scholarly journals Evaluation of patients with schistosomal portal hypertension treated in a tertiary hospital

2009 ◽  
Vol 22 (4) ◽  
pp. 212-215
Author(s):  
Fábio Ferrari Makdissi ◽  
Paulo Herman ◽  
Renata Potonyacz Colaneri ◽  
Barbara dos Santos Nunes ◽  
Vincenzo Pugliese ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Clinical Signs ◽  
Hemodynamic Instability ◽  
Tertiary Hospital ◽  
Public Health Issue ◽  
High Morbidity ◽  
Variceal Hemorrhage ◽  
Hemorrhagic Event ◽  
History Of

BACKGROUND: Schistosomiasis is an important public health issue in more than 70 countries around the world. About 600 million people are at risk to acquire the parasite and there are 200 million infected worldwide. AIM: To evaluate the characteristics of schistosomal portal hypertension individuals who underwent previous esophageal varices bleeding treated in a tertiary hospital. METHODS: The records of 155 patients were evaluated and clinical, laboratorial, endoscopic, epidemiological features and hemorrhagic event severity were analyzed to individualize this population. RESULTS: Mean age was 37.2 years and no clinical signs of hepatic failure were observed. Serum laboratory tests to evaluate liver function were normal or slightly alter. Anemia was present in 70 %, leucopenia in 75 % and thrombocytopenia in 86 % of the patients. At endoscopic evaluation varices were classified as grade III and IV in 91.3 %; red spots were observed in 40.3 % and congestive gastropathy in 13.6 %. Patients presented a mean of 2.8 previous episodes of variceal hemorrhage and, in 75 % with hemodynamic instability. CONCLUSIONS: Patients with schistosomal portal hypertension and history of upper digestive bleeding from esophageal varices are young individuals, without either clinical or laboratorial evidence of liver dysfunction, that present high morbidity due to the severity of the acute event of bleeding.

Portal Hypertension and Variceal Hemorrhage

2015 ◽  
Author(s):  
Amir Qamar
Keyword(s):  
Portal Hypertension ◽  
Natural History ◽  
Esophageal Varices ◽  
Variceal Hemorrhage ◽  
Portal Hypertensive Gastropathy ◽  
Gastric Antral Vascular Ectasia ◽  
Esophageal Variceal ◽  
Gastroesophageal Varices ◽  
Vascular Ectasia ◽  
History Of

Gastrointestinal bleeding in patients with cirrhosis can occur from a number of different causes, including portal hypertension, gastric antral vascular ectasia, and acute variceal hemorrhage. The management of these conditions involves a combined medical and endoscopic approach, with radiologic and surgical therapies restricted to refractory cases. This review covers the natural history of gastroesophageal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia; diagnostic principles; primary and secondary prophylaxis relating to esophageal variceal hemorrhage; and treatment overviews for gastric variceal hemorrhage, portal hypertensive gastropathy, and gastric antral vascular ectasia. Figures show the pathophysiology of complications of cirrhosis, esophageal varices as seen during an upper endoscopic procedure, natural history of esophageal varices in patients with cirrhosis, portal hypertensive gastropathy, gastric antral vascular ectasia, and management principles for acute variceal hemorrhage, esophageal variceal ligation, and gastric varices. Tables list the prevalence of various etiologies of hemorrhage in patients with cirrhosis, current recommendations for follow-up screening and surveillance of varices, sensitivities and specificities of some noninvasive markers, and principles of initial management of acute variceal hemorrhage. This review contains 8 highly rendered figures, 4 tables, and 44 references.

scholarly journals Right Cerebellar Tuberculosis with Cranial Nerve Palsy in Pulmonary Tuberculosis Patient

2021 ◽  
Vol 7 (2) ◽  
pp. 65
Author(s):  
I Komang Rusgi Yandi ◽  
Isnin Anang Marhana
Keyword(s):  
Young Adult ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Tuberculosis Patient ◽  
Public Health Issue ◽  
High Morbidity ◽  
Radiological Findings ◽  
Blurred Vision ◽  
History Of

