scholarly journals Endoscopy in Management of Portal Hypertension

2020 ◽  
Author(s):  
Bhavik Bharat Shah ◽  
Usha Goenka ◽  
Mahesh Kumar Goenka
Keyword(s):  
Portal Hypertension ◽  
Clinical Performance ◽  
Mucosal Immune Response ◽  
Endoscopic Management ◽  
Portal Circulation ◽  
Gastrointestinal Complications ◽  
Disease States ◽  
Life Threatening ◽  
Portal Hypertensive Enteropathy ◽  
Severity Of The Disease

Portal hypertension (PH) is a serious consequence of several disease states affecting prehepatic, intrahepatic, or posthepatic portal circulation. Backpressure caused by PH transmits through the collaterals to form varices at various sites. PH also leads to hyperdynamic congestion and altered gastrointestinal mucosal immune response, resulting in portal hypertensive gastropathy (PHG), portal hypertensive enteropathy (PHE), and portal colopathy (PC). These PH associated phenomena may lead to torrential life-threatening bleed or chronic blood loss leading to debilitating chronic anemia. Endoscopy plays a pivotal role in the management of these patients both for diagnostic and therapeutic purpose. The choice of therapeutic strategy depends on many factors: severity of the disease, patient’s clinical performance, and whether it is done as an emergency or as a prophylactic approach. In this chapter, we evaluate the endoscopic management of patients with the gastrointestinal complications of PH.

scholarly journals Endoscopic Management of Portal Hypertension

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Peter Ghali ◽  
Philip Wong ◽  
Marc Deschenes
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Ultrasound ◽  
Capsule Endoscopy ◽  
Interventional Therapy ◽  
Gastric Varices ◽  
Active Management ◽  
Endoscopic Management ◽  
Diagnostic Modality ◽  
Gastroesophageal Varices ◽  
Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

scholarly journals Zinc and Sepsis

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 976 ◽  
Author(s):  
Wiebke Alker ◽  
Hajo Haase
Keyword(s):  
Defense Mechanism ◽  
Acute Phase Proteins ◽  
Innate Immune ◽  
Zinc Homeostasis ◽  
Major Health ◽  
Nutritional Immunity ◽  
Life Threatening ◽  
Zinc Concentrations ◽  
Severity Of The Disease ◽  
Major Health Issue

Sepsis, defined as a “life-threatening organ dysfunction caused by a dysregulated host-response to infection” is a major health issue worldwide and still lacks a fully elucidated pathobiology and uniform diagnostic tests. The trace element zinc is known to be crucial to ensure an appropriate immune response. During sepsis a redistribution of zinc from serum into the liver has been observed and several studies imply a correlation between zinc and sepsis outcome. Therefore the alterations of zinc concentrations in different tissues might serve as one part of the host’s defense mechanism against pathogens during sepsis by diverse mechanisms. It has been suggested that zinc is involved in nutritional immunity, acts as a hepatoprotective agent, or a differentiation signal for innate immune cells, or supports the synthesis of acute phase proteins. Further knowledge about these events could help in the evaluation of how zinc could be optimally applied to improve treatment of septic patients. Moreover, the changes in zinc homeostasis are substantial and correlate with the severity of the disease, suggesting that zinc might also be useful as a diagnostic marker for evaluating the severity and predicting the outcome of sepsis.

scholarly journals Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

2009 ◽  
Vol 46 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Fernanda Prata Martins ◽  
Erika Pereira de Macedo ◽  
Gustavo Andrade de Paulo ◽  
Frank Shigueo Nakao ◽  
José Celso Ardengh ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Portal Hypertension ◽  
Gastric Varices ◽  
Study Endpoint ◽  
Mild Abdominal Pain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Related Mortality ◽  
Overall Mortality

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

scholarly journals The Indirect Implication of SARS-CoV-2 Resulting in Kayexalate Toxicity in a Patient with Acute Kidney Injury

2021 ◽  
Vol 5 (1) ◽  
pp. 6-13
Author(s):  
Charles E. Middleton IV ◽  
William Daley ◽  
Neha Varshney
Keyword(s):  
Acute Kidney Injury ◽  
Virus Disease ◽  
Severe Disease ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Subsequent Treatment ◽  
Gastrointestinal Complications ◽  
Treatment Regimens ◽  
Organ Systems ◽  
Life Threatening

The clinical features of corona virus disease 2019 (COVID-19) are variable, but the majority of patients experience mild flu-like symptoms. The cases of severe disease include complications such as progressive pneumonia, acute kidney injury, multi-organ failure, and even death. This paper explores the association between COVID-19 and its effect on multiple organ systems and how the subsequent treatment of this disease can itself lead to morbidity and mortality. We present a case which emphasizes the life threatening gastrointestinal complications associated with treatment of acute kidney injury (AKI) in a patient with COVID-19. We conclude that the patients whose treatment regimens utilize medical resins should be closely monitored for gastrointestinal complications so as to mitigate the known adverse effects associated with these drugs, such as colonic mucosal ulceration, perforation, or even death.

