scholarly journals Laparoscopic Cholecystectomy for Cholelithiasis in Patients With Liver Cirrhosis

1995 ◽  
Vol 1 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Tetsuro Ishikawa ◽  
Michio Sowa ◽  
Masayoshi Nagayama ◽  
Yukio Nishiguchi
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Gallbladder Wall ◽  
Bleeding Tendency ◽  
Postoperative Course ◽  
Class A ◽  
Calot’S Triangle ◽  
First Case ◽  
Class B ◽  
Preoperative Examination

We performed laparoscopic cholecystectomy for symptomatic cholelithiasis on four patients with cirrhosis of the liver, two of whom had clinical portal hypertension and splenomegaly. Preoperative examination disclosed hypersplenism in one patient, while mild thrombocytopenia and decreased prothrombin concentration were noted in three patients. However, no remarkable bleeding tendency was recognized clinically in any of the patients. Preoperatively, by Child-Pugh's criteria, three patients had class B disease and one class A disease. Intraoperatively, remarkable inflammatory change or fibrotic change of the gallbladder wall and Calot's triangle was observed in two cases, and collateral veins and lymphangial congestion were observed in all four cases. In the first case, extreme bleeding and lymphorrhea from dissected sites were observed, and a 1.5 unit of transfusion of whole blood was required during operation. Postoperatively, increase in ascites which was controlled with diuretics was recognized in one case. However, the postoperative course was uneventful in all cases, and no serious complications were recognized.That laparoscopic cholecystectomy can be safely performed in patients with cirrhosis if careful and appropriate management of bleeding and lymphorrhea from sites of dissection is ensured, is encouraging.

Cardiomyopathy in Cirrhotic Patients and Its Relationship with the Severity of Cirrhosis

2021 ◽  
Vol 15 (10) ◽  
pp. 2779-2782
Author(s):  
Saira Khalid ◽  
Nasir Shah ◽  
Yasir Abbas Zaidi ◽  
Muhammad Saleem Hasan ◽  
Saqib Jahangir ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Severe Disease ◽  
P Value ◽  
Cirrhotic Cardiomyopathy ◽  
Male Predominance ◽  
Class A ◽  
Class B ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Class C

Study Objectives: To determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis and to compare it across varying grades of cirrhosis on Child Turcotte Pugh classification. Study Design and Settings: It was a descriptive cross-sectional study carried at Department of Medicine, Lahore General Hospital Lahore over 1 year from Jan 2018 to Dec 2018. Patients and Methods: The present research involved 100 male and female patients aged between 16-70 years having liver cirrhosis diagnosed at least 6 months ago. These patients underwent echocardiographic screening of cardiomyopathy which was diagnosed by the presence of diastolic dysfunction (i.e. increased E/A ratio>1). An informed written consent was obtained from every patient. Results of the Study: There was a male predominance (M:F, 1.6:1) among cirrhotic patients with a mean age of 51.9±9.8 years. The mean BMI was 26.5±3.7 Kg/m2 while the mean duration of cirrhosis was 22.0±10.9 months. Majority (49.0%) of the patients belonged to CTP Class C followed by Class-B (39.0%) and Class-A (12.0%). Cirrhotic cardiomyopathy was observed in 41.0% patients with cirrhosis. There was statistically insignificant difference in the observed frequency of cirrhotic cardiomyopathy among various subgroups of cirrhotic patients depending upon patient’s age (p-value=0.928), gender (p-value=0.997), BMI (p-value=0.983) and duration of disease (p-value=0.782). However, it increased considerably with worsening of disease on CTP Classification; Class-A vs. Class-B vs. Class-C (8.3% vs. 35.9% vs. 53.1%; p-value=0.013). Conclusion: Cirrhotic cardiomyopathy was observed in a substantial proportion of cirrhotic patients and was more frequent in patients with more severe disease which warrants routine echocardiographic screening of cirrhotic patients so that timely recognition and anticipated treatment of this complication may improve the case outcome in future medical practice. Keywords: Cirrhosis, Cardiomyopathy, Child Turcotte Pugh Class

scholarly journals DYNAMICS OF CYTOKINS AND THEIR INTERRELATION IN LIVER CIRRHOSIS

2015 ◽  
Vol 7 (1) ◽  
pp. 110-114
Author(s):  
B B Fishman ◽  
M A Toneeva ◽  
V E Kulikov ◽  
V A Kornilova ◽  
E R Antonova
Keyword(s):  
Liver Cirrhosis ◽  
Reference Values ◽  
Average Concentration ◽  
Necrosis Factor Alpha ◽  
Class A ◽  
Tnf Α ◽  
Cytokine Levels ◽  
Class B ◽  
Factor Alpha ◽  
Necrosis Factor

