hemodynamic diagnosis of gastric varices concerning new classifications; explore and illustrate new ‘portal hypertension theories’ of gastric variceal disease and corresponding management and shed light on current evidence-based treatments through a ‘new’ algorithmic approach, established on hemodynamic physiology of gastric varices.

scholarly journals Noncirrhotic portal hypertension and nodular regenerative hyperplasia of the liver in dogs with mucopolysaccharidosis type I

Hepatology ◽  
1998 ◽  
Vol 28 (2) ◽  
pp. 385-390 ◽  
Author(s):  
Michael F. McEntee ◽  
Kathy N. Wright ◽  
Ian Wanless ◽  
Robert DeNovo ◽  
John F. Schneider ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Nodular Regenerative Hyperplasia ◽  
Type I ◽  
Mucopolysaccharidosis Type ◽  
Mucopolysaccharidosis Type I ◽  
Noncirrhotic Portal Hypertension

Combined endoscopic intervention (ligation+sclerotherapy) compared with TIPS for prevention of bleeding from gastro-esophageal varices in patients with liver cirrhosis

2016 ◽  
Vol 5 (1) ◽  
pp. 124
Author(s):  
Utkirbek Matkuliev
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Varicose Veins ◽  
Portal System ◽  
Endoscopic Intervention ◽  
Portosystemic Shunts ◽  
System Pressure ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of ◽  
The Mean

Background: Liver cirrhosis (LC) and portal hypertension (PH) is one of the most serious problems of modern surgical hepatology. The most common complication of liver cirrhosis is bleeding from varicose veins of esophagus and stomach. Today experts have several ways to prevent rebleeding from varices: pharmacotherapy, endoscopic intervention, transjugular intrahepatic portosystemic shunt (TIPS), a surgical portocaval bypass. Purpose of this study was to compare effectiveness of transjugular intrahepatic portosystemic shunts (TIPS) and combined endoscopic therapy the management of bleeding in cirrhotic patients.Methods: We observed 96 consecutive patients with portal hypertension who were treated in 2nd clinic of Tashkent Medical Academy (2014-2015). Bleeding was in history of 17 (17.7%) patients. The duration of the bleeding averaged 9.7±4.3 hours. Ascites was observed in 54.5 % of patients. Patients were divided two major groups. First group included 72 patients who was performed endoscopic intervention. Second group consisted of 24 patients who underwent TIPS in emergency cases.Results: Seventy-two patients were assigned to variceal ligation and Sclerotherapy, other 24 patients to TIPS. In the ligation combined Sclerotherapy group, a second treatment was performed 8–10 days after the initial endoscopy. Deterioration of portal gastropathy was observed in 9 (9.4%) cases after EL and 24 (25.0%) after ES (p <0.05). The mean portal system pressure prior to TIPS placement was 53.67±4.21 mm Hg, which decreased to 25.10±4.06 mmHg after the first shunt tract was established (P <0.001). The mean portal system pressure prior to the second TIPS was 43.68±3.98 mm Hg and decreased to 25.14±4.67 mm Hg after the procedures (P <0.001).Conclusions: TIPS can become dysfunctional if stenosis develops in the shunt or the hepatic vein above the shunt. Screening allows detection of stenosis before portal hypertensive–related complications recur. Revision of stenotic shunts can be easily accomplished in most cases. Techniques for screening and revision will be discussed. This is one of the most effective methods to control patients with liver cirrhosis.

Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients

Hepatology ◽  
1992 ◽  
Vol 16 (6) ◽  
pp. 1343-1349 ◽  
Author(s):  
Shiv K. Sarin ◽  
Deepak Lahoti ◽  
Sanjay P. Saxena ◽  
Nandguri S. Murthy ◽  
Uday K. Makwana
Keyword(s):  
Portal Hypertension ◽  
Natural History ◽  
Gastric Varices ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
History Of

scholarly journals Portal Hypertension, Nodular Regenerative Hyperplasia of the Liver, and Obstructive Portal Venopathy due to Metastatic Breast Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Andrew T. Turk ◽  
Matthias J. Szabolcs ◽  
Jay H. Lefkowitch
Keyword(s):  
Breast Cancer ◽  
Portal Hypertension ◽  
Breast Carcinoma ◽  
Portal Vein ◽  
Metastatic Breast ◽  
Nodular Regenerative Hyperplasia ◽  
Metastatic Breast Carcinoma ◽  
Noncirrhotic Portal Hypertension ◽  
Diagnostic Difficulties ◽  
Recurrent Breast

Nodular regenerative hyperplasia (NRH) of the liver is associated with noncirrhotic portal hypertension, rheumatologic and hematologic disorders, administration of certain drugs, and other underlying conditions. This report describes a 64-year-old man with clinically presumed cirrhosis who presented to our institution with coffee-ground emesis, esophageal varices, ascites, and encephalopathy. Eleven years earlier he had been treated for breast cancer with mastectomy and chemo-radiotherapy. He died suddenly, and the autopsy showed no evidence of cirrhosis but instead demonstrated NRH with extensive emboli of recurrent breast carcinoma within the portal vein and its intrahepatic branches. Neoplastic occlusion of the portal vein as a cause of presinusoidal noncirrhotic portal hypertension has not previously been reported for metastatic breast carcinoma. This case highlights the importance of obstructive portal venopathy in the pathogenesis of NRH as well as the diagnostic difficulties that may be encountered in determining the cause of portal hypertension.

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