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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
All patients with cirrhosis should have an endoscopy to look for oesophageal and gastric varices. If these are absent, the endoscopy should be repeated in 3 years. If small varices are present, no treatment is indicated unless there is evidence of possible bleeding (such as cherry red spots). If middle or large varices are seen, the patient should be offered prophylaxis with banding and/or pharmacological treatment with non-selective β-blockers.
Chronic Liver Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Julia M. Boster, Kelly A. Klaczkiewicz, Shikha S. Sundaram
Infants and children with cholestasis may have acholic stools, which are pale or clay-colored due to the lack of normal bile in the stool. Patients with cirrhosis can develop clinical signs and symptoms of portal hypertension, including ascites and a caput medusa. Esophageal or gastric varices may present with obvious hematemesis (vomiting blood) or melena (stool that is dark/black and tarry from digested blood), but the bleeding may be occult. Gastrointestinal bleeding in patients with cirrhosis is a medical emergency and can be life-threatening.
Portal hypertension
Published in Mohammad Ibrarullah, Atlas of Diagnostic Endoscopy, 2019
Classification of gastric varices
Two-year free of complications during antiviral therapy predicts stable re-compensation in immediate-treatment HBV-related decompensated cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2023
Zhiying He, Jialing Zhou, Yu Tian, Shanshan Wu, Yameng Sun, Xiaojuan Ou, Jidong Jia, Bingqiong Wang, Xiaoning Wu, Hong You
In this retrospective, single-center cohort study, a total of 1704 liver cirrhotic patients who occurred decompensated complications and were hospitalized at Beijing Friendship Hospital from Mar 2013 to May 2018, were consecutively screened according to the following criteria: (1) age ≥18 years; (2) hepatitis B surface (HBsAg) positive for more than six months; (3) clinical evidence for liver cirrhosis, including any of: a) esophageal gastric varices confirmed by endoscopy; b) features of cirrhotic portal hypertension confirmed by imaging assessment, including liver surface nodularity, splenomegaly or portal vein ≥ 1.3 cm; c) laboratory test showed PLT < 100 × 109/L and ALB < 35 g/L; (4) presence of ascites or VH as the first episode of decompensated complications, and clinical material about first event was available; (5) follow-up time duration from the first decompensated event was more than 12 months.
Two-step complete splenic artery embolization for the management of symptomatic sinistral portal hypertension
Published in Scandinavian Journal of Gastroenterology, 2022
Jiacheng Liu, Jie Meng, Ming Yang, Chen Zhou, Chongtu Yang, Songjiang Huang, Qin Shi, Yingliang Wang, Tongqiang Li, Yang Chen, Bin Xiong
A total of 32 patients were diagnosed with esophageal or gastric varices by endoscopy or enhanced CT. Of these, 26 patients presented IGVs (21 and five cases were classified as IGV1 and IGV1 + IGV2, respectively), with 13 cases complicated with spontaneous portosystemic shunts (SPSSs). The remaining six patients presented gastroesophageal varices (1, 1, and 4 cases were classified as GOV1, GOV2, and GOV1 + GOV2, respectively). Splenic vein thrombosis was found in all patients, including 18 venous occlusions. Apart from that, six and five cases were complicated with portal vein thrombosis and superior mesenteric vein thrombosis, respectively. Liver function test results were normal in all patients. Thrombocytopenia was found in 15 patients (38.5%), including 13 mild and two moderate cases.
Effects of anti-diabetic treatments in type 2 diabetes and fatty liver disease
Published in Expert Review of Clinical Pharmacology, 2021
Elizabeth M. Lamos, Megan Kristan, Maka Siamashvili, Stephen N. Davis
The aforementioned studies do not specifically address risks or complications associated with bariatric surgery in patients with DM and NASH. European and United States guidelines support the use of bariatric surgery in appropriate individuals for treatment of obesity in individuals with NAFLD but make no recommendation as to which type of surgery [24,46]. The choice of which procedure should be pursued should be individualized based on factors including cirrhosis and bleeding risk, need for endoscopic access to the remnant, malabsorption and presence of ascites, gastric varices, or portal hypertension. For example, RYGB prevents access to the stomach remnant making access to this with a GI bleed or biliary obstruction an issue in a cirrhotic patient. SG presents a risk in a patient with gastric varices. Gastric banding, in the presence of ascites, may pose an unacceptable risk of infection. Additionally, if there is any concern that an individual may require a liver transplant in the future, consideration of the potential benefits (weight loss) and thus improved transplant candidacy versus risks (surgical complications, surgical approach, etc.) should be discussed [47,48].