Management of portal hypertension, Budd –Chiari syndrome and portal vein thrombosis

Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients ’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in th e management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and therapies such as transjugular intrahepatic portosystemic shunt (TIPSS) in patients with refractory bleedin g, have resulted in improved mortality rates, currently around 11–20% per episode.
Source: Medicine - Category: Internal Medicine Authors: Tags: Management problems in liver disease Source Type: research

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AbstractPatients with advanced liver disease have traditionally been considered at risk for bleeding complications. However, although bleeding in patients with cirrhosis frequently occurs due to complications of portal hypertension, research performed within the last 15  years has increasingly shown that hemostasis in patients with liver failure generally achieves a state of “rebalance”, whereby compensatory systems restore a relatively neutral or even slightly pro-thrombotic state. Much recent clinical and in vitro research has, in fact, shown over-compensati on, such that patients with acute and stable c...
Source: Hepatology International - Category: Infectious Diseases Source Type: research
This article is protected by copyright. All rights reserved. PMID: 29633495 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: J Thromb Haemost Source Type: research
Cirrhosis is a disease which may develop as a consequence of various conditions. In advanced liver disease, blood coagulation can be seriously affected. Portal hypertension, vascular abnormalities and/or a dysbalance in coagulation factors may result in bleeding disorders or in the development of thrombosis. Fibrinogen is the main protein involved in clot formation and wound healing. The aim of this work was to analyse the glycosylation pattern of the isolated fibrinogen molecules by lectin-based protein microarray, together with the carbonylation pattern of the individual fibrinogen chains, possible changes in the molecul...
Source: Thrombosis Research - Category: Hematology Authors: Tags: Full Length Article Source Type: research
We report the clinical case of 23-year-old patient with liver cirrhosis of unknown genesis, significant resistant ascites, and 2 episodes of bleeding from esophageal varices. Evaluation did not find any cause of liver disease, and the patient was placed on the transplant wait list due to subcompensated liver function (Model for End-Stage Liver Disease score of 16, Child-Pugh class B) and poorly controlled severe portal hypertension. After treatment with diuretics, largevolume paracentesis, antibiotics, and vasoconstrictors, hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved sign...
Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation - Category: Transplant Surgery Authors: Tags: Exp Clin Transplant Source Type: research
Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased ­patency.Dig Dis
Source: Digestive Diseases - Category: Gastroenterology Source Type: research
Authors: Leonardi F, Maria N, Villa E Abstract The liver plays a crucial role in coagulation cascade. Global hemostatic process is profoundly influenced by the presence of liver disease and its complications. Patients with cirrhosis have impaired synthesis of most of the factors involved in coagulation and fibrinolysis process due to a reduced liver function and altered platelet count secondary to portal hypertension. Altered routine tests and thrombocytopenia were considered in the past as associated with increased risk of bleeding. These concepts explain both the routine use of plasma and/or platelets transfusion...
Source: Clinical and molecular hepatology - Category: Gastroenterology Tags: Clin Mol Hepatol Source Type: research
Introduction: Cirrhosis is characterized by both bleeding and thrombotic complications due to underlying procoagulative haemostatic imbalance. Among thrombotic-events, portal-vein thrombosis (PVT) is the most common with annual incidence ranging between 4.6% and 12.8%. Demonstrated associated risk-factors are severity of portal-hypertension and slowed portal-flow. However, data regarding haemostasis in the portal venous-system of cirrhotics are lacking.
Source: Digestive and Liver Disease - Category: Gastroenterology Authors: Tags: OC-30 Source Type: research
We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification) in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revea...
Source: Case Reports in Gastroenterology - Category: Gastroenterology Source Type: research
CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH. PMID: 27194018 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
ABSTRACT BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) is a heterogeneous group of diseases characterised by portal hypertension in the absence of cirrhosis. The efficacy and safety of the transjugular intrahepatic portosystemic shunt (TIPS) in this population is unknown. METHODS The charts of patients with INCPH undergoing TIPS in 7 centers between 2000 and 2014 were retrospectively reviewed. RESULTS. Forty‐one patients were included. Indication for TIPS was recurrent variceal bleeding (n=25) and refractory ascites (n=16). Patients were categorised according to the presence (n=27) or absence (n=14) of s...
Source: Hepatology - Category: Internal Medicine Authors: Tags: Liver Failure, Cirrhosis and Portal Hypertension Source Type: research
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