scholarly journals Refractory ascites—the contemporary view on pathogenesis and therapy

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7855 ◽  
Author(s):  
Beata Kasztelan-Szczerbinska ◽  
Halina Cichoz-Lach
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Medical Therapy ◽  
Standard Treatment ◽  
Treatment Options ◽  
Early Recurrence ◽  
Refractory Ascites ◽  
Low Sodium Diet ◽  
Low Sodium ◽  
Cirrhotic Patients

Refractory ascites (RA) refers to ascites that cannot be mobilized or that has an early recurrence that cannot be prevented by medical therapy. Every year, 5–10% of patients with liver cirrhosis and with an accumulation of fluid in the peritoneal cavity develop RA while undergoing standard treatment (low sodium diet and diuretic dose up to 400 mg/day of spironolactone and 160 mg/day of furosemide). Liver cirrhosis accounts for marked alterations in the splanchnic and systemic hemodynamics, causing hypovolemia and arterial hypotension. The consequent activation of renin-angiotensin and sympathetic systems and increased renal sodium re-absorption occurs during the course of the disease. Cirrhotic patients with RA have poor prognoses and are at risk of developing serious complications. Different treatment options are available, but only liver transplantation may improve the survival of such patients.

Komplikationen der Leberzirrhose – medikamentöse versus interventionelle Therapie

2019 ◽  
Vol 144 (18) ◽  
pp. 1259-1266
Author(s):  
Lukas Sturm ◽  
Martin Rössle ◽  
Michael Schultheiß
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Variceal Bleeding ◽  
Hepatorenal Syndrome ◽  
Beta Blockers ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Refractory Ascites ◽  
Effective Therapeutic Option ◽  
Intrahepatic Portosystemic Shunt

AbstractThe prognosis of patients with liver cirrhosis is impaired by complications such as variceal bleeding, ascites, hepatorenal syndrome, hepatic encephalopathy and hepatocellular carcinoma. A steadily increasing array of treatment options for these complications is available, including pharmaceutical treatment (e. g. beta blockers for varices or diuretics for ascites), endoscopic treatment (e. g. band ligation of varices), radiological interventions (e. g. transjugular shunt, transarterial chemoembolization) and liver transplantation. Most of the complications occur due to portal hypertension. Therefore, decompressive treatment by implantation of a transjugular intrahepatic portosystemic shunt (TIPS) an effective therapeutic option for many complications of liver cirrhosis. Its main indications are acute and recurrent variceal bleeding in patients with advanced disease as well as refractory ascites. The TIPS does not affect options of abdominal surgery and may therefore be used as a bridge to liver transplantation.

scholarly journals Splenectomy in Liver Cirrhosis with Splenomegaly and Hypersplenism

2020 ◽  
Author(s):  
Adianto Nugroho
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Human Body ◽  
Elevated Risk ◽  
Risk Of Infection ◽  
Pneumococcal Sepsis ◽  
Cirrhotic Patients

Spleen is a “mysterious” organ since with unique functions, and might be related to other pathology in the human body. Splenomegaly and hypersplenism can manifest following the development of portal hypertension in liver cirrhosis through fibrogenesis, immune and microenvironment dysregulation. Cirrhotic patients are generally considered as immunocompromised and prone to infections. Splenectomy in cirrhotic patients has produced concern over decrease immunity and elevated risk of infection, namely overwhelming post splenectomy pneumococcal sepsis. This review discus the splenectomy effect to the liver and how it can play a role in cirrhotic patients with portal hypertension without readily available access to liver transplantation.

scholarly journals NOTCH3 rs1043996 Polymorphism Is Associated with the Occurrence of Alcoholic Liver Cirrhosis Independently of PNPLA3 and TM6SF2 Polymorphisms

2021 ◽  
Vol 10 (19) ◽  
pp. 4621
Author(s):  
Ana Bainrauch ◽  
Dino Šisl ◽  
Antonio Markotić ◽  
Ana Ostojić ◽  
Slavko Gašparov ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Logistic Regression ◽  
Liver Cirrhosis ◽  
Logistic Regression Model ◽  
Control Group ◽  
Alcoholic Liver Cirrhosis ◽  
Common Indication ◽  
Model Adjustment ◽  
Cirrhotic Patients

