Diagnosis and Management of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a severe complication of cirrhosis. The prevalence of overt HE (OHE) ranges from 30% to 45%, whereas the prevalence of minimal HE (MHE) is as high as 85% in some case series. Widespread use of transjugular intrahepatic portosystemic shunt to control complications related to portal hypertension is associated with an increase in HE incidence. If the diagnosis of OHE remains simple in most cases, then the diagnosis of MHE is less codified because of many differential diagnoses with different therapeutic implications. This review analyzes current knowledge about the pathophysiology, diagnosis, an...
Source: Clinics in Liver Disease - March 11, 2021 Category: Gastroenterology Authors: Marika Rudler, Nicolas Weiss, Charlotte Bouzbib, Dominique Thabut Source Type: research
Management of Severe and Refractory Ascites
Considering the poor prognosis, severe and refractory ascites is a milestone in cirrhotic patients. Liver transplantation must be considered first. In the case of contraindication to liver transplantation or when the waiting period is estimated to be more than 6 months, transjugular intrahepatic portosystemic shunt should be discussed in eligible patients. Regardless of the type of treatment, a careful selection of patients is crucial to avoid further decompensation and specific complications of each treatment. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 11, 2021 Category: Gastroenterology Authors: H élène Larrue, Jean Pierre Vinel, Christophe Bureau Source Type: research
Monitoring Renal Function and Therapy of Hepatorenal Syndrome Patients with Cirrhosis
Acute kidney injury (AKI) is a frequent complication in patients with cirrhosis. Patients with cirrhosis can develop AKI due to different causes. Hepatorenal syndrome (HRS) is a unique cause of AKI occurring in patients with advanced cirrhosis and is associated with high short-term mortality. The differential diagnosis between different causes of AKI may be challenging. In this regard, new urine biomarkers may be helpful. Liver transplantation is the definitive treatment of patients with HRS-AKI. Vasoconstrictors and albumin represent the first-line pharmacologic treatment of HRS-AKI. This review summarizes current knowled...
Source: Clinics in Liver Disease - March 11, 2021 Category: Gastroenterology Authors: Adri à Juanola, Cristina Solé, David Toapanta, Pere Ginès, Elsa Solà Source Type: research
The Role of Hepatic Venous Pressure Gradient in the Management of Cirrhosis
This article addresses the applications of measuring portal pressure in cirrhosis, including the differential diagnosis of portal hypertension; estimation of prognosis in cirrhosis, including preoperative evaluation before hepatic and extrahepatic surgery; assessment of the response to drug therapy (mainly in the context of drug development); and assessing the regression of portal hypertension syndrome. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Daniel Veldhuijzen van Zanten, Elizabeth Buganza, Juan G Abraldes Source Type: research
Prevention of First Decompensation in Advanced Chronic Liver Disease
This article explains the importance of preventing first decompensation and summarizes the evidence for etiologic and etiology-independent (most important, nonselective beta-blockers and statins) therapies. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Mattias Mandorfer, Benedikt Simbrunner Source Type: research
Prevention of Variceal Bleeding and Rebleeding by Nonselective Beta-Blockers
Nonselective beta-blockers represent the mainstay of medical therapy in the prophylaxis of variceal bleeding and rebleeding in patients with portal hypertension. Their efficacy has been demonstrated by numerous trials; however, there exist safety concerns in advanced disease, such as in patients with refractory ascites. Importantly, nonselective beta-blockers also exert nonhemodynamic beneficial effects that may contribute to a prolonged decompensation-free survival, as recently shown in the PREDESCI trial. This review summarizes the current evidence on nonselective beta-blocker therapy and proposes a tailored, patient-cen...
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Mathias Jachs, Thomas Reiberger Source Type: research
Bacterial Infections in Cirrhosis as a Cause or Consequence of Decompensation?
Bacterial infections are ominous events in liver cirrhosis. Cirrhosis-associated immune dysfunction and pathologic bacterial translocation are responsible for the increased risk of infections. Bacteria induce systemic inflammation, which worsens circulatory dysfunction and induces oxidative stress and mitochondrial dysfunction. Bacterial infections, frequently associated with decompensation, are the most common precipitating event of acute-on-chronic liver failure (ACLF). After decompensation, patients with cirrhosis have an increased risk of developing infections. Bacterial infections should be ruled out in these patients...
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Salvatore Piano, Paolo Angeli Source Type: research
Acute Decompensation and Acute-on-Chronic Liver Failure
Liver cirrhosis is a major healthcare problem. Acute decompensation, and in particular its interplay with dysfunction of other organs, is responsible for the majority of deaths in patients with cirrhosis. Acute decompensation has different courses, from stable decompensated cirrhosis over unstable decompensated cirrhosis to pre-acute-on-chronic liver failure and finally acute-on-chronic liver failure, a syndrome with high short-term mortality. This review focuses on the recent developments in the field of acute decompensation and acute-on-chronic liver failure. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Philip Ferstl, Jonel Trebicka Source Type: research
Current Concepts of Cirrhotic Cardiomyopathy
Cirrhotic cardiomyopathy (CCM) connotes systolic and/or diastolic dysfunction in patients with end-stage liver disease in the absence of prior heart disease. Its prevalence is variable across different studies but recent data suggest that CCM may affect up to one third of liver transplant candidates. The etiology of CCM is multifactorial. CCM defining features were recently revised to improve the diagnostic and prognostic yield of CCM criteria and inform candidate selection for liver transplantation. CCM appears to increase the risk for unfavorable outcomes pre- and post-transplant. Close clinical and echocardiographic fol...
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Manhal J. Izzy, Lisa B. VanWagner Source Type: research
Invasive Procedures in Patients with Cirrhosis
The aim on of this article is to provide an update on the coagulation disturbances of patients with cirrhosis. It summarizes basic concepts of coagulation in cirrhosis, available tests used to predict bleeding, procedures and risk of bleeding, and the rationale and expert-based recommendations of prophylactic measures for patients with cirrhosis who undergo invasive procedures. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Annabel Blasi, Andr és Cárdenas Source Type: research
Complications of Cirrhosis
Cirrhosis ranks among the most common global causes of morbidity and mortality. While effective therapies for some liver diseases, such as direct-acting antivirals against hepatitis C, have profoundly changed the landscape, an increasing number of patients with cirrhosis due to fatty liver disease, alcoholic liver disease, and autoimmune disease need to be evaluated for liver transplantation in the absence of effective treatment options. The knowledge gained from recent trials and the important results obtained from landmark research studies continuously inform our clinical practice. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 9, 2021 Category: Gastroenterology Authors: Andres Cardenas, Thomas Reiberger Tags: Preface Source Type: research
The Changing Liver Transplant Recipient
Hepatitis C virus has historically been the leading indication for liver transplant, followed by nonalcoholic steatohepatitis (NASH) and alcoholic liver disease. Severe alcoholic hepatitis has become a growing indication for liver transplant, and overall alcohol use rates continue to increase in the United States. Rates of obesity and NASH in the United States continue to increase and are expected to place increasing demand on liver transplant infrastructure. In the current absence of robust pharmacologic therapy for NASH, the use of bariatric procedures and surgeries is being explored, as are other innovative approaches t...
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Authors: Ross Vyhmeister, C. Kristian Enestvedt Source Type: research
Liver Transplantation
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Authors: David Goldberg Source Type: research
Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Source Type: research
Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Source Type: research
