Filippo Schepis, MD Università degli Studi di Modena e Reggio Emilia
|
|
- Lydia Dennis
- 5 years ago
- Views:
Transcription
1 Filippo Schepis, MD Università degli Studi di Modena e Reggio Emilia Il sottoscritto dichiara di non aver avuto/di aver avuto negli ultimi 12 mesi conflitto d interesse in relazione a questa presentazione e che la presentazione non contiene/contiene discussione di farmaci in studio o ad uso off-label
2 Ascites: old and new non-pharmacological treatments Filippo Schepis, MD Hepatic Hemodynamic Laboratory Gastroenterology Unit University Hospital of Modena - Italy
3 NATURAL HISTORY OF CIRRHOSIS Baveno VI, 2015 D Amico et al, AP&T 2014
4 NATURAL HISTORY OF ASCITES FIRST ONSET ASCITES RESPONSIVE TO DIURETICS REFRACTORY ASCITES Hyponatremia Hepatorenal syndrome type I/II Salerno et al, Am J Gastroenterol 1993 Modified from Bernardi & Caraceni
5 ASCITES PATHOPHYSIOLOGY THE CLASSICAL PARADIGMA PORTAL HYPERTENSION SPLANCHNIC VASODILATION EFFECTIVE HYPOVOLEMIA RAAs SNS ADH REDUCED RENAL PERFUSION Ascites RETENTION OF Na + RETENTION OF H 2 O Modified from Bernardi & Caraceni
6 ASCITES PATHOPHYSIOLOGY THE CLASSICAL PARADIGMA PORTAL HYPERTENSION SPLANCHNIC VASODILATION EFFECTIVE HYPOVOLEMIA RAAs SNS ADH REDUCED RENAL PERFUSION AlfaPump TIPS LV paracentesis Peritoneovenous shunt Ascites RETENTION OF Na + RETENTION OF H 2 O Modified from Bernardi & Caraceni
7 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Ascites AND Cirrhosis Type: Article OR Review Resuls: 12,018 items
8 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Ascites AND Cirrhosis AND Diuretic Type: Article OR Review Resuls: 1,687 items
9 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Peritoneovenous shunts AND Ascites AND Cirrhosis Type: Article OR Review Resuls: 367 items
10 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Paracentesis AND Cirrhosis Type: Article OR Review Resuls: 1,356 items
11 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Transjugular shunt AND Ascites Type: Article OR Review Resuls: 1,377 items
12 HISTORY OF ASCITES TREATMENT A SCOPUS Overview Keywords: Alfapump AND Ascites Type: Article OR Review Resuls: 11 items
13 RECCOMANDATIONS FOR THE MANAGEMENT OF ASCITES Modified from Pericleous et al, EJGH 2016
14 RECCOMANDATIONS FOR THE MANAGEMENT OF ASCITES
15 PERITONEOVENOUS SHUNTING
16 PERITONEOVENOUS SHUNTING Renal impairment Readmission for Ascites
17 PERITONEOVENOUS SHUNTING
18 REPEATED PARACENTESIS + ALBUMIN INFUSION Survival Survival Gines et al Gastroenterology 1988
19 POST-PARACENTESIS CIRCULATORY DYSFUNCTION (PPCD) * * 8 g/l * * Gines et al, Gastroenterology 1988 Gines et al, Gastroenterology 1996
20 TOTAL PARACENTESIS + ALBUMIN INFUSION Large-volume paracentesis (LVP) is the first-line therapy in patients with large ascites (grade 3 ascites) (A1). LVP should be completed in a single session (A1). LVP should be performed together with the administration of albumin (8 g/l of ascitic fluid removed) to prevent circulatory dysfunction after LVP (A1). Readmission Survival EASL guidelines 2010 Titò et al Gastroenterology 1990
21 PARACENTESIS TECNIQUE
22 TIPS Courtesy of A. Rampoldi
23 TIPS
24 REFRACTORY ASCITES TIPS vs PARACENTESIS Salerno et al. Gastroenterology 2007
25 REFRACTORY ASCITES TIPS vs PARACENTESIS INCIDENCE OF HEPATIC ENCEPHALOPATHY 57% 36% Saab, Cochrane 2006
26 1,0 0,8 0,6 0,4 0,2 TIPS PTFE-covered vs Bare stents Free of TIPS Dysfunction P = PTFE (n=39) Bare stents (n=41) Days Clinical Recurrence PTFE Bare n VB / Ascites (n) /1 4/8 p <0.05 Bureau et al. Gastroenterology 2004
27
28 TIPS With Covered Stents Increase Transplant-free Survival of Patients With Cirrhosis and Recurrent Ascites eptfe-tips vs LVP (LVP every 3 w, not > 6 in 2 months) Post-TIPS PSPG < 12mmHg Bureau et al, Gastroenterology 2016
29
30 Post-TIPS PSPG Influences Survival Independently of MELD in Patients With Cirrhosis and Refractory Ascites (N=168) Log rank test: p 0,729 Log rank test: p 0,043 Schepis et al submitted
