scholarly journals Transjugular intrahepatic portosystemic shunting in combined treatment of a patient with decompensated liver cirrhosis and malignant neoplasm of the uterus (clinical case)

2020 ◽  
Vol 39 (3) ◽  
pp. 91-95
Author(s):  
Sergey A. Alentyev ◽  
Igor E. Onnicev ◽  
Igor Berlev ◽  
Anton L. Muzharovskiy
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Surgical Treatment ◽  
Clinical Case ◽  
Decompensated Cirrhosis ◽  
Malignant Neoplasms ◽  
Recurrent Bleeding ◽  
Decompensated Liver Cirrhosis ◽  
Transjugular Intrahepatic Portosystemic Shunting ◽  
Portosystemic Shunting

Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).

scholarly journals Splenomegaly and thrombocytopenia in patients with liver cirrhosis

2010 ◽  
Vol 67 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Jelena Djordjevic ◽  
Petar Svorcan ◽  
Dusica Vrinic ◽  
Branka Dapcevic
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Hepatic Dysfunction ◽  
Spleen Size ◽  
Hepatitis Viruses ◽  
Decompensated Liver Cirrhosis ◽  
Splenic Sequestration ◽  
Frequent Finding

Backgroud/Aim. Splenomegaly is a frequent finding in patients with liver cirrhosis and portal hypertension and may cause hypersplenism. The occurrence of thrombocytopenia in those patients can be considered as an event with multiple etiologies. Two mechanisms may act alone or synergistically with splenic sequestration. One is central which involves either myelosuppression because of hepatitis viruses or the toxic effects of alcohol abuse on the bone marrow. The second one involves the presence of antibodies against platelets. It also depends upon the stage and etiology of liver disease. The aim of the study was to investigate a correlation between the platelet count and spleen size and the risk factors for thrombocytopenia in patients with liver cirrhosis. Methods. We studied 40 patients with decompensated liver cirrhosis who were hospitalized in the Department of Gastroenterohepatology. The liver function was graded according to Child Pugh score. Spleen size was defined ultrasonografically on the basis of craniocaudal length. Suspicion of portal hypertension was present when longitudinal spleen length was more than 11 cm. Thrombocytopenia was determined by platelet count under 150 000/mL. Results. We did not find any significant correlation between hepatic dysfunction and spleen size (p = 0.9), and between hepatic dysfunction and thrombocytopenia (p = 0.17). Our study did not find any significant correlation between spleen size and peripheral platelet count (p = 0.5), but we found a significant correlation between thrombocytopenia and etiology of cirrhosis - decreased platelet count was more common among patients with cirrhosis of alcoholic etiology than in other etiologies of cirrhosis (p = 0.001). Conclusion. According to our study, liver cirrhosis, portal hypertension and thrombocytopenia could be present even in the absence of enlarged spleen suggesting the involvement of other mechanisms of decreasing platelet account.

scholarly journals Budd-Chiari Syndrome in a Patient with Hepatitis C

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Joseph Frankl ◽  
Charles Hennemeyer ◽  
Michael S. Flores ◽  
Archita P. Desai
Keyword(s):  
Portal Hypertension ◽  
Hepatitis C ◽  
Signs And Symptoms ◽  
Venous Occlusion ◽  
Decompensated Cirrhosis ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Portosystemic Shunting ◽  
Chiari Syndrome

Chronic Budd-Chiari syndrome can present with cirrhosis and signs and symptoms similar to those of other chronic liver diseases. We present a case of Budd-Chiari syndrome discovered during attempted transjugular intrahepatic portosystemic shunting in a patient with decompensated cirrhosis believed to be secondary to hepatitis C. Although the patient had hepatocellular carcinoma, the Budd-Chiari syndrome was a primary disease due to hepatic venous webs. Angioplasty was performed in this case, which resolved the patient’s symptoms related to portal hypertension. Follow-up venography 5 months after angioplasty demonstrated continued patency of the hepatic veins. A biopsy was obtained in the same setting, which showed centrilobular fibrosis indicating that venous occlusion was indeed the cause of cirrhosis. It is important to consider a second disease when treating a patient with difficult to manage portal hypertension.