Introduction: Tuberculosis (TB) is a major public health issue. The most devastating clinical manifestations of TB is Central nervous system (CNS) TB. CNS TB is found approximately in 1% of all patients with active TB, and cerebellar TB is rarely reported. CNS TB can present as meningitis, arachnoiditis, tuberculomas, or the uncommon forms of tuberculous subdural empyema and brain abscess.Case: A 23-year-old patient was reported in October 2018 with signs and symptoms of 2-month history of vertigo, headache, vomiting, weakness, fever, blurred vision, lingual palsy, dysmetria, and decrease of consciousness. The patient had a few months of history of cough, contact with a TB patient, his father, and loss of body weight. On admission, the patient had fever (38.50 C) and Glasgow coma score of 13.Discussion:  CNS TB can occur in an immunocompromised patient with malnutrition, whether a child or young adult. The patient in this case had risk factors because he is a young adult and had contact with a patient of TB, his father. Based on epidemiology, clinical signs and symptoms, radiological findings, and the result of AFB-stained sputum, the patient was diagnosed with right cerebellar TB and PTB.Conclusion: The high morbidity and mortality characteristics of CNS TB are very important to note, thus the prompt diagnosis and therapy should be done. The specific therapy of ATD combined with surgery seems to provide a good result. The clinical and radiological findings were used as the evaluation of the medication.

scholarly journals Rupture of esophageal varices due to portal hypertension

2010 ◽  
Vol 50 (5) ◽  
pp. 316
Author(s):  
Yusri Dianne Jurnalis ◽  
Yorva Sayoeti ◽  
Marlinda Marlinda
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Common Cause ◽  
Initial Episode ◽  
One Year ◽  
The One ◽  
Upper Gastrointestinal ◽  
Emergent Case

Variceal bleeding is the most common cause of serious upper gastrointestinal (UGI) bleeding in children. Most variceal bleeding is esophageal.1 Hemorrhages from esophageal varices due to portal hypertension are a major cause of morbidity and mortality. There is a 30% mortality rate following an initial episode of variceal hematemesis. Mortality increases to 70% with recurrent variceal hemorrhage. Moreover, the one year survival rate after variceal hemorrhage is often poor (32 to 80%).2-4 We report a case of esophageal varices rupture caused by portal hypertension, an emergent case in the Pediatric Gastrohepatology division.

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

scholarly journals Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

2021 ◽  
Vol 10 (8) ◽  
pp. e10810817005
Author(s):  
Gustavo Vargas Borgongino Monteiro ◽  
Marcela Chagas Lima Mussi ◽  
Mateus Jorge Nardelli ◽  
Bruno Campos Santos ◽  
Cláudia Alves Couto
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Ductal Carcinoma ◽  
Rare Complication ◽  
Nodular Regenerative Hyperplasia ◽  
Trastuzumab Emtansine ◽  
Her2 Breast Cancer ◽  
History Of ◽  
The Right

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.

scholarly journals Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis

2004 ◽  
Vol 59 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Roberto de Cleva ◽  
William Abrão Saad ◽  
Paulo Herman ◽  
Vincenzo Pugliese ◽  
Bruno Zilberstein ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Portal Pressure ◽  
Previous History ◽  
Portal Flow ◽  
Portal Hemodynamics ◽  
Significant Drop ◽  
Hemodynamic Assessment ◽  
History Of ◽  
Hepatosplenic Schistosomiasis

PURPOSE: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension. METHODS: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final). RESULTS: The initial portal pressure was elevated (mean 28.5 ± 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 ± 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 ± 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 ± 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed. CONCLUSIONS: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.

scholarly journals Endoscopic Band Ligation in Patients with Variceal Bleeding

2018 ◽  
Vol 3 (1) ◽  
pp. 320-324
Author(s):  
Narayan Prasad Belbase ◽  
Aditya Jalan ◽  
Hari Prasad Upadhya ◽  
Rohit Mishra ◽  
Mukesh Karki ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Esophageal Varices ◽  
Alcoholic Cirrhosis ◽  
Oesophageal Varices ◽  
Common Cause ◽  
Band Ligation ◽  
Male Predominance ◽  
History Of ◽  
Cirrhosis Mortality