31 UNDER-DILATED TIPS ASSOCIATE WITH EFFICACY AND REDUCED ENCEPHALOPATHY IN CIRRHOTIC PATIENTS Schepis et al CGH, 2018
32
33 AlfaPump Back to the origin?
34 AlfaPump Refractory ascites 96% vs. 81% primary or secondary antibiotic prophylaxis for spontaneous bacterial peritonitis Bureau et al J Hep 2017
35 Fig. 2 AlfaPump Bureau et al J Hep 2017
36 AlfaPump Bureau et al J Hep 2017
37 Fig. 3 AlfaPump Bureau et al J Hep 2017
38 AlfaPump Bureau et al J Hep 2017
39 AlfaPump Solà et al, Liver Transplant 2017
40 AlfaPump Bureau et al J Hep 2017
41 AlfaPump Bureau et al J Hep 2017
42 Take Home Messages After more than 2000 years, paracentesis remains the fastest non pharmacological way to remove ascites Large volume paracentesis must be performed in association to albumin infusion The only available non pharmacological treatment which improves survival is TIPS A better definition of candidate patients to TIPS together with a better control of post TIPS hemodynamic events will decrease mortality and morbidity related to TIPS Future palliative treatment of refractory or difficult to treat ascites should take into account its physiopathology
43 GRAZIE PER L ATTENZIONE
Management of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University
Management of Cirrhotic Complications Uncontrolled Ascites Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Topic Definition, pathogenesis Current therapeutic options Experimental treatments
More informationDiagnostic Procedures. Measurement of Hepatic venous pressure in management of cirrhosis. Clinician s opinion
5 th AISF Post-Meeting Course Diagnostic and Therapeutic Invasive Procedures in Hepatology Rome, February 25 th Diagnostic Procedures Measurement of Hepatic venous pressure in management of cirrhosis Clinician
More informationInvasive Evaluation of Portal Hypertension. Vincenzo La Mura, MD PhD Department of Biomedical Sciences for Health University of Milan
Invasive Evaluation of Portal Hypertension Vincenzo La Mura, MD PhD Department of Biomedical Sciences for Health University of Milan Vincenzo La Mura, MD, PhD Dipartimento di scienze Biomediche per la
More informationComplication of Portal Hypertension: should the patients in the waiting list be treated differently?
