Whipple’s Pancreatoduodenectomy in the Background of Chronic Liver Disease (CLD): An Institutional Experience

Introduction. Whipple’s pancreatoduodenectomy (PD) is a formidable operation, associated with a high risk of morbidity and mortality. In the setting of an underlying chronic liver disease, the incidence of complications and mortality increases manifold. Patients and Outcomes. Of the 112 Whipple’s PD performed between 2018 to 2020 at a high-volume HPB and liver transplant centre, 4 patients underwent the surgery in the background of an underlying chronic liver disease (CLD). All except one were performed in Child’s A cirrhotics. There was a single 30-day mortality in this series of 4 patients that occurred in the background of Child’s B cirrhosis. On follow-up at 1 year, there was one more mortality in the series, owing to liver decompensation following chemotherapy. Conclusion. Judicious preoperative selection criteria, adequate preoperative nutritional and physiological optimisation, and prudent weighing of risk vs. benefit of undergoing Whipple’s PD in periampullary malignancies in the setting of CLD are the major determinants of the surgical outcome.

Treatment Of Variceal Bleeding

Cirrhosis is termed as the late stage of progressive hepatic fibrosis characterized by the disruption of the hepatic parenchymal structure and the formation of regenerative nodules. Many factors play a role in the etiology of cirrhosis. Currently, mortality is still high and causes significant work loss. The prognosis of patients with cirrhosis is largely due to its complications. Treatment of cirrhosis is limited except liver transplantation. An important cause of the morbidity and mortality associated with cirrhosis is the development of variceal bleeding secondary to portal hypertension. The prognosis of patients with variceal bleeding depends on the bleeding or other complications is associated with underlying chronic liver disease and its management. The mortality rate due to active variceal bleeding is around 20 percent during each bleeding and re-bleeding is observed in 70 percent of patients within one year. Upper gastrointestinal bleeding unrelated to portal hypertension is also common in patients with portal hypertension (eg, peptic ulcer disease). In this article, we will talk about variceal bleeding secondary to portal hypertension and its treatment based on current data.

Hypocalcaemia in a Patient with Chronic Liver Disease: A Case Report

Acute hypocalcaemia is an uncommon presentation in clinical practice. However, severe acute hypocalcaemia may require immediate resuscitative measures. Thus, the case presented is aimed to highlight the importance of thorough assessment and prompt management in replacing the calcium. This case looks at a 34-year-old woman with underlying chronic liver disease (primary biliary cirrhosis) and hypoalbuminemia presented with symptom of perioral and peripheral paraesthesia for three days and was then infused with slow intravenous calcium gluconate. In avoiding recurrence, she was prescribed daily oral supplementation of calcium carbonate.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 115-117

Anxiety and depression on the liver transplant waiting list: a case for psychological prehabilitation?

Introduction: Anxiety and depression in patients awaiting liver transplantation are associated with worse clinical outcomes. However, optimising patient mental health is not routinely addressed in pre-transplant care. Aims: To understand the prevalence of anxiety and depression in patients awaiting transplantation and their access to pharmacological and psychological therapies. Methods: Patients awaiting transplantation were offered screening for anxiety and depression using the Hospital Anxiety and Depression Screening (HADS) tool. Data pertaining to patient demographics and previous treatment for anxiety and depression were recorded and analysed. Findings: Over 50% of patients recorded abnormal scores for anxiety and depression. Of the 19 patients screened, 42% had received treatment for either disorder, and most found the intervention unhelpful due to lack of follow-up appointments and limited understanding of their underlying chronic liver disease. There was a significant association between female sex and screening positive for depression. Conclusion: Anxiety and depression are prevalent in patients awaiting liver transplantation. The integration of a psychologist into the transplantation multidisciplinary team may improve patient outcomes.

Hepatosplenic T cell lymphoma presenting as multiorgan failure

A 59-year-oldwoman presented with a 2-month history of malaise, abdominal distention and unintentional weight loss. She was initially managed as community acquired pneumonia with a suspicion of underlying chronic liver disease but she deteriorated rapidly into a multiorgan failure necessitating transfer to intensive care unit of a tertiary hospital. She was investigated with liver and bone marrow biopsy that confirmed the diagnosis of hepatosplenic T cell lymphoma. She was treated with cyclophosphamide, doxorubicin, vincristine, etoposide and prednisolone chemotherapy that was changed to salvage ifosfamide carboplatin etoposide (ICE) chemotherapy due to poor response with first-line chemotherapy and disease progression. Unfortunately, her disease progressed further and she opted for palliative management.