scholarly journals Treatment and prevention of bleeding from varicose veins of the esophagus

2021 ◽  
Vol 1 (215) ◽  
pp. 80-83
Author(s):  
Eduard Mogilevets ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
High Efficiency ◽  
Varicose Veins ◽  
Mortality Rates ◽  
Long Term Results ◽  
Recurrent Bleeding ◽  
Chronic Liver Diseases ◽  
Treatment And Prevention

Liver cirrhosis is the result of various chronic liver diseases. Portal hypertension is a serious complication of cirrhosis. Its consequences, in turn, along with other complications are gastroesophageal varicose bleeding, which cause high mortality rates. The article contains analysis of the results of laparoscopic esophagogastric devascularization without esophageal transsection and splenectomy in a patient with liver cirrhosis portal hypertension and recurrent bleeding from varicose veins of the esophagus. First successful surgery according to this method was introduced in the Grodno Municipal Clinical Hospital No. 4 in November 2011. Immediate and long-term results show a rather high efficiency of using this operation in the treatment and prevention of bleeding from varicose veins of the esophagus with cirrhosis. It is advisable to conduct further studies of the effectiveness of using this operation, despite the encouraging results of the use of this modification of laparoscopic esophagogastric devascularization.

scholarly journals Granulocyte Colony-stimulating Factor as Bridging Therapy for Pediatric Decompensated Liver Cirrhosis Prior to Liver Transplantation: an Open-label Randomised Controlled Trial

2021 ◽  
Author(s):  
Tri Hening Rahayatri ◽  
Aria Kekalih ◽  
Alida Harahap ◽  
Aryono Hendarto ◽  
Hanifah Oswari ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Side Effects ◽  
Nutritional Status ◽  
Controlled Trial ◽  
Intervention Group ◽  
Decompensated Cirrhosis ◽  
Open Label ◽  
Decompensated Liver Cirrhosis ◽  
Interventional Group

Abstract Decompensated cirrhosis in children is a leading indication of liver transplantation (LT). Granulocyte-colony stimulating factor (G-CSF) therapy has shown promising results in adult decompensated cirrhosis. Our study aimed to investigate the effect of G-CSF on liver function, Pediatric End-stage liver disease (PELD) score, CD34+ cells mobilization, nutritional status, short-term side effects, and survival in children indicated for liver transplantation (LT).We performed an open-label, randomized controlled trial with decompensated liver cirrhosis between 3 months to 12 years old. The intervention group received a subcutaneous injection of G-CSF (5 μg/kg/day) for twelve courses in addition to standard medical treatment (SMT) for liver cirrhosis. We measured liver function, PELD scores, CD34+ cell mobilization, the change of leucocyte and neutrophil count, nutritional status, side effects, and survival within three months. Thirty-five pediatric patients were randomized into 17 interventional groups and 18 control groups. During the trial, 14 (82%) of the interventional group completed the intervention course. The median age was 18 months in the interventional group and 14.5 months in the control group. The alanine aminotransferase (ALT) level showed significant improvement in the intervention group, while other liver parameters, PELD score, nutritional status, and survival, did not. CD34+ cells mobilization rose in the interventional group but was statistically insignificant. Minor side effects of G-CSF were found in the intervention group.Multiple doses of G-CSF significantly improve ALT but did not improve PELD score, nutritional status, and survival in three months.