Wilma Debernardi Venon Gastroepatologia, Az. Osp. San Giovanni Battista ditorino Complication of Portal Hypertension: should the patients in the waiting list be treated differently? Il sottoscritto dichiara
More informationAlcoholic Liver Disease as First Indication
Alcoholic Liver Disease as First Indication Patrizia Burra Multivisceral Transplant Unit Gastroenterology Department of Surgery, Oncology and Gastroenterology Padua University Hospital, Padua, Italy Patrizia
More informationInitial approach to ascites
Ascites: Filling and Draining the Water Balloon Common Pathogenesis in Refractory Ascites, Hyponatremia, and Cirrhosis intrahepatic resistance sinusoidal portal hypertension Splanchnic vasodilation (effective
More informationLiver transplant: what is left after the viruses
Riunione Monotematica A.I.S.F. 2016 The Future of Liver Disease: Beyond HCV is there a Role for Hepatologist? Milan 15 th 2016 Liver transplant: what is left after the viruses Stefano Ginanni Corradini
More informationPazienti con Genotipo 1 e Cirrosi Scompensata, pre-/post-olt
Monotematica AISF 2013 Pazienti con Genotipo 1 e Cirrosi Scompensata, pre-/post-olt Pietro Andreone Dipartimento di Scienze Mediche e Chirurgiche Alma Mater Studiorum, Università di Bologna Pisa, 17-19
More informationAscites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology
Ascites Management Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Disclosure 1. The speaker Atif Zaman, MD MPH have no relevant
More informationTreating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC
Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC mino.mitri@ubc.ca No Conflict of Interest 157 patients 157 patients 6 transplanted Criteria Liver
More informationTIPS in the Management of Portal Hypertension Clinician s Opinion
TIPS in the Management of Portal Hypertension Clinician s Opinion Oliviero Riggio 5 th AISF post meeting course Diagnostic and Therapeutic Procedures in Hepatology 2012 Oliviero Riggio Dipartimento di
More informationManagement of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy
Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:
More informationPrototypes of autoimmune hepatitis and sclerosing cholangitis in childhood
RIUNIONE MONOTEMATICA AISF 2013 Personalizzazione della Cura in Epatologia 17-19 ottobre 2013, PISA Prototypes of autoimmune hepatitis and sclerosing cholangitis in childhood La sottoscritta dichiara di
More informationProf. Mohammad Umar. MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA
Prof. Mohammad Umar MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA Chairman and Head Department of Medicine Rawalpindi Medical College, Rawalpindi. Consultant Gastroenterologist / Hepatologist
More informationHepatocellular carcinoma: Intra-arterial treatments
Hepatocellular carcinoma: Intra-arterial treatments Irene Bargellini U.O. Radiologia Interventistica Azienda Ospedaliero Universitaria Pisana IRENE BARGELLINI,MD UO RADIOLOGIA INTERVENTISTICA, AZIENDA
More informationRole of Nutritional Support in the Treatment of Alcoholic Liver Disease
Riunione Monotematica AISF Alcoholic Liver Disease: The New Challenge Roma, 4-6 Ottobre 2017 Role of Nutritional Support in the Treatment of Alcoholic Liver Disease Esmeralda Capristo Divisione di Patologie
More informationEDUCATION PRACTICE. Cirrhosis With Refractory Ascites: Serial Large Volume Paracentesis, TIPS, or Transplantation?
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:931 935 EDUCATION PRACTICE Cirrhosis With Refractory Ascites: Serial Large Volume Paracentesis, TIPS, or Transplantation? VANDANA KHUNGAR* and SAMMY SAAB*,
More informationA patient with acute on chronic liver failure
A patient with acute on chronic liver failure Dott.ssa Marta Cavallin Dept. of Medicine of University of Padova, Italy 6 th Post Meeting AISF Rome, 23 rd February 2013 Dott.ssa Marta Cavallin medico in
More informationJOURNAL PRESENTATION. Dr Tina Fan Tseung Kwan O Hospital 17 th Jan 2013
JOURNAL PRESENTATION Dr Tina Fan Tseung Kwan O Hospital 17 th Jan 2013 THE COMBINATION OF OCTREOTIDE AND MIDODRINE IS NOT SUPERIOR TO ALBUMIN IN PREVENTING RECURRENCE OF ASCITES AFTER LARGE-VOLUME PARACENTESIS
More informationThe Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008
The Management of Ascites & Hepatorenal Syndrome Florence Wong University of Toronto Falk Symposium March 14, 2008 Management of Ascites Sodium Restriction Mandatory at all stages of ascites in order to
More informationHepatorenal syndrome. Jan T. Kielstein Departent of Nephrology Medical School Hannover
Hepatorenal syndrome Jan T. Kielstein Departent of Nephrology Medical School Hannover Hepatorenal Syndrome 1) History of HRS 2) Pathophysiology of HRS 3) Definition of HRS 4) Clinical presentation of HRS
More informationNorepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome
Norepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome Disclosure I have no conflicts of interest to disclose Name: Margarita Taburyanskaya Title: PharmD, PGY1 Pharmacy Practice Resident
More informationStaging and prognostic systems: beyond BCLC?