Alcoholic liver cirrhosis (ALC) is the most common indication for liver transplantation (LT) in Croatia and presents a risk factor for the development of hepatocellular carcinoma (HCC). However, genetic susceptibility has not yet been systematically studied. We aimed to investigate the contribution of the risk polymorphisms PNPLA3 rs738409, EGF rs4444903, TM6SF2 rs58542926, MTHFR rs1801133, previously identified in other populations and, additionally, the contribution of Notch-related polymorphisms (NOTCH1 rs3124591, NOTCH3 rs1043996 and rs1044116, NOTCH4 rs422951). The study included 401 patients. The ALC group consisted of 260 LT candidates, 128 of whom had histopathologically confirmed HCC, and 132 of whom were without HCC. The control group included 141 patients without liver disease. Genotyping was performed by PCR using Taqman assays. The patients’ susceptibility to ALC was significantly associated with PNPLA3 rs738409, TM6SF2 rs58542926, and NOTCH3 rs1043996 polymorphisms. These polymorphisms remained significantly associated with ALC occurrence in a logistic regression model, even after additional model adjustment for sex and age. Cirrhotic patients with the PNPLA3 GG genotype demonstrated higher activity of ALT aminotransferases than patients with CC or CG genotypes. The susceptibility to the development of HCC in ALC was significantly associated with PNPLA3 rs738409 and EGF rs4444903 polymorphisms, and logistic regression confirmed these polymorphisms as independent predictors.

scholarly journals Peritoneal Recurrence of Initially Controlled Hepatocellular Carcinoma after Living Donor Liver Transplantation

2015 ◽  
Vol 9 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Nariman Sadykov ◽  
Akihiko Soyama ◽  
Masaaki Hidaka ◽  
Ayaka Kinoshita ◽  
Mitsuhisa Takatsuki ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Living Donor ◽  
Standard Treatment ◽  
Peritoneal Recurrence ◽  
Milan Criteria ◽  
Donor Liver Transplantation ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Possible Cause

It is well known that the presence of end-stage liver disease increases the risk of developing hepatocellular carcinoma (HCC). Liver transplantation (LT) for patients within the Milan criteria has become a standard treatment for HCC in most developed centers worldwide. However, a major cause of death in cirrhotic patients with HCC after transplantation is tumor recurrence, including peritoneal recurrences, which develops rarely but presents a significant problem with regard to their management. Our experience includes two cases with HCC within the Milan criteria of peritoneal recurrences after living donor LT. Both patients had interventions for HCC in their medical history before LT, and we propose that these might have been a possible cause of the HCC peritoneal recurrence.

scholarly journals CLINICALAND ENDOSCOPIC PROFILE OF PEPTIC ULCER DISEASE IN LIVER CIRRHOTICS : STUDY AT A LIVER TRANSPLANT CENTRE IN SOUTH INDIA

2020 ◽  
pp. 1-2
Author(s):  
MS Revathy ◽  
Amiya Ranjan ◽  
B. Sumathi ◽  
Manimaran M
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Refractory Ascites ◽  
Biliary Cirrhosis ◽  
Gi Endoscopy ◽  
Ulcer Disease ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Cirrhotic Patients