Clinical case of chronic portal vein thrombosis

2020 ◽  
pp. 27-41
Author(s):  
L. Zaklyakova ◽  
B. Levitan ◽  
M. Bolgova ◽  
V. Skvortsov ◽  
I. Zaklyakov
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Oral Anticoagulant ◽  
Clinical Case ◽  
Standard Treatment ◽  
Decompensated Cirrhosis ◽  
Mechanical Trauma ◽  
Vein Thrombosis

Portal vein thrombosis (PVT) is a form of venous thrombosis that causes impaired or terminated blood flow in the portal vein. PVT is the main reason for the development of extrahepatic portal hypertension. The article presents a clinical case of chronic PVT with signs of severe portal hypertension and ascites. A feature of the case is that in a patient with suspected decompensated cirrhosis of the liver with the ineffectiveness of standard treatment, PVT was detected. The cause of PVT was mechanical trauma of the portal vein and hemocoagulation thrombophilia. For health reasons, the patient was prescribed rivaroxaban. Rivaroxaban is an oral anticoagulant from the group of Xa inhibitors. Against the background of treatment, recanalization of PVT was noted in the patient. Our experiment has shown that rivaroxaban is a promising drug for treatment of PVT.

scholarly journals Unsolved issues of pregnancy in liver cirrhosis

2019 ◽  
Vol 91 (4) ◽  
pp. 114-117
Author(s):  
A Iskrenov Kotzev ◽  
L Stoyanov Tanchev ◽  
Ch Savov Pavlov ◽  
S Yotov Tanchev
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Vital Signs ◽  
Abnormal Uterine Bleeding ◽  
Chronic Viral Hepatitis ◽  
Uterine Bleeding ◽  
Variceal Hemorrhage ◽  
Decompensated Liver Cirrhosis ◽  
Viral Hepatitis C ◽  
Life Threatening

Pregnancy in patients with liver cirrhosis and portal hypertension occurs very rare, because of their significantly derailed reproductive functions. Тhe risks for the mother and the fetus are connected with worsening of the portal hypertension, progression of decompensated liver cirrhosis and development of its complications: liver failure, ascites, hepatorenal syndrome, hepatic encephalopathy and variceal hemorrhage, and with increased incidence of spontaneous abortions and abnormal uterine bleeding. The decision for continuation of the pregnancy in cirrhotic patients must be based on individual approach and a multidisciplinary team consisting of obstetricians, hepatologists, anesthesiologists, surgeons and hematologists must participate in the therapy. We are presenting a clinical case with 34 years old pregnant woman with Child-Pugh class C cirrhosis and untreated chronic viral hepatitis C. The patient was admitted in emergency with abortus imminens, vaginal bleeding, anemia, thrombocytopenia and impaired hemostasis. The pregnancy was interrupted in the Department of obstetrics and gynecology due to the high risk for mother’s life. Later the patient developed severe disseminated intravascular coagulation (DIC) syndrome with life-threatening uterine bleeding. The DIC syndrome and the bleeding were resolved after therapy in intensive care unit and the patient was discharged from the hospital with stable vital signs.

scholarly journals Differential diagnostics and correction of metabolic and immunological disorders in patients with hepatic cirrhosis, complicated hepatosplenomegalia and portal hypertension

2019 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Well Being ◽  
Differential Diagnostics ◽  
Recurrent Bleeding ◽  
Group I ◽  
Group Ii