Staging and prognostic systems: beyond BCLC? Alessandro Vitale, MD, PhD, FEBS U.O.C. di Chirurgia Epatobiliare e dei Trapianti Epatici, Department of Surgery, Oncology and Gastroenterology, University
More informationColangiocarcinoma on the rise!
Colangiocarcinoma on the rise! D. ALVARO, Univ. Sapienza, Rome, Italy. MONOTEMATICA AISF, The future of Liver Diseases, Milano 13-15 Ottobre 2016 Domenico ALVARO, MD. SAPIENZA, ROMA Il sottoscritto dichiara
More informationBeta-blockers in cirrhosis: Cons
Beta-blockers in cirrhosis: Cons Eric Trépo MD, PhD Dept. of Gastroenterology. Hepatopancreatology and Digestive Oncology. C.U.B. Hôpital Erasme. Université Libre de Bruxelles. Bruxelles. Belgium Laboratory
More informationEDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1187 1191 EDUCATION PRACTICE Management of Refractory Ascites ANDRÉS CÁRDENAS and PERE GINÈS Liver Unit, Institute of Digestive Diseases, Hospital Clínic,
More informationBETA-BLOCKERS IN CIRRHOSIS.PRO.
BETA-BLOCKERS IN CIRRHOSIS.PRO. Angela Puente Sánchez. MD PhD Hepatology Unit. Gastroenterology department Marques de Valdecilla University Hospital. Santander INTRODUCTION. Natural history of cirrhosis
More informationContraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for:
Contraindications Absolute Relative Primary prevention variceal bleeding HCC if centrally located Active congestive heart failure Obstruction all hepatic veins Thomas D. Boyer, M.D. University of Arizona
More informationComplications of Cirrhosis
Complications of Cirrhosis Causes of Cirrhosis Alcohol Chronic Viral Hepatitis (B/C) Haemochromatosis Autoimmune Hepatitis NAFLD/NASH Primary Biliary Cirrhosis Primary Sclerosing Cholangitis 1-AT deficiency
More informationREVIEW. Ariel W. Aday, M.D.,* Nicole E. Rich, M.D.,* Arjmand R. Mufti, M.D., and Shannan R. Tujios, M.D.
REVIEW CON ( The Window Is Closed ): In Patients With Cirrhosis With Ascites, the Clinical Risks of Nonselective beta-blocker Outweigh the Benefits and Should NOT Be Prescribed Ariel W. Aday, M.D.,* Nicole
More informationPierluigi Toniutto Clinica di Medicina Interna Azienda Ospedaliero Universitaria Udine
Pierluigi Toniutto Clinica di Medicina Interna Azienda Ospedaliero Universitaria Udine Il sottoscritto dichiara di non aver avuto negli ultimi 12 mesi conflitto d interesse in relazione a questa presentazione
More informationLong term administration of human albumin improves survival in patients with cirrhosis and refractory ascites
Received: 3 May 2018 Revised: 2 August 2018 Accepted: 12 September 2018 DOI: 10.1111/liv.13968 CIRRHOSIS AND LIVER FAILURE Long term administration of human albumin improves survival in patients with cirrhosis
More informationEASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis European Association for the Study of the Liver 1 Ascites is the
More informationVARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.
VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic
More informationHepatorenal syndrome. Jan Jan T. T. Kielstein Departent of of Nephrology Medical School School Hannover
Hepatorenal syndrome Jan Jan T. T. Kielstein Departent of of Nephrology Medical School School Hannover Hepatorenal Syndrome 1) History of HRS 2) Pathophysiology of HRS 3) Definition of HRS 4) Clinical
More informationManagement of refractory ascites in cirrhosis: Are we out of date?
Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.4254/wjh.v8.i28.1182 World J Hepatol 2016 October 8; 8(28): 1182-1193 ISSN 1948-5182 (online)
More informationDenver Shunts vs TIPS for Ascites
Denver Shunts vs TIPS for Ascites Hooman Yarmohammadi MD Assistant Professor of Radiology Interventional Radiology & Image Guided Therapies Memorial Sloan-Kettering Cancer Center, New York, USA Hooman
More informationAscites is the most common complication of cirrhosis and. Natural History of Patients Hospitalized for Management of Cirrhotic Ascites
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:1385 1394 Natural History of Patients Hospitalized for Management of Cirrhotic Ascites RAMON PLANAS,* SILVIA MONTOLIU,* BELEN BALLESTÉ, MONICA RIVERA, MIREIA
More informationPALLIATIVE CARE IN END-STAGE LIVER DISEASE
PALLIATIVE CARE IN END-STAGE LIVER DISEASE Ken S. Ota, DO Family Medicine Banner Good Samaritan Medical Center Learning Objectives: Describe the common bio-psycho-social issues in end-stage liver disease
More informationPortal hypertension is the main complication of cirrhosis
GASTROENTEROLOGY 2001;120:726 748 Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis GUADALUPE GARCIA TSAO
More informationManagement of Cirrhosis Related Complications
Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this
More informationManaging Cirrhosis. Cirrhosis of the liver is a progressive, fibrosing. Ascites. By Cameron Ghent, MD, FRCPC. Complications of Cirrhosis
Focus on CME at the University of Western Ontario Managing Cirrhosis By Cameron Ghent, MD, FRCPC Cirrhosis of the liver is a progressive, fibrosing process resulting in nodule formation and microvascular
More informationManagement of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL
Management of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL Terminology Acute decompensation of cirrhosis - stable patient with sudden deterioration Acute-on-chronic liver failure
More informationManaging the expansion of TIPS stents supports optimal post TIPS gradient and reduces post TIPS HE
Managing the expansion of TIPS stents supports optimal post TIPS gradient and reduces post TIPS HE Schepis Filippo, MD Hepatic Hemodynamic Laboratory Gastroenterology Unit University Hospital of Modena
More informationTherapy Insight: management of hepatorenal syndrome
Therapy Insight: management of hepatorenal syndrome Andrés Cárdenas and Pere Ginès* SUMMARY Hepatorenal syndrome (HRS), a feared complication of advanced cirrhosis, is characterized by functional renal
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Accelerated intravascular coagulation and fibrinolysis (AICF) in liver disease, 390 391 Acid suppression in liver disease, 403 404 ACLF.
More informationHepatology on the AMU
Hepatology on the AMU RCP day, 8 th February 2018 Jo Leithead Consultant in Hepatology and Liver Transplantation Addenbrookes Hospital Cambridge Is liver disease relevant to me? Williams R, Lancet 2014
More informationThe role of TIPS in the management of liver transplant candidates
Original Article The role of TIPS in the management of liver transplant candidates United European Gastroenterology Journal 217, Vol. 5(8) 11 117! Author(s) 217 Reprints and permissions: sagepub.co.uk/journalspermissions.nav
More informationINCIDENCE OF BACTERIAL INFECTIONS IN CIRRHOSIS
INCIDENCE OF BACTERIAL INFECTIONS IN CIRRHOSIS Yoshida H et al (1993)* Deschenes M et al (1999)** Strauss E et al (1993) Borzio M et al (2002) PATIENTS 1140 140 170 405 INFECTIONS 15.4% 20% 47% 34% * Many
More informationCIRRHOTIC MANAGEMENT
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationMANAGING END STAGE LIVER DISEASE IN RESOURCE LIMITED SETTINGS
MANAGING END STAGE LIVER DISEASE IN RESOURCE LIMITED SETTINGS Mark W. Sonderup Division of Hepatology and Liver Laboratory Department of Medicine University of Cape Town & Groote Schuur Hospital Cirrhosis..
More informationEvidence-Base Management of Esophageal and Gastric Varices
Evidence-Base Management of Esophageal and Gastric Varices Rino Alvani Gani Hepatobiliary Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National
More informationTerlipressin: An Asset for Hepatologists!
