scholarly journals External Hemorrhage from a Portacaval Anastomosis in a Patient with Liver Cirrhosis

2014 ◽  
Vol 2014 ◽  
pp. 1-2
Author(s):  
Murat Biyik ◽  
Ramazan Ucar ◽  
Sami Cifci ◽  
Orhan Ozbek ◽  
Gokhan Gungor ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Abdominal Wall ◽  
Variceal Bleeding ◽  
Anterior Abdominal Wall ◽  
Major Complication ◽  
Gastric Varices ◽  
Portacaval Anastomosis ◽  
Esophageal And Gastric Varices

Variceal bleeding is the major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage mainly occurs in gastrointestinal lumen. Extraluminal hemorrhages are quite rare, such as intraperitoneal hemorrhages. We aimed to present a variceal bleeding case from the anastomosis on the anterior abdominal wall, as an extraordinary bleeding location, in a patient with portal hypertension in whom there were no esophageal and gastric varices.

scholarly journals Characteristics of peptic ulcer bleeding in cirrhosis with esophageal and gastric varices

2019 ◽  
Author(s):  
Zheng Lu ◽  
Xiaotian Sun ◽  
Jingjing Han ◽  
Bo Jin ◽  
Wenhui Zhang ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Variceal Bleeding ◽  
Gastric Varices ◽  
Ulcer Bleeding ◽  
Common Symptom ◽  
Peptic Ulcer Bleeding ◽  
Esophageal And Gastric Varices ◽  
Independent Risk Factors ◽  
Endoscopic Characteristics

Abstract Background Upper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding, which has been easily neglected. Thus, this study aimed to analyzed and compared the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis patients. Methods Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 in our hospital were enrolled, and classified into peptic ulcer bleeding group (n=248) and variceal bleeding group (n=402) based on the bleeding cause. The clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated and compared, and independent risk factors for 42-day morality in peptic ulcer bleeding in cirrhotic EGV patients were determined. Results Compared with variceal bleeding group, peptic ulcer bleeding group were older (55.58±11.37 vs. 52.87±11.57, P<0.01) and more stable, and the most common symptom was melena. Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P<0.01). The success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35%, respectively (P=0.021). Univariate and multivariate analysis identified emergency intervention (P=0.018, OR [95% CI] 11.270 [1.503-84.501]), hepatic encephalopathy before bleeding (P=0.034, OR [95% CI] 6.831 [1.159-40.255]) and hepatic renal syndrome before bleeding (P=0.013, OR [95% CI] 8.482 [1.568-45.869]) as three independent predictors for 42-day mortality. Conclusion Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics, and urgent endoscopic treatment is needed once diagnosed.

scholarly journals Managing liver cirrhotic complications: Overview of esophageal and gastric varices

2020 ◽  
Vol 26 (4) ◽  
pp. 444-460 ◽  
Author(s):  
Cosmas Rinaldi Adithya Lesmana ◽  
Monica Raharjo ◽  
Rino A. Gani
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Portal Pressure ◽  
Gastric Varices ◽  
Non Invasive ◽  
Esophagogastric Varices ◽  
Cirrhotic Patients ◽  
Clinically Significant ◽  
Gradient Measurement

Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

scholarly journals Beyond the scope and the glue: update on evaluation and management of gastric varices

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cyriac Abby Philips ◽  
Rizwan Ahamed ◽  
Sasidharan Rajesh ◽  
Tom George ◽  
Meera Mohanan ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Endovascular Procedures ◽  
Gastric Varices ◽  
Current Evidence ◽  
Ultrasound Guided ◽  
Algorithmic Approach ◽  
Evidence Based Treatments ◽  
Intrahepatic Portosystemic Shunt ◽  
Shed Light