Hepatic venous-portal gradient (HVPG) measurement: pearls and pitfalls

2021 ◽  
pp. 20210061
Author(s):  
Qiqi Lu ◽  
Sum Leong ◽  
Kristen Alexa Lee ◽  
Ankur Patel ◽  
Jasmine Ming Er Chua ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Risk Stratification ◽  
Variceal Bleeding ◽  
Gold Standard ◽  
Crucial Role ◽  
Venous Pressure ◽  
Common Cause ◽  
Life Threatening ◽  
Selection And Assessment

Hepatic venous pressure gradient (HVPG) is the gold-standard for measurement of portal hypertension, a common cause for life-threatening conditions such as variceal bleeding and hepatic encephalopathy. HVPG also plays a crucial role in risk stratification, treatment selection and assessment of treatment response. Thus recognition of common pitfalls and unusual hepatic venous conditions is crucial. This article aims to provide a radiographical and clinical guide to HVPG with representative clinical cases.

scholarly journals Capsule Endoscopy in the Investigation of Patients with Portal Hypertension and Anemia

2008 ◽  
Vol 22 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Spyros Goulas ◽  
Konstantina Triantafyllidou ◽  
Stephanos Karagiannis ◽  
Panayiota Nicolaou ◽  
Petros Galanis ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Matched Control ◽  
Normal Liver ◽  
Portal Hypertensive Gastropathy ◽  
Endoscopic Techniques ◽  
Colonic Varices ◽  
Endoscopic Characteristics ◽  
Portal Hypertensive Enteropathy

INTRODUCTION: Data on small bowel abnormalities in patients with portal hypertension (PHT) are limited. Bleeding from the gastrointestinal tract and anemia are common complications in these patients. Capsule endoscopy (CE) was used to evaluate small bowel (SB) pathology in patients with PHT and anemia, and possible associations with various parameters were examined.METHODS: Thirty-five patients with PHT referred for CE investigation of the SB for anemia were prospectively enrolled in the study, as well as 70 age- and sex-matched control patients with anemia, normal liver function and no evidence of PHT who underwent CE.RESULTS: Findings compatible with portal hypertensive enteropathy (PHE) were detected in 65.7% of the patients and in 15.7% of the controls (χ2=26.641, P=0.000). Abnormalities in PHT patients included varices in 25.7%, diffuse changes of mucosa with inflammatory-like appearance in 42.9%, and angiodysplasias and/or spider angiomas in 22.9% of cases. The presence of PHE was significantly associated only with the presence of severe portal hypertensive gastropathy, while the presence of SB varices alone was significantly associated with the presence of severe portal hypertensive gastropathy, larger esophageal varices and the presence of colonic varices.CONCLUSIONS: Varices, diffuse changes of mucosa with inflammatory-like appearance, and angiodysplasias and/or spider angiomas are detected more often in patients with PHT than in controls, and probably constitute the endoscopic characteristics of PHE. CE of the SB added a significant number of likely important findings to those detected by conventional endoscopic techniques for the clinical management of patients with PHT and anemia.

scholarly journals Quality Control of Serum and Plasma by Quantification of (4E,14Z)-Sphingadienine-C18-1-Phosphate Uncovers Common Preanalytical Errors During Handling of Whole Blood

2018 ◽  
Vol 64 (5) ◽  
pp. 810-819 ◽  
Author(s):  
Xinyu Liu ◽  
Miriam Hoene ◽  
Peiyuan Yin ◽  
Louise Fritsche ◽  
Peter Plomgaard ◽  
...  
Keyword(s):  
Whole Blood ◽  
Plasma Samples ◽  
Blood Samples ◽  
Disease States ◽  
Long Term Storage ◽  
Reliable Assessment ◽  
Therapeutic Decisions ◽  
Life Threatening ◽  
Research Findings

