Antithrombotic Drugs in Cirrhosis

In patients with liver cirrhosis treated for portal vein thrombosis, there was no increase in the risk of bleeding, but there was a decrease in the incidence of liver decompensation and an increase in the survival of treated patients when compared to the untreated ones(1). Current guidelines(2) do not provide specific recommendations for the prophylaxis or treatment of thromboembolic diseases in patients with liver cirrhosis(3). In order to determine the influence of anti-thrombotic treatment on the prognosis of liver cirrhosis, 85 patients with liver cirrhosis were followed clinically, by laboratory and ultrasound parameters, for 6 months. Microsoft Excel and IBM SPSS Statistics 20 were used to analyse the data of patients, divided into two groups according to the presence or absence of anti-thrombotic treatment initiated for cardiovascular pathology. The obtained results showed that the mortality rate between the two groups was similar: 11.54% untreated, 12.12% treated, the decompensation rate of untreated patients was higher than that of the treated ones (36.54% vs. 24.24%) with antithrombotic drugs and that no patient among those treated with antithrombotic drugs showed upper digestive haemorrhage (p =0.038). The conclusions drawn from this study were that patients with liver cirrhosis in antithrombotic treatment have a better prognosis than untreated ones, in the absence of major bleeding complications, but for a change in guidelines and current practice, studies are needed on a larger number of patients in order to validate these observations.

UNCOMPLICATED DIVERTICULOSIS OF THE SMALL BOWEL - RARE CAUSE OF ACUTE ABDOMEN

Male patient, 76 years old, has been accussing diffuse abdominal pain for about 12 hours. Clinical examination: stable haemodynamic and respiratory, with a scar-free abdomen, slightly elusive, painfully spontaneous and palpable, with a muscular defense sketch. Biological: leukocytosis 17000 / ml. Abdominal ultrasound: fine liquid blade in Douglas. Simple abdominal radiography: hydroaeric levels of the small intestine. Having the diagnosis of acute abdomen due to the undetermined cause, an exploratory laparatomy is performed that detects: diffuse distension of small bowel, showing relatively bulky sacral / diverticular dilatations, disposed on the mesostennial margin, dispersed over almost the entire length of the jejunum without signs of inflammation or perforation. Exploration of the rest of the peritoneal cavity does not detect other lesions, so we have no other explanation for patient symptomatology. Favorable postoperative progression. At 6 months and 1 year control, the patinent reports only short episodes of abdominal discomfort remission under symptomatic treatment. Acquired intestinal diverticulosis is an extremely rare entity, with a prevalence of between 0.073% and 1.3% [1]. Localization is at the level of the jejunum (80%), ileum (15%), and very rarely in the entire small intestine (5%) [2]. Clinically, diverticulosis is asymptomatic in most cases, may display nonspecific dyspeptic symptoms and may be complicated by inferior digestive haemorrhage, inflammation or perforation [1]. Etiology is not fully elucidated, but research on pathophysiological mechanisms has led to the hypothesis of mucosal and sub-mucosal herniation where the arteries permeate the muscular layer as a result of intraluminal pressure increase [3].