Abstract Gastric varices are encountered less frequently than esophageal varices. Nonetheless, gastric variceal bleeding is more severe and associated with worse outcomes. Conventionally, gastric varices have been described based on the location and extent and endoscopic treatments offered based on these descriptions. With improved understanding of portal hypertension and the dynamic physiology of collateral circulation, gastric variceal classification has been refined to include inflow and outflow based hemodynamic pathways. These have led to an improvement in the management of gastric variceal disease through newer modalities of treatment such as endoscopic ultrasound-guided glue-coiling combination therapy and the emergence of highly effective endovascular treatments such as shunt and variceal complex embolization with or without transjugular intrahepatic portosystemic shunt (TIPS) placement in patients who are deemed ‘difficult’ to manage the traditional way. Furthermore, the decisions regarding TIPS and additional endovascular procedures in patients with gastric variceal bleeding have changed after the emergence of ‘portal hypertension theories’ of proximity, throughput, and recruitment. The hemodynamic classification, grounded on novel theories and its cognizance, can help in identifying patients at baseline, in whom conventional treatment could fail. In this exhaustive review, we discuss the conventional and hemodynamic diagnosis of gastric varices concerning new classifications; explore and illustrate new ‘portal hypertension theories’ of gastric variceal disease and corresponding management and shed light on current evidence-based treatments through a ‘new’ algorithmic approach, established on hemodynamic physiology of gastric varices.

Effect of Helicobacter pylori infection on esophagogastric variceal bleeding in patients with liver cirrhosis and portal hypertension

2013 ◽  
Vol 28 (9) ◽  
pp. 1444-1449 ◽  
Author(s):  
Yoshihiro Sakamoto ◽  
Kazuhiko Oho ◽  
Atsushi Toyonaga ◽  
Masafumi Kumamoto ◽  
Tsuyoshi Haruta ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Helicobacter Pylori Infection

scholarly journals Liver Cirrhosis: Modern Approach to the Problem

2020 ◽  
Vol 3 (31) ◽  
pp. 53-61
Author(s):  
T. Bentsa ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Portal Pressure ◽  
Refractory Ascites ◽  
Bacterial Peritonitis ◽  
Common Causes ◽  
Β Blockers