Abstract BACKGROUND Nonadherence to standard operating procedures (SOPs) during handling and processing of whole blood is one of the most frequent causes affecting the quality of serum and plasma. Yet, the quality of blood samples is of the utmost importance for reliable, conclusive research findings, valid diagnostics, and appropriate therapeutic decisions. METHODS UHPLC-MS-driven nontargeted metabolomics was applied to identify biomarkers that reflected time to processing of blood samples, and a targeted UHPLC-MS analysis was used to quantify and validate these biomarkers. RESULTS We found that (4E,14Z)-sphingadienine-C18-1-phosphate (S1P-d18:2) was suitable for the reliable assessment of the pronounced changes in the quality of serum and plasma caused by errors in the phase between collection and centrifugation of whole blood samples. We rigorously validated S1P-d18:2, which included the use of practicality tests on >1400 randomly selected serum and plasma samples that were originally collected during single- and multicenter trials and then stored in 11 biobanks in 3 countries. Neither life-threatening disease states nor strenuous metabolic challenges (i.e., high-intensity exercise) affected the concentration of S1P-d18:2. Cutoff values for sample assessment were defined (plasma, ≤0.085 μg/mL; serum, ≤0.154 μg/mL). CONCLUSIONS Unbiased valid monitoring to check for adherence to SOP-dictated time for processing to plasma or serum and/or time to storage of whole blood at 4 °C is now feasible. This novel quality assessment step could enable scientists to uncover common preanalytical errors, allowing for identification of serum and plasma samples that should be excluded from certain investigations. It should also allow control of samples before long-term storage in biobanks.

scholarly journals Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

2010 ◽  
Vol 92 (7) ◽  
pp. 555-558 ◽  
Author(s):  
Mark Lynch ◽  
Seshadri Sriprasad ◽  
Kesavapillai Subramonian ◽  
Peter Thompson
Keyword(s):  
Transurethral Resection ◽  
Postoperative Bleeding ◽  
Endoscopic Management ◽  
Wide Spread ◽  
Postoperative Haemorrhage ◽  
Post Surgery ◽  
Life Saving ◽  
Prophylactic Measures ◽  
Life Threatening ◽  
Life Threatening Complication

INTRODUCTION Intractable haemorrhage after endoscopic surgery, including transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP), is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent bleeding post-endoscopic prostatic surgery should be treated promptly to prevent the risk of rapid deterioration. We demonstrated that the technique of open prostate packing may be life-saving.

scholarly journals Massive avascular malformations causing life threatening portal hypertension

2012 ◽  
Vol 11 (4) ◽  
pp. 552-553
Author(s):  
Aman Arya ◽  
Nirmal Kakani ◽  
Nabil Hussain ◽  
Natasha Chandok
Keyword(s):  
Portal Hypertension ◽  
Life Threatening

scholarly journals Its Congenital Hepatic Fibrosis; Not Cirrhosis At All

2018 ◽  
Vol 1 (2) ◽  
pp. 124-126
Author(s):  
Ananta Shrestha ◽  
Mamun Al-Mahtab ◽  
Salimur Rahman ◽  
Jahangir Sarkar ◽  
Thupten K Lama
Keyword(s):  
Portal Hypertension ◽  
Hepatic Fibrosis ◽  
Autosomal Recessive ◽  
Rare Condition ◽  
Recessive Trait ◽  
Congenital Hepatic Fibrosis ◽  
Life Threatening ◽  
Hepatic Histology ◽  
Upper Abdomen ◽  
Medical University

Congenital hepatic fibrosis is a rare condition characterized by extensive fibrosis of liver but with preserved normal lobular architecture inherited as autosomal recessive trait. We report a 19 year-old-female admitted to Bangabandhu Sheikh Mujib Medical University with the complaints of lump in upper abdomen since last 13 years and episodes of fever and abdominal pain for same duration. She was diagnosed with hepatic TB on hepatic histology. Congenital hepatic fibrosis is a rare cause of portal hypertension that presents during childhood. Prognosis of congenital hepatic fibrosis is good. Life threatening events in these patients are related with variceal bleeding and episodes of cholangitis. Owing to relatively good liver function these patients tolerate portosystemic shunt surgeries quite well.Though rare, congenital hepatic fibrosis should be included in the differential diagnosis of portal hypertension in early life.

Sign in / Sign up

Export Citation Format

Share Document