The research objectives are to determine serum interleukins (IL-2, IL-6) and tumor necrosis factor alpha (TNF - α) and evaluate their interrelation in liver cirrhosis (class A, B, C according to Chad - Pugh). 117 patients were examined and their cytokines levels were determined using enzyme-linked immunosorbent assay.Elevation of cytokine levels IL-2, I-6 and TNF-α within reference values was found in liver cirrhosis cases, expect for level IL-6 in liver cirrhosis cases of class C. In these cases IL-6 level exceeds reference values and is within the limit of 9,94 - 25,21 pg / ml with average concentration of 14,89±4,96 pg / ml. Correlation is found between TNF- α and IL-6 (r = - 0,499) in liver cirrhosis of class A and correlation between TNF- α and IL-2 (r = 0,421) is found in liver cirrhosis of class B.

scholarly journals Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

2021 ◽  
Vol 22 (2) ◽  
pp. 100-106
Author(s):  
Tarana Yasmin ◽  
Sohely Sultana ◽  
Mahmuda Nusrat Ima ◽  
Md Quamrul Islam ◽  
Shyamal Kumar Roy ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Doppler Ultrasound ◽  
Hepatic Vein ◽  
Wave Form ◽  
Venous Blood Flow ◽  
Class A ◽  
Class B ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

scholarly journals Laparoscopic Cholecystectomy in patients with Chronic Liver Disease; A ten years experience

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Abuzar Saleem ◽  
Haroon Javed Majid ◽  
Muhammad Tufail
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Liver Function Tests ◽  
Chronic Cholecystitis ◽  
Chronic Liver ◽  
Class A ◽  
Class B

To evaluate the safety and efficacy of laparoscopic cholecystectomy in patients with chronic liver disease. It was a retrospective analysis. The study was conducted at Shaikh Zayed Hospital, Lahore between 1993 and 2002. Out of 656 patients undergoing laparoscopic cholecystectomy during this period, 22(6 male, 16 female) were having chronic liver disease as well. Ultrasonography was mainstay of diagnosis of cholelithiasis while liver function tests, platelet count and prothrombin time were done to evaluate liver status.. Eighteen patients were having Child`s class A while rest were in Child`s class B. Laparoscopic cholecystectomy was successful in 20 patients of chronic liver disease. Liver biopsy and paraumbilical hernia repair were additional procedures performed in 8 patients. Two patients were converted to open cholecystectomy due to bleeding and adhesions. Acute cholecystitis was found in 3 patients while rest were having chronic cholecystitis. Mean operative time was 75.45+/-10.9 minutes and mean hospital stay was 2.81+/-1.1 days. Postoperative complications in the form of wound infection (2 pts), prolonged ileus (2 pts) and port hernia (1 pt) occurred in 5 patients. There was no mortality. Laparoscopic cholecystectomy can be safely performed in patients with mild to moderate chronic liver disease without any additional morbidity.

scholarly journals Triangle of Safety Technique: A New Approach to Laparoscopic Cholecystectomy

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulrahman F. M. S. Almutairi ◽  
Yousef A. M. S. Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operating Time ◽  
Gallbladder Wall ◽  
Cystic Artery ◽  
Safe Procedure ◽  
Calot’S Triangle ◽  
Safety Technique ◽  
Delayed Complications ◽  
Cbd Injury

Backgrounds and Study Aims. Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy (LC). Misidentification of the CBD during dissection of the Calot's triangle can lead to such injuries. The aim of the authors in this study is to present a new safe triangle of dissection. Patients and Method. 501 patients under went LC in the following approach; The cystic artery is identified and mobilized from the gall bladder (GB) medial wall down towards the cystic duct which would simultaneously divide the medial GB peritoneal attachment. This is then followed by dividing the lateral peritoneal attachment. The GB will be unfolded and the borders of the triangle of safety (TST) are achieved: cystic artery medially, cystic duct laterally and the gallbladder wall superiorly. The floor of the triangle is then divided to delineate both cystic duct and artery in an area relatively far from CBD. Results. There were little significant immediate or delayed complications. The mean operating time was 68 minutes, nearly equivalent to the conventional method. Conclusions. Dissection at TST appears to be a safe procedure which clearly demonstrates the cystic duct and may help to reduce the CBD injuries.

scholarly journals Correlation of global longitudinal strain with disease severity in liver cirrhosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Dimitroglou ◽  
C Aggeli ◽  
A Alexopoulou ◽  
T Alexopoulos ◽  
D Patsourakos ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Disease Severity ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Class A ◽  
Class B ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software.  Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2  and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p &lt; 0.001), SV (r = 0.554, p &lt; 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

scholarly journals IMMATURE PLATELET FRACTION (IPF) DAN TROMBOPOIETIN DI SIROSIS HATI