DIAGNOSTIC AND THERAPEUTIC ADVANCES IN HEPATOLOGY Terlipressin: An Asset for Hepatologists! S.K. Sarin and Praveen Sharma One Case Scenario A 48-year-old male with alcoholic cirrhosis who was abstinent
More informationRiunione Monotematica AISF 2017 Roma 5 Ottobre Management of Alcohol Use Disorders in Patients with Alcoholic Liver Disease
Riunione Monotematica AISF 2017 Roma 5 Ottobre 2017 Management of Alcohol Use Disorders in Patients with Alcoholic Liver Disease Lorenzo Leggio, M.D., Ph.D., M.Sc. Lorenzo Leggio, M.D., Ph.D., M.Sc. Il
More informationTitle: Complete splenic embolization for the treatment of refractory ascites after liver transplantation
Title: Complete splenic embolization for the treatment of refractory ascites after liver transplantation Authors: Oana Anisa Nutu, Iago Justo Alonso, Alberto Alejandro Marcacuzco Quinto, Jorge Calvo Pulido,
More informationFrom Sodium Retention to Therapy for Refractory Ascites The Role for New Drugs. Florence Wong University of Toronto. Falk Symposium October 14, 2007
From Sodium Retention to Therapy for Refractory Ascites The Role for New Drugs Florence Wong University of Toronto Falk Symposium October 14, 2007 Sodium Retention in Cirrhosis Occurs as a result of hemodynamic
More informationISPUB.COM. Management of Ascites. V Mahesh SOURCE OF SUPPORT DIAGNOSIS OF ASCITES INTRODUCTION CAUSES [,] DIAGNOSTIC TESTS
ISPUB.COM The Internet Journal of Gastroenterology Volume 5 Number 2 Management of Ascites V Mahesh Citation V Mahesh. Management of Ascites. The Internet Journal of Gastroenterology. 2006 Volume 5 Number
More informationSign up to receive ATOTW weekly -
HEPATORENAL SYNDROME ANAESTHESIA TUTORIAL OF THE WEEK 240 10 TH SEPTEMBER 2011 Gerry Lynch Rotherham General Hospital Correspondence to gerry.lynch@rothgen.nhs.uk QUESTIONS Before continuing, try to answer
More informationTowards Precision Medicine in Primary Biliary Cholangitis
Riunione Monotematica A.I.S.F. 2016 THE FUTURE OF LIVER DISEASES: Beyond HCV is there a role for the hepatologist? 14 th October 2016 Towards Precision Medicine in Primary Biliary Cholangitis Marco Carbone,
More informationManagement of Chronic Liver Failure/Cirrhosis Complications in Hospitals. By: Dr. Kevin Dolehide
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals By: Dr. Kevin Dolehide Overview DX Cirrhosis and Prognosis Compensated Decompensated Complications Of Cirrhosis Management Of Complications
More informationAcute kidney injury and hepatorenal syndrome in cirrhosis
bs_bs_banner doi:10.1111/jgh.12709 REVIEW ARTICLE Acute kidney injury and hepatorenal syndrome in cirrhosis Mads Egerod Israelsen,* Lise Lotte Gluud and Aleksander Krag* *Department of Gastroenterology,
More informationHepatocellular carcinoma: from guidelines to individualized treatment
AISF 2012 Rome, 22-24 February 2012 Hepatocellular carcinoma: from guidelines to individualized treatment A.D. 1088 Luigi Bolondi Professor of Medicine, Chairman Department of Digestive Diseases and Internal
More informationSteps in Assessing Fibrosis 4/30/2015. Overview of Liver Disease Associated With HCV
Overview of Liver Disease Associated With HCV Marion G. Peters, MD John V. Carbone, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco San Francisco,
More informationVirtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12:
Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12: 805-809. CLINICAL PEARL Indications for Use of TIPS in Treating Portal Hypertension Elizabeth C. Verna,
More informationVariceal bleeding. Mainz,
Variceal bleeding Mainz, 21.09.2008 Risk of complications 5 years 10 years Ascites 10 % 25 % HCC 10 % 25 % Bleeding < 5 % 5-10 % Enceph. < 5 % < 5 % Typical situation : Mortality 10 % to 40 % Sequence
More informationThe Use of Albumin for the Prevention of Hepatorenal Syndrome in Patients with Spontaneous Bacterial Peritonitis and Cirrhosis
The Use of Albumin for the Prevention of Hepatorenal Syndrome in Patients with Spontaneous Bacterial Peritonitis and Cirrhosis http://www.funnyjunk.com/funny_pictures/1743659/enlarged/ Daniel Giddings,
More informationJMSCR Vol 05 Issue 11 Page November 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i11.33 Prevalence of Hyponatremia among patients
More informationL USO DELLA RISORSA ALBUMINA LA PROSPETTIVA DEL CLINICO
AISF-SIMTI POSITION PAPER - L USO APPROPRIATO DELL ALBUMINA Roma, 29 marzo 2016 L USO DELLA RISORSA ALBUMINA LA PROSPETTIVA DEL CLINICO Mauro Bernardi Semeiotica Medica Dipartimento di Scienze Mediche
More informationManagement of the Cirrhotic Patient in the ICU
Management of the Cirrhotic Patient in the ICU Peter E. Morris, MD Professor & Chief, Pulmonary, Critical Care and Sleep Medicine University of Kentucky Conflict of Interest Funding US National Institutes
More informationConflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension.
