scholarly journals Diagnosis and management challenges of acute mesenteric venous thrombosis in patients with liver cirrhosis: a single institution's experience

2017 ◽  
Vol 4 (6) ◽  
pp. 1837
Author(s):  
Hazem M. Zakaria ◽  
Khaled G. Ammar ◽  
Sherif M. Saleh ◽  
Mohammed Abbas ◽  
Nahla M. Gaballa ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Venous Thrombosis ◽  
Diagnostic Tools ◽  
Mesenteric Venous Thrombosis ◽  
Low Protein ◽  
Cirrhotic Patients ◽  
Coagulation Status ◽  
Triphasic Ct ◽  
Primary Resection And Anastomosis ◽  
Resection And Anastomosis

Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoagulant, while 30 patients (75%) were surgically explored and 28 patients of them had gangrenous bowel loops and underwent primary resection and anastomosis. Three patients underwent second look operation. Three patients had recurrent symptoms after 1 month of the first presentation. The overall 30- and 90-day mortality was 27.5% and 37.5% respectively.Conclusions: Cirrhotic patients may have hypercoagulable state and the usual laboratory tests don’t accurately assess the coagulation status in these patient. Acute MVT in cirrhotic patients has a high early morbidity and mortality that needs early diagnosis and urgent management with selective surgical intervention and proper anticoagulant.

Portal and mesenteric venous thrombosis in cirrhotic patients

2002 ◽  
Vol 123 (4) ◽  
pp. 1409-1410 ◽  
Author(s):  
Lucio Amitrano ◽  
Maria Anna Guardascione ◽  
Vincenzo Brancaccio ◽  
Luigi Iannaccone ◽  
Paul R.J. Ames ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Mesenteric Venous Thrombosis ◽  
Cirrhotic Patients

scholarly journals Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Francesca Romana Ponziani ◽  
Barbara Funaro ◽  
Andrea Lupascu ◽  
Maria Elena Ainora ◽  
Matteo Garcovich ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Early Identification ◽  
Transcranial Doppler Ultrasound ◽  
Minimal Hepatic Encephalopathy ◽  
Diagnostic Tools ◽  
Cirrhotic Patients ◽  
Cerebral Vascular

Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.

scholarly journals Malnutrition in Patients with Liver Cirrhosis

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 540
Author(s):  
Julia Traub ◽  
Lisa Reiss ◽  
Benard Aliwa ◽  
Vanessa Stadlbauer
Keyword(s):  
Liver Cirrhosis ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Diagnostic Tools ◽  
Screening Methods ◽  
Nutrient Metabolism ◽  
Oral Nutritional Supplements ◽  
Cirrhotic Patients

Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs—depending on the screening methods used and patient populations studied—in 5–92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures—especially the timing of meals—oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.

scholarly journals Primary Catheter-Directed Thrombolysis For Porto-Mesenteric Venous Thrombosis (PMVT) In Non-Cirrhotic Patients.

2021 ◽  
Author(s):  
Chia-Ling Chiang ◽  
Huei-Lung Liang ◽  
Ming-Feng Li
Keyword(s):  
Venous Thrombosis ◽  
Intestinal Ischemia ◽  
Balloon Dilation ◽  
Secondary Patency ◽  
Mesenteric Venous Thrombosis ◽  
Technical Success ◽  
Catheter Directed Thrombolysis ◽  
Major Procedure ◽  
Cirrhotic Patients ◽  
Urokinase Infusion

Abstract Purpose: To report our technique, treatment strategy and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients.Methods: 16 non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004-2020. 8 patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000-30,000 IU/hour concomitant with heparin 300-400 IU/hour), catheter aspiration and/or balloon dilation/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU/hour) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in 8 patients. A total of up to 20.4 million IU urokinase was infused for 1-30 days’ treatment duration. TIPS was created in 3 patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall 1- and 2-year primary and secondary patency were both 74.0% and 84.6% respectively. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT . TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.

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