Introduction: Esophageal varices (EV) affect about 50% of patients with liver cirrhosis. Mortality rate from the initial EV bleeding can rise up to 30% in patients with advanced liver disease and large varices. Several RCTs have shown endoscopic variceal banding to be more effective than sclerotherapy for the long-term prevention of variceal bleeding.Objective: This study was conducted to see the outcome of endoscopic banding in the management of esophageal varices in Nepalese population.Methodology: This was a prospective observational study conducted in the Department of Surgical Gastroenterology, College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur, Nepal over a period of 2 years. Patients attending the COMS emergency/surgical OPD with history of UGI bleed with features consistent with portal hypertension during this period were enrolled. The endoscopic variceal band ligation was done based on similar principles applied to Barren and ligation in the treatment of internal haemorrhoids.Results During this period of two years 50 patients were analysed. The mean age of the study subjects was 52.26+/-12.80 years and male predominance was seen (M:F=42:8). Alcoholic chronic liver disease (CLD) (74%) was the most common cause of portal hypertension. Child's B score was seen among 54%, grade III varices were seen in 36% and grade II in 32%. Acute bleeding of varices was present in nine (18%) cases. On an average 3.8 sessions were required to obliterate the varices. Control of acute bleed and variceal eradication was seen in 77.78% cases and in 96% cases respectively. Complications following banding were seen in 20% cases. Mortality was seen in two (4%) cases.Conclusions: Alcoholic cirrhosis was the most common cause of portal hypertension and endoscopic banding of oesophageal varices in Nepalese population had comparable eradications, complications and recurrences with similar other studies conducted in other parts of the world. BJHS 2018;3(1)5 : 320-324

scholarly journals Mucormycosis Infections during the Second Wave of COVID-19: Experience from a Tertiary Care Centre in India

2021 ◽  
Vol 28 (4) ◽  
pp. 425-431
Author(s):  
Sudhir BHANDARI ◽  
◽  
Shivankan KAKKAR ◽  
Amitabh DUBE ◽  
Mohnish GROVER ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
High Morbidity ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Invasive Fungal Diseases ◽  
Co Morbidity ◽  
History Of ◽  
Second Wave

Background: Mucormycosis is an uncommon fungal infection with high morbidity and mortality. There had been a sudden surge in the cases of mucormycosis during the second wave of Coronavirus Disease 2019 (COVID-19) in India. Objective: The etiology, pathophysiology, and correlations of mucormycosis at tertiary hospital in India is explored in the present study. Methods: In this retrospective observational study, all coronavirus disease associated mucormycosis (CAM) cases admitted at this center between April 2021 to June 2021 were included. The cases were evaluated in terms of their background, most common presentations, chief underlying etiologies, severity of disease, comorbidities, investigation profiles, prognosis, and treatment provided. Results: Among the total 231 cases reported with mucormycosis, age group of 40 - 50 years (28%) was the most afflicted and the 20 30 year was the least. Men (68%) were more afflicted than Women. 66% patients had a history of vaccination against COVID-19. 63% patients presented with a High-Resolution Computerized Tomography (HRCT) score of 9-16. 60% required oxygen support and 71% required steroids. Diabetes mellitus was the most prevalent comorbidity. Conclusion: The salience of the second inferno wave of COVID-19 was witness to COVID-19 patients who had pre existing diabetes mellitus. Individuals with diabetes in general foster more extreme COVID-19 infections and end up using corticosteroids. In any case, the corticosteroids – alongside diabetes – increment the danger of getting mucormycosis. The specific pathophysiology of COVID-19 may represent co-morbidity with Invasive Fungal diseases (IFI).

Sign in / Sign up

Export Citation Format

Share Document