Complications of end stage liver disease Conflict of interest disclosures None Amir Qamar, MD Instructor of Medicine Brigham and Women s s Hospital Harvard Medical School Boston, MA 02115 The many complications
More informationHepatorenal Syndrome
Review Abdussalam Shredi MD, Sakolwan Suchartlikitwong MD, Hawa Edriss MD Abstract Hepatorenal syndrome is a form of acute kidney injury that occurs in chronic liver disease and acute fulminant liver failure.
More informationT herapeutic (that is, total) paracentesis is used in patients
90 LIVER AND BILIARY DISEASE Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by : a randomised pilot study R Moreau, T
More informationAASLD PRACTICE GUIDELINE. The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension. Preamble.
AASLD PRACTICE GUIDELINE The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension Thomas D. Boyer 1 and Ziv J. Haskal 2 Preamble The recommendations in this article
More informationCIRCULATORY AND RENAL FAILURE IN CIRRHOSIS
CIRCULATORY AND RENAL FAILURE IN CIRRHOSIS Pere Ginès, MD Liver Unit, Hospital Clínic Barcelona, Catalunya, Spain CIRCULATORY AND RENAL FAILURE IN CIRRHOSIS Hecker R and Sherlock S, The Lancet 1956 RENAL
More informationfollowing the last documented transfusion; thereafter, evaluate the residual impairment(s).
Adult Listings 5.01 Category of Impairments, Digestive System 5.02 Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood
More informationHepatorenal syndrome
Annals of Hepatology 2003; 2(1): January-March: 23-29 Concise Review Annals of Hepatology Hepatorenal syndrome Andrés Cárdenas, M.D., 1 Vicente Arroyo, M.D. 2 Abstract Hepatorenal syndrome is complication
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationCIRRHOSIS Definition
Cirrhosis Update Robert S. Brown, Jr., MD, MPH Vice Chair, Transitions of Care Interim Chief, Division of Gastroenterology & Hepatology Weill Cornell Medical College CIRRHOSIS Definition Irreversible fibrous
More informationPerché viene la NASH (2): microbiota e permeabilità intestinale G. Svegliati-Baroni
Perché viene la NASH (2): microbiota e permeabilità intestinale G. Svegliati-Baroni Clinica di Gastroenterologia SOS Epatopatie Croniche e Trapianto di Fegato Università Politecnica delle Marche Ancona
More informationInfections In Cirrhotic patients. Dr Abid Suddle Institute of Liver Studies King s College Hospital
Infections In Cirrhotic patients Dr Abid Suddle Institute of Liver Studies King s College Hospital Infection in cirrhotic patients Leading cause morbidity/mortality Common: 30-40% of hospitalised cirrhotic
More informationDOTTORATO DI RICERCA IN SCIENZE MEDICO-CHIRURGICHE GASTROENTEROLOGICHE E DEI TRAPIANTI TITOLO TESI FACTORS PREDICTING MORTALITY AFTER TIPS FOR
Alma Mater Studiorum Università di Bologna DOTTORATO DI RICERCA IN SCIENZE MEDICO-CHIRURGICHE GASTROENTEROLOGICHE E DEI TRAPIANTI Ciclo XXII Settore/i scientifico-disciplinare/i di afferenza: MED/12 TITOLO
More informationEnd-Stage Liver Disease (ESLD): A Guide for HIV Physicians
Slide 1 of 32 End-Stage Liver Disease (ESLD): A Guide for HIV Physicians Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California
More informationAscites is the most frequent complication of cirrhosis,
Beneficial Effect of Midodrine in Hypotensive Cirrhotic Patients with Refractory Ascites G & H C l i n i c a l C a s e S t u d i e s Achuthan Sourianarayanane, MD, MRCP 1 David S. Barnes, MD 1,2 Arthur
More informationEsophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationHepatorenal syndrome a defined entity with a standard treatment?