The study of the role of the spleen in the pathogenesis of liver cirrhosis is important for treatment. Currently available literature data indicate the role of altered spleen functions in the pathogenesis of liver cirrhosis. The aim of this study was to clarify the features of the etiology and pathogenetic disorders in patients with hepatosplenomegaly. Materials and methods. We investigated the uniform elements of blood and blood serum from 58 patients with hepatosplenomegaly amid cirrhosis, portal hypertension complicated. Patients were divided into two groups depending on the antigenic load: I - patients with liver cirrhosis against the background of hepatitis viruses HBV/HCV and II - patients with autoimmune hepatitis against the background of herpes viruses CMV/VEB. Treatment of patients included the use of antiherpetic immunoglobulins and hematopoietic cord blood progenitor cells. Results. In patients of group I was detected an increase in the spontaneous oxidative activity of neutrophils and depletion of the oxidative reserve in oxygen-dependent phagocytosis. It activated the signaling pathways of pro-inflammatory cytokines IL-6 (an increase of 60 times). We found an increased content of CD22+ -plasma B-lymphocyte that elevated synthesized concentrations of IgA. In patients of group II were found an increase in the activity of C3 and a decrease in the C4-components of complement; thrombocytopenia due to the presence of platelet autoantibodies; increased synthesis of immunoglobulins IgM, IgG, increased synthesis of IFN-. All patients showed disturbances in the metabolism of amino acids in various metabolic cycles - ornithine, which disrupted the formation of urea and indicates the accumulation of ammonia, which can enhance the cytotoxic effect in group I; methionine with a violation of the formation of cystine from cysteine and the accumulation of homocysteine, which enhances the synthesis of IFN-γ, which was increased in group II by 4 times. Conclusions. Some etiological and pathogenetic features of the formation of liver cirrhosis complicated by portal hypertension and recurrent bleeding from varicose veins of the esophagus were revealed. The immunological and metabolic changes verified by us correlated with the disappearance of the clinical manifestations of the disease, improved well-being, and the absence of recurrence of bleeding.

scholarly journals Efficacy and Safety of Ledispavir/Sofosbuvir with or without Ribavirin in patients with Decompensated Liver Cirrhosis and Hepatitis C Infection: a Cohort Study

2020 ◽  
Vol 29 (3) ◽  
pp. 385-390
Author(s):  
Liliana Simona Gheorghe ◽  
Carmen Preda ◽  
Laura Iliescu ◽  
Doina Istratescu ◽  
Andreea Elena Chifulescu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatitis C ◽  
Real Life ◽  
Decompensated Cirrhosis ◽  
Hcv Rna ◽  
Efficacy And Safety ◽  
Decompensated Liver Cirrhosis ◽  
Serious Adverse Events ◽  
Genotype 1B ◽  
Ctp Score

Background and Aims: Ledipasvir/Sofosbuvir (LDV/SOF) with or without Ribavirin (RBV) has shown good results in terms of efficacy and safety in clinical trials in advanced liver cirrhosis, but real-life data are still needed in order to confirm this profile. We investigated the efficacy and safety of LDV/SOF in a large Romanian population with liver cirrhosis and genotype 1b hepatitis C virus (HCV). Methods: We analyzed a multicentric retrospective cohort enrolling 349 patients with decompensated liver cirrhosis due to HCV who received LDV/SOF±RBV 12/24 weeks (301/48). Patients were included between 2017-2018, all with genotype 1b. Main inclusion criteria were liver cirrhosis and detectable HCV RNA. The cases were followed-up monthly during therapy and 12 weeks after the end of therapy. Results: The cohort included 60% females with a median age of 61, 16% interferon (IFN) pre-treated, 53% with comorbidities, 40/53/7 % with Child Pugh A/B/C, 4% with virus B co-infection and 8% with previously treated hepatocellular carcinoma. Mean initial MELD score was 11.92 (6.82÷ 24.5). Six patients were lost during follow-up. Sustained virologic response (SVR) in intention-to-treat was reported in 85.1%. Predictive factors of SVR in decompensated cirrhosis were female gender (p=0.01), advanced age (p<0.001), lower bilirubin levels (p=0.002) and lower CTP score (p=0.02). In patients with CTP score B or C low bilirubin levels (p=0.003), low INR (p<0.001), increased platelet count (p=0.04), low CTP score (p<0.001), lack of encephalopathy (p=0.02), serum albumin >3.5g/dl (p=0.002) predicted improvement of liver function. Serious adverse events were reported in 16/349 (4.6%), most of them due to severe liver decompensation (9/16). Conclusions: LDV/SOF±RBV proved to be highly efficient in our difficult to treat population with 85.1% SVR.

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