2018 ◽  
Vol 19 (2) ◽  
pp. 112
Author(s):  
Esti Rohani ◽  
Yetti Hernaningsih ◽  
Suprapto Ma’at ◽  
Ummi Maimunah
Keyword(s):  
Liver Cirrhosis ◽  
Disease Severity ◽  
Clinical Problem ◽  
Serum Levels ◽  
Cross Sectional ◽  
Class A ◽  
Immature Platelet Fraction ◽  
Significant Difference ◽  
Class B ◽  
Major Clinical Problem

Liver cirrhosis remains a major clinical problem worldwide when associated with significant morbidity and mortality due toits complications. The presence of liver cirrhosis state affects the production of TPO influencing the process of thrombopoiesis. Thethrombopoiesis activity can be described by the Immature Platelet Fraction (IPF) value which is young platelets. The immature Plateletfraction value increases when platelet production enhances as well, on the contrary when the production declines, the IPF value is alsodecreased. This study was performed by cross-sectional method using 31 subject samples suffering from liver cirrhosis, consisting of ChildPugh score class A 2 samples (6.4%), Child Pugh score class B 9 samples (29%) and Child Pugh score class C 20 samples (64.6%). Theexamination of TPO levels was done by ELISA method using Humans TPO QuantikineR, the IPF value was examined using Sysmex XE-2100 Hematology Analyzer. The thrombopoietin serum levels in the samples ranged from 23.5 to 96.6 pg/mL with a mean of 45.1pg/mL.The immature Platelet Fraction values varied from 1.7% to 19.1% with a mean of 6.7%. From the statistical analysis, the levels of TPO andIPF at various degrees of the disease severity were not significantly different. There was no significant correlation between the TPO leveland IPF value, r = 0.038, p = 0.837. There was no significant difference between the TPO level and the IPF value in the splenomegaly andnonsplenomegaly state. In conclusion, based on this study no significant correlation was found between the IPF value with thrombopoietinserum levels, as well as the IPF and thrombopoietin levels, and there was no association with the disease severity.

scholarly journals Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis

2011 ◽  
Vol 68 (11) ◽  
pp. 917-922 ◽  
Author(s):  
Zeljka Savic ◽  
Vladimir Vracaric ◽  
Ljiljana Hadnadjev ◽  
Zora Petrovic ◽  
Dragomir Damjanov
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Alcoholic Liver Cirrhosis ◽  
Class A ◽  
Class B ◽  
Pugh Class ◽  
Class C ◽  
Upper Gastrointestinal ◽  
General Mortality

Background/Aim. Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

scholarly journals Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

2018 ◽  
Vol 16 (2) ◽  
pp. 50-53
Author(s):  
Anil Shrestha ◽  
Dipendra Khadka ◽  
Richa Shrestha
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Endoscopy ◽  
Cross Sectional ◽  
Class A ◽  
Red Color ◽  
Class B ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Small Varices

Background: Majority of cirrhotic patients develop  varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

scholarly journals Clinical features of the combined course of liver cirrhosis and atrial fibrillation

2021 ◽  
Vol 25 (2(98)) ◽  
pp. 3-8
Author(s):  
A. Baylo
Keyword(s):  
Atrial Fibrillation ◽  
Liver Cirrhosis ◽  
Cardiovascular System ◽  
Clinical Features ◽  
Clinical Protocol ◽  
Class A ◽  
Software Packages ◽  
Group I ◽  
Class B ◽  
Group Ii

Objective – to investigate the clinical features of the combined course of liver cirrhosis of classes A, B, C according to the Child-Pugh scale and atrial fibrillation in comparison with an isolated course of liver cirrhosis. Material and methods. 106 patients were examined, of which 70 patients were with a combined course of liver cirrhosis and permanent AF (group I), 36 patients with an isolated course of liver cirrhosis (group II) and 20 healthy individuals. The diagnosis of liver cirrhosis was established according to the unified clinical protocol of medical care "Liver cirrhosis and its complications", which was approved by the MHU №751 Sep 28, 2012 and AASLD Practice Guidelines. The symptoms of the gastrointestinal tract and the cardiovascular system were assessed. SPSS Statistics and Excel for Windows 2013 software packages were used for statistical analysis. Results. Edematous syndrome was 3.3 times more common in patients with liver cirrhosis and atrial fibrillation than in patients with liver cirrhosis (p = 0.035), in particular in patients of class C group I by 35.6% more often than in group II patients of the same class. The frequency of dyspnea in patients of group I was 7.4 times higher than in patients of group II (p<0.001), including in patients of class A by 52%, class B by 29.6% and class by 35.7%. The frequency of chest pain was higher in group I patients (p = 0.002) than in group II patients. Conclusions. The frequency of gastrointestinal manifestations gradually increases with worsening of the severity of liver cirrhosis according to the Child-Pugh scale in patients of both groups. Manifestations of the cardiovascular system were present mainly in patients of group I and did not depend on the severity of liver cirrhosis.

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