Introduction. Liver cirrhosis (LC) is an important medical and socio-economic problem not only in Ukraine, but throughout the world. The urgency of this disease is due to its significant spread, increase of the number of etiological factors, as well as the occurrence of severe complications, which often leads to death. The prognosis depends on several factors, such as etiology, the severity of liver damage, the presence of complications and concomitant diseases. The aim of the study. To review the scientific literature and summarize the published studies devoted to the study of the etiology, classification, clinical picture and diagnosis of liver cirrhosis. Materials and methods. The content analysis, the method of systemic and comparative analysis, the bibliosemantic method of studying the current scientific research on the etiology, classification, clinical picture and diagnosis of LC were used. The search for sources was carried out in scientometric databases: PubMed-NCBI, Medline, Research Gate, Cochrane Database of Systematic Reviews for the keywords: liver cirrhosis, diagnosis, treatment. 37 literary sources were selected and analyzed. Results. LC is currently ranked 11th among the most common causes of death. The common causes of LC are chronic alcohol intoxication and viral hepatitis B, C, and D. LC is represented by an increase in severity, which is characterized by the lesions of the liver parenchyma with necrosis, dystrophy of hepatocytes, their nodular regeneration, as well as its interstitium with diffuse proliferation of connective tissue, leading to liver failure and portal hypertension. Most patients with cirrhosis remain asymptomatic until they develop decompensated LC. Despite the existence of a number of LC classifications – by morphology, etiology, severity, course, hepatocellular insufficiency stage, the severity of the disease is usually assessed by evaluation of the hepatic functional reserve (according to the C. G. Child – R. N. Pugh classification). Patients with LC often have life-threatening conditions such as variceal hemorrhages, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome. Variceal bleeding is a major complication of portal hypertension, which is associated with significant mortality. Ascites represents the most common decompensating event in patients with LC. The appearance of ascites is strongly related to portal hypertension, which leads to splanchnic arterial vasodilation, reduction of the effective circulating volume, activation of endogenous vasoconstrictor systems, and avid sodium and water retention in the kidneys. Bacterial translocation further worsens hemodynamic alterations of patients with cirrhosis and ascites. Ascites is also associated with a high risk of developing the further complications of cirrhosis such as dilutional hyponatremia, spontaneous bacterial peritonitis and/or other bacterial infections and acute kidney injury. Pharmacotherapy for LC should be implemented in accordance with up-to-date guidelines and in conjunction with etiology management, nutritional optimization and patients’ education. The main treatment of uncomplicated ascites is diuretics such as spironolactone in combination with a loop one. Vasoconstrictors and albumin are recommended for the treatment of refractory ascites. In its turn antibiotics play a well-established role in the treatment and prevention of spontaneous bacterial peritonitis. The administration of vasopressor terlipressin and albumin is recommended for the treatment of hepatorenal syndrome. Pharmacological therapy of variceal bleeding aims to decrease the portal pressure by acting on its pathophysiological mechanisms such as increased hepatic vascular tone and splanchnic vasodilatation. Propranolol blocks the β-1 in the heart and the peripheral β-2 adrenergic receptors. β-1 blockade of cardiac receptors reduces heart rate, cardiac output and subsequently decreases flow into splanchnic circulation. β-2 blockade leads to unopposed α-1 adrenergic activity that causes splanchnic vasoconstriction and reduction of portal inflow. Both effects contribute to reduction in portal pressure. Carvedilol is more powerful in reducing hepatic venous pressure gradient than traditional nonselective β-blockers. Endoscopic treatment in many cases is used for the variceal bleeding (eg., ligation of the esophageal varices and tissue glue usage for the gastric varices). A shunt (transjugular intrahepatic portosystemic shunting – TIPS) is used to treat severe and often repeat variceal hemorrhage or refractory ascites. Non-selective β-blockers effectively reduce variceal re-bleeding risk in LC patients with moderate/large varices. Conclusions. Liver cirrhosis is one of the most dangerous multi-organ diseases of a human with multiple pathogenetic links, the causes of which invariably remain hepatitis viruses, alcohol, toxic substances, drugs, ultraviolet radiation, genetic factors, some chronic diseases of the internal organs. There are a number of classifications of liver cirrhosis – by morphology, etiology, severity, course, severity of hepatocellular insufficiency etc. Examination of this category of patients requires timeliness, scrupulousness, compliance with a comprehensive approach using modern clinical, laboratory and instrumental methods. During the objective examination of a patient a doctor traditionally draws attention to the presence of telangiectasia, palmar erythema, jaundice, “raspberry” tongue, scratching marks, gynecomastia in men, ascites and “caput medusae”, during the palpation the liver is enlarged, dense, with a sharp lower edge, spleen is enlarged. Among the laboratory methods, in addition to routine ones, the immunological tests are used, among the main instrumental examination – ultrasound, computed tomography, indirect elastometry of the liver or Fibroscan, esophagogastrofibroscopy, puncture biopsy of the liver, in particular modern ones – vibrational transient elastography and magnetic resonance elastography. Although liver cirrhosis is the final stage of liver disease, this diagnosis cannot be considered a verdict for a patient, because today there are quite effective treatments using the principles of differentiation – the impact on the etiological factor, liver state and comorbid lesions and their complications often allows if not to cure the patient, then to prevent the negative disease course. Among them, there are diet, the use of etiotropic drugs, intestinal sanitation, correction of clinical and laboratory syndromes, portal hypertension syndrome, endothelial and autonomic dysfunction as causes of comorbid lesions and their complications.

scholarly journals Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Zheng Lu ◽  
Xiaotian Sun ◽  
Jingjing Han ◽  
Bo Jin ◽  
Wenhui Zhang ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Prothrombin Time ◽  
Variceal Bleeding ◽  
Gastric Varices ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding ◽  
Ulcer Group ◽  
Cirrhotic Patients ◽  
Endoscopic Characteristics

AbstractUpper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding. Thus, this study aimed to analyze the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis. Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 were enrolled, and classified into peptic ulcer bleeding group (n = 248) and variceal bleeding group (n = 402). Clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated, and independent risk factors for 42-day morality were determined. The mean age and gender ratio of peptic ulcer bleeding group were higher than those in variceal bleeding group (55.58 ± 11.37 vs. 52.87 ± 11.57, P < 0.01; 4.51:1 vs. 2.87:1, P = 0.023). Variceal bleeding group most commonly presented as red blood emesis and coffee grounds (67.16%), while peptic ulcer group primarily manifested as melena (62.10%). Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P < 0.01). Albumin level in variceal bleeding group was lower higher (P < 0.01), but serum bilirubin, creatinine and prothrombin time were significantly higher (all P < 0.01). Success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35% (P = 0.021). Univariate and multivariate analysis identified prothrombin time (P = 0.041, OR [95% CI] 0.884 [0.786–0.995]), MELD score (P = 0.000, OR [95% CI] 1.153 [1.073–1.240]), emergency intervention (P = 0.002, OR [95% CI] 8.656 [2.219–33.764]), hepatic encephalopathy before bleeding (P = 0.003, OR [95% CI] 8.119 [2.084–31.637]) and hepatic renal syndrome before bleeding (P = 0.029, OR [95% CI] 3.877 [1.152–13.045]) as the independent predictors for 42-day mortality. Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics.