Hepatorenal syndrome a defined entity with a standard treatment? Falk Symposium 162 Dresden - October 14, 2007 Alexander L. Gerbes Klinikum of the University of Munich Grosshadern Department of Medicine
More informationManagement of ascites in cirrhosis
doi:10.1111/j.1440-1746.2011.06925.x ADVANCES IN CLINICAL PRACTICE jgh_6925 11..20 Management of ascites in cirrhosis Florence Wong Department of Medicine, Toronto General Hospital, University of Toronto,
More informationCare of the Patient With Cirrhosis
REVIEW Care of the Patient With Cirrhosis Anitha Yadav, M.D., and Hugo E. Vargas, M.D. Caring for patients with cirrhosis involves multidisciplinary and timely management of several complications while
More informationProgram Disclosure. This program is supported by an educational grant from Salix Pharmaceuticals.
Program Disclosure This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the sponsorship
More informationTreatment and management of ascites and hepatorenal syndrome: an update
564673TAG0010.1177/1756283X14564673Therapeutic Advances in GastroenterologyK. Lenz et al. review-article2014 Therapeutic Advances in Gastroenterology Review Treatment and management of ascites and hepatorenal
More informationPathophysiology, diagnosis and treatment of ascites in cirrhosis
Annals of hepatology 2002; 1(2): April-June: 72-79 Concise Review Annals of hepatology Pathophysiology, diagnosis and treatment of ascites in cirrhosis Vicente Arroyo 1, M.D. Abstract The mechanism by
More informationACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis
ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,
More informationESLD a Guide for HIV Physicians. Marion Peters University of California San Francisco June 2015
ESLD a Guide for HIV Physicians Marion Peters University of California San Francisco June 2015 Disclosures Honararia from Johnson and Johnson Roche Merck Gilead Spouse employee of Hoffman La Roche Natural
More informationAssociation between the Serum Sodium Levels and the Response to Tolvaptan in Liver Cirrhosis Patients with Ascites and Hyponatremia
doi: 10.2169/internalmedicine.0629-17 Intern Med 57: 2451-2458, 2018 http://internmed.jp ORIGINAL ARTICLE Association between the Serum Sodium Levels and the Response to Tolvaptan in Liver Cirrhosis Patients
More informationThe Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust
The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.
More informationHepatorenal Syndrome
Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot
More informationRISK STRATIFICATION IN CIRRHOSIS: FOCUS ON UMBILICAL HERNIA Sam Hawkins MD PGY5
RISK STRATIFICATION IN CIRRHOSIS: FOCUS ON UMBILICAL HERNIA Sam Hawkins MD PGY5 PATIENT PRESENTATION 73M w/ Hep B Cirrhosis, HTN, DM II Liver disease followed at OSH x2 years (when moved from China), on
More informationDefinition: fibrosis and nodular regeneration resulting from hepatocellular injury
Cirrhosis Understanding the liver: Patterns of LFT Abnormalities - Hepatocellular/Transaminitis: o Ratio of AST: ALT >2:1 ETOH (keep in mind AST is also produced by red cells, heart muscle) o If Aminotransferases
More informationB C Outlines. Child-Pugh scores
B C 2016-12-09 Outlines Child-Pugh scores CT MRI Fibroscan / ARFI Histologic Scoring Systems for Fibrosis Fibrosis METAVIR Ishak None 0 0 Portal fibrosis (some) 1 1 Portal fibrosis (most) 1 2 Bridging
More informationFaculty Disclosure. Objectives. Cirrhosis Management for the Family Physician 18/11/2014
Cirrhosis Management for the Family Physician Mang Ma, MD, FRCP Professor University of Alberta Faculty: Mang Ma Faculty Disclosure Relationships with commercial interests: Advisory Board: Merck, Gilead
More information