Background: Peptic ulcer disease in patients with liver cirrhosis poses significant morbidity and mortality . It is also a cause for gastrointestinal bleed . Our study aims at providing a clinical and endoscopic profile of peptic ulcer disease in patients suffering from liver cirrhosis . Objective: Providing an insight into the clinical and endoscopic profile of patients suffering from liver cirrhosis and peptic ulcer disease, with special reference to Child Pugh score, spontaneous bacterial peritonitis, refractory ascites and other comorbidities. Methods: This study was conducted in the Department of Medical Gastroenterology, Govt Stanley medical college, Chennai from September 2018 to April 2019. All cirrhotic patients underwent relevant blood investigations, ultrasound abdomen, portal vein doppler and upper GI endoscopy. Gastric ulcers were biopsied according to standard protocol. RUT was not performed in all cases for H.Pylori detection . Results: A total of 361 cirrhotic patients that underwent upper GI endoscopy, 45 patients were incuded in our study based on the inclusion criteria. The prevalence of peptic ulcer disease in liver cirrhotics was 12.4% . Males to females ratio of 38:7. Mean age was 38 years ±2.8. Mean CTP score was 8.42±1.90 . median of 8 , mode 10 . Ascites was noted in 37, SBP in 22 and refractory ascites in 4. Etiology for cirrhosis was alcohol (44.4%) , cryptogenic(17.8%) , hepatitis B(15.6%) , Budd Chiari syndrome(8.9%) , hepatitis C(4.4%), wilsons disease (2.2%) , secondary biliary cirrhosis(2.2%) , autoimmune hepatitis(2.2%) . 23 had CPT score B, followed by CPT C in 15 and CPT A in 7 . Conclusion: In conclusion, a significant proportion of patients with cirrhosis develop PUD. Furthermore, H pylori infection and NSAIDs are not the only, or perhaps even the most important, risk factors for PUD in patients with cirrhosis. These observations have important practical implications for physicians caring for patients with chronic liver disease.

scholarly journals A new challenge for linagliptin: diabetes, organ transplantation and chronic renal insufficiency in the same patient

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 100-103
Author(s):  
Benedetta M. Bonora
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Post Transplantation ◽  
Dipeptidyl Peptidase 4 ◽  
First Case ◽  
Treatment Of Diabetes ◽  
Cirrhotic Patients ◽  
Oral Hypoglycemic Drugs

The association between liver cirrhosis and type 2 diabetes mellitus (DMT2) has been known for many years. It is estimated that changes in glucose metabolism are present in at least two thirds of cirrhosis patients. Diabetes can be both a consequence of liver disease and a pre-existing condition. In the first case, liver transplantation would be the solution but post-transplant diabetes remains a common condition. For patients with liver cirrhosis the therapeutic approach for the treatment of DMT2 is extremely limited and the studies available on this type of population are very few. The pharmacokinetic characteristics of linagliptin are well suited for patients with DMT2 and chronic liver disease; in fact, no dose adjustment is required in patients regardless of the degree of hepatic impairment. With regard to the treatment of diabetes in post-transplantation, data on the efficacy and safety of oral hypoglycemic drugs are scarce; however, the available studies suggest that dipeptidyl peptidase 4 (DPP4i) inhibitors are safe and effective in these patients. In describing this clinical case, we discuss how the use of a DPP4i, and in particular of linagliptin, may represent a valid therapeutic strategy in the management of diabetic, cirrhotic patients who undergo liver transplantation (Diabetology).

scholarly journals MELD Score Is Not Related to Spontaneous Bacterial Peritonitis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Luciana Haddad ◽  
Tatiana Morgado Conte ◽  
Liliana Ducatti ◽  
Lucas Nacif ◽  
Luiz Augusto Carneiro D’Albuquerque ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Outpatient Setting ◽  
Meld Score ◽  
Waiting List ◽  
Ambulatory Setting ◽  
Refractory Ascites ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

This study investigates the correlation between SBP and repeated paracentesis, and its relation to MELD score, in cirrhotic patients with refractory ascites in an outpatient setting. Through the data base, 148 cirrhotic patients were prospectively included in the study with refractory ascites undergoing relief paracentesis from March 2012 to March 2013. Demographics data, etiology of liver disease, MELD score, and inscription on the waiting list for liver transplantation were analyzed. The ascites removed was analyzed through cellular count and culture for the diagnosis of spontaneous bacterial peritonitis. The cirrhotic patients underwent a total of 854 paracentesis procedures in the ambulatory setting during the study period. Eighty-one patients (54%) were on the waiting list for liver transplantation. Patients on the liver transplant list had higher associated costs due to a higher total number of outpatient paracentesis procedures (394.7 ± 512.3 versus 291.7 ± 384.7) and a higher volume drained per procedure (6.5 ± 8.5 versus 4.8 ± 6.4). There were 28 episodes of SBP (3.3%) diagnosed in 24 patients. In conclusion, the prevalence of asymptomatic SBP in cirrhotic patients with refractory ascites undergoing repeated paracentesis is low. MELD score is not related to spontaneous bacterial peritonitis.

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