scholarly journals Elective Splenectomy Combined with Modified Hassab’s or Sugiura Procedure for Portal Hypertension in Decompensated Cirrhosis

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Ya-wu Zhang ◽  
Feng-xian Wei ◽  
Zhen-gang Wei ◽  
Gen-nian Wang ◽  
Man-cai Wang ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Large Scale ◽  
Statistical Significance ◽  
Postoperative Mortality ◽  
Major Complication ◽  
Decompensated Cirrhosis ◽  
Mortality And Morbidity ◽  
Morbidity Data ◽  
Sugiura Procedure

Objective. Portal hypertension is a major complication of decompensated cirrhosis. In China, modified Hassab’s and Sugiura procedure are the two major methods of nonshunting surgery. This study aims to compare the efficacy and safety of the two procedures for portal hypertension.Method. Between January 1994 and December 2009, 172 elective patients diagnosed with decompensated cirrhosis with significant hypersplenism adopted elective splenectomy for hypersplenism, and also modified Hassab’s (n= 91) or Sugiura (n= 81) procedure was additionally performed to reduce the risk of variceal bleeding. Postoperative mortality and morbidity data were collected, and a retrospectively comparative analysis was conducted.Results. All of the patients were treated successfully without death during operation, and no variceal bleeding occurred during hospitalization. There were 4 (4.4%) deaths in Hassab’s group and 3 (3.7%) deaths in Sugiura group postoperatively (P > 0.05). During follow-up, the survival rate was 90.2%, 82.42%, and 71.43% in Hassab’s group and 96.29%, 81.48%, and 75.31% in Sugiura group in 1, 3, and 5 years (P > 0.05). There were 22/71 and 12/63 patients in each groups who suffered no deadly variceal bleeding (P = 0.11). Bleeding related death and no bleeding related death occurred in 7/23 and 3/13 patients in each group (P = 0.26 and 0.14, respectively).Conclusion.Elective splenectomy combined with modified Sugiura procedure seemed to be associated with a reduced trend of no deadly variceal bleeding compared with Hassab’s procedure. As statistical significance was not found, further large scale and prospective study was warranted.

scholarly journals Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
A. Wiechowska-Kozłowska ◽  
K. Zasada ◽  
M. Milkiewicz ◽  
P. Milkiewicz
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Doppler Ultrasound ◽  
Gastric Wall ◽  
Splenic Vein ◽  
Maximum Velocity ◽  
Invasive Procedure ◽  
Gastric Varices ◽  
Oesophageal Varices ◽  
Cross Sectional

Purpose. Endoscopic ultrasound (EUS) permits the detailed visualization of clinically significant features of portal hypertension; however, it is an invasive procedure that is not widely available. The aim of this cross-sectional study was to determine whether a correlation exists between the features of portal hypertension detected using both Doppler ultrasound and EUS in subjects with liver cirrhosis.Materials and Methods. Analyzed cohort included 42 patients who underwent a detailed Doppler ultrasound focusing on the parameters of blood flow in the portal/splenic vein as well as an endoscopic/EUS procedure that included the assessment of the size and localization of “deep” varices.Results. The size of “deep” oesophageal varices detected with EUS exhibited no correlation with the parameters assessed by Doppler ultrasound. However, the size of the “deep” gastric varices detected using EUS correlated with the time averaged maximum velocity (Tmaxas well asVmin,Vmax) for the portal vein using Doppler ultrasound and exhibited a correlation with theVmaxandTmaxfor the splenic vein. No significant correlation was determined between the diameter of the azygous vein and the thickness of the gastric wall when seen on EUS versus the parameters measured with Doppler ultrasound.Conclusion. EUS provides important information regarding the features of portal hypertension, and in the case of “deep” oesophageal varices exhibits a limited correlation with the parameters detected by Doppler ultrasound. Thus, despite its invasiveness, EUS is a method that provides a reliable and unique assessment of the features of portal hypertension in patients with liver cirrhosis.

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