Successful Distal Gastrectomy for Gastric Cancer with Child-Pugh Class B Alcoholic Liver Cirrhosis

Background/Aim. Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

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Validation of a new prognostic model to predict short and medium-term survival in patients with liver cirrhosis

BMC Gastroenterology ◽

10.1186/s12876-020-01407-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tomasz Dziodzio ◽

Robert Öllinger ◽

Wenzel Schöning ◽

Antonia Rothkäppel ◽

Radoslav Nikolov ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Risk Score ◽

Meld Score ◽

Medium Term ◽

Term Survival ◽

Risk Of Death ◽

Class B ◽

Pugh Class ◽

End Stage

Abstract Background MELD score and MELD score derivates are used to objectify and grade the risk of liver-related death in patients with liver cirrhosis. We recently proposed a new predictive model that combines serum creatinine levels and maximum liver function capacity (LiMAx®), namely the CreLiMAx risk score. In this validation study we have aimed to reproduce its diagnostic accuracy in patients with end-stage liver disease. Methods Liver function of 113 patients with liver cirrhosis was prospectively investigated. Primary end-point of the study was liver-related death within 12 months of follow-up. Results Alcoholic liver disease was the main cause of liver disease (n = 51; 45%). Within 12 months of follow-up 11 patients (9.7%) underwent liver transplantation and 17 (15.1%) died (13 deaths were related to liver disease, two not). Measures of diagnostic accuracy were comparable for MELD, MELD-Na and the CreLiMAx risk score as to power in predicting short and medium-term mortality risk in the overall cohort: AUROCS for liver related risk of death were for MELD [6 months 0.89 (95% CI 0.80–0.98) p < 0.001; 12 months 0.89 (95% CI 0.81–0.96) p < 0.001]; MELD-Na [6 months 0.93 (95% CI 0.85–1.00) p < 0.001 and 12 months 0.89 (95% CI 0.80–0.98) p < 0.001]; CPS 6 months 0.91 (95% CI 0.85–0.97) p < 0.01 and 12 months 0.88 (95% CI 0.80–0.96) p < 0.001] and CreLiMAx score [6 months 0.80 (95% CI 0.67–0.96) p < 0.01 and 12 months 0.79 (95% CI 0.64–0.94) p = 0.001]. In a subgroup analysis of patients with Child-Pugh Class B cirrhosis, the CreLiMAx risk score remained the only parameter significantly differing in non-survivors and survivors. Furthermore, in these patients the proposed score had a good predictive performance. Conclusion The CreLiMAx risk score appears to be a competitive and valid tool for estimating not only short- but also medium-term survival of patients with end-stage liver disease. Particularly in patients with Child-Pugh Class B cirrhosis the new score showed a good ability to identify patients not at risk of death.

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Efficacy of albumin in the treatment of alcoholic cirrhosis of the liver in combination with obesity

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(2)-13 ◽

2020 ◽

Vol 24 (2) ◽

pp. 274-278

Author(s):

N. H. Virstiuk ◽

N. R. Matkovska

Keyword(s):

Liver Cirrhosis ◽

Statistical Processing ◽

Alcoholic Cirrhosis ◽

Medical Documentation ◽

Alcoholic Liver Cirrhosis ◽

Group I ◽

Class B ◽

Life Threatening ◽

Treatment Onset

Annotation. Liver cirrhosis is characterized by an increase in morbidity and prevalence, life-threatening complications, disability and increased mortality of the working population. The aim of the study was to study the effect of albumin on the course of alcoholic liver cirrhosis in combination with obesity at the stage of decompensation. The study included 52 patients with alcoholic liver cirrhosis in combination with obesity (confirmed before the onset of ascites) with the primary uncomplicated ascites of 2-3 degrees, 46 men and 6 women aged 35 to 59 years; 32 patients were diagnosed with class B and 20 – with class C according to the Child-Pugh score. Depending on the treatment, patients were divided into 2 groups: Group I included 26 patients who received in their combination therapy albumin 40.0 g/week for 2 weeks of inpatient treatment and 20.0 g/week for 12 weeks of outpatient treatment, followed by a maintenance dose of 20.0 g/month (10.0 g/2 weeks) for 12 weeks; 24 weeks after the start of treatment, 16 patients gave their consent and continued maintenance therapy for another 24 weeks. Group II included 26 patients who received basic therapy without albumin. Assessment of patients was performed before treatment, 12, 24, 48 weeks after treatment onset; in 96 weeks – according to medical documentation. Statistical processing of the results was performed using software Microsoft Excel spreadsheet and application package Statistica v. 12.0 StatSoft, USA. In patients with alcoholic liver cirrhosis in combination with obesity, the inclusion in the complex therapy of long-term use of albumin improves the course of the disease according to the Child-Pugh score, MELD, DMF and CLIF-SOFA indices. There was a reduce the recurrence of ascites, the number of complications, a re-hospitalization within a year, an increase in the survival of patients within 48 months. No side effects of albumin were noted. Thus, long-term use of albumin in complex treatment of patients with alcoholic liver cirrhosis in combination with obesity contributes to an increase in the effectiveness of treatment.

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Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Journal of Medicine ◽

10.3329/jom.v22i2.56698 ◽

2021 ◽

Vol 22 (2) ◽

pp. 100-106

Author(s):

Tarana Yasmin ◽

Sohely Sultana ◽

Mahmuda Nusrat Ima ◽

Md Quamrul Islam ◽

Shyamal Kumar Roy ◽

...

Keyword(s):

Liver Cirrhosis ◽

Doppler Ultrasound ◽

Hepatic Vein ◽

Wave Form ◽

Venous Blood Flow ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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Photobacterium damselae subsp. damselae bacteraemia in a patient with liver cirrhosis

BMJ Case Reports ◽

10.1136/bcr-2021-242580 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242580

Author(s):

Satoshi Hayano ◽

Takayuki Masaki ◽

Risako Tadakuma ◽

Masayuki Kashima

Keyword(s):

Liver Cirrhosis ◽

Soft Tissue ◽

Blood Culture ◽

Brackish Water ◽

Immunocompromised Patients ◽

Class B ◽

Photobacterium Damselae ◽

History Of ◽

Pugh Class ◽

Raw Fish

Photobacterium damselae subsp. damselae is a family of Vibrionaceae and exists in the marine environment. The organism rarely causes soft-tissue infection in humans; moreover, most of the infected individuals have a history of fishing or exposure to brackish water. We experienced the case of a 63-year-old patient with a history of liver cirrhosis (Child-Pugh class B) who presented with a fever and swelling of the left leg with pain. His symptoms developed after fishing and eating raw fish with exposure of brackish water. He was diagnosed with cellulitis, and Photobacterium damselae spp. damselae was detected in blood culture. The patient was treated with ceftazidime and minocycline and he was discharged after recovery. We need to be aware that in immunocompromised patients with cellulitis exposed to brackish water, organisms other than Staphylococci and Streptococci may be the causative organisms.

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Correlation of global longitudinal strain with disease severity in liver cirrhosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.155 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Dimitroglou ◽

C Aggeli ◽

A Alexopoulou ◽

T Alexopoulos ◽

D Patsourakos ◽

...

Keyword(s):

Liver Cirrhosis ◽

Disease Severity ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software. Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2 and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p < 0.001), SV (r = 0.554, p < 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

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