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Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
An important complication of cirrhosis which may present with unexplained fever is spontaneous bacterial peritonitis. Whereas acute peritonitis, characterized by acute abdominal pain and rigidity, and vomiting, is not difficult to diagnose, this form is uncommon in cirrhosis. Usually, in spontaneous bacterial peritonitis there is an insidious onset of fever in a cirrhotic patient who has recently undergone an acute infection, especially diarrhea, or an investigative procedure, such as abdominal paracentesis. The diagnosis can be made by examination of the ascitic fluid which reveals an exudate and bacteriological culture may provide the microorganism.
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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Liver cirrhosis is chronic irreversible liver damage with loss of hepatic cellular architecture. Macroscopically, the liver looks shrunken, scarred and nodular. The commonest cause in the UK is long-term alcohol abuse. Where it is endemic chronic hepatitis B or C, infection is also a common cause. There are many signs of chronic liver disease, such as clubbing, leuconychia, palmar erythema, spider naevi and ascites. Severe liver dysfunction results in coagulopathy, encephalopathy, hypoalbuminaemia, susceptibility to sepsis, hypoglycaemia and peritonitis. When the cause is in doubt, investigations include ultrasound and duplex scanning, ferritin, total iron-binding capacity, hepatitis serology, autoantibodies, alpha fetoprotein, caeruloplasmin and alpha-1-antitrypsin. Management aims to reduce deterioration with low-salt diets to avoid ascites, alcohol abstinence and avoiding hepatotoxic medications and medications metabolised in the liver as well as opiates and sedatives. Definitive treatment depends on the cause; complications such as ascites should be treated with diuretics and drainage. Spontaneous bacterial peritonitis should be urgently treated with IV antibiotics according to local protocol.
Use of Complementary and Alternative Therapies in Hepatic Disorders
Published in Mary J. Marian, Gerard E. Mullin, Integrating Nutrition Into Practice, 2017
Changes in microbiota have also been implicated in causation of HE, but the reports are conflicting.36–38 In regard to HE, benefits of probiotics are modulated by changes in gut microbiota: an increase in nonurease-producing bacteria like lactobacilli and a concomitant reduction in urease producers like Escherichia coli and Staphylococcus aureus. However, a multistrain probiotic had no benefit in these patients except for a nonsignificant trend toward reduction in serum ammonia levels in those with elevated ammonia.39 It should be noted that these changes in gut microbiota may also have a role in the pathogenesis of other complications of cirrhosis (e.g., spontaneous bacterial peritonitis, hepatorenal syndrome), which can induce encephalopathy. The 2014 Practice Guidelines by the American Association for the Study of Liver Disease (AASLD) do not support the role of probiotics in the treatment of HE. The guidelines do recommend though daily energy intakes should be 35–40 kcal/kg ideal BW, daily protein intake should be 1.2–1.5 g/kg/day, small meals or liquid nutritional supplements evenly distributed throughout the day and a late night snack should be offered, and oral BCAA supplementation may allow recommended nitrogen intake to be achieved and maintained in patients intolerant of dietary protein.40
Pharmacological management of portal hypertension and its complications in children: lessons from adults and opportunities for the future
Published in Expert Opinion on Pharmacotherapy, 2021
Sarah Henkel, Carol Vetterly, Robert Squires, Patrick McKiernan, James Squires
Long-term PPI use has shown decreased risk of bleeding overall in adults: a randomized control trial demonstrated a hazard ratio of 0.098 when patients were given anti-secretory treatment over an 18-month time period [42]. Similar to adults, the benefit of long-term PPI therapy in children is thought to result from protection of the gastro-esophageal varices which are more prone to bleeding due to their position and exposure to food and acid [31]. However, a growing body of literature is highlighting several deleterious effects associated with extended PPI use. In adult patients with cirrhosis, long-term use increased risk of spontaneous bacterial peritonitis, progression of cirrhosis, and possibly increased incidence and severity of hepatic encephalopathy [43–45]. Toxicity profiles in children are still emerging, but have been associated with increased risks of gastrointestinal and respiratory tract infections, vitamin B12 deficiency, hypomagnesaemia, and bone fractures [46].
Early diagnosis and successful treatment of cytomegalovirus peritonitis in children with primary nephrotic syndrome: case series and literature review
Published in Renal Failure, 2020
Haiting Lin, Lizhi Chen, Songyang Wen, Zhihui Yue, Ying Mo, Xiaoyun Jiang, Liuyi Huang
Cytomegalovirus (CMV) is a major pathogen in immunocompromised patients, including solid organ transplant recipients, HIV-infected patients, and patients treated with immunomodulating drugs. CMV infection is a substantial cause of morbidity and mortality in immunocompromised hosts [1]. Spontaneous bacterial peritonitis is a serious complication of childhood NS. The most common organisms causing spontaneous bacterial peritonitis are S. pneumoniae and Gram negative organisms, particularly Escherichia coli [2]. To our knowledge, CMV peritonitis without gut perforation had been reported very rarely in immunocompromised patients [3–6] and had not been reported in patients with NS. Here we report four children in the early diagnosis and effective treatment of CMV peritonitis with primary NS.
Serum Sphingosine-1-phosphate level and peritonitis in peritoneal dialysis patients
Published in Renal Failure, 2020
Qiong Bai, Hong-Xia Guo, Chun-Yan Su, Qing-Feng Han, Tao Wang, Wen Tang
Peritoneal dialysis (PD) is currently a renal replacement therapy (RRT) modality for the treatment of end-stage renal disease (ESRD) [1]. However, PD related peritonitis is a serious complication which is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis [2–4]. Risk factors for PD related peritonitis have been well documented, with bacterial translocation from the gut well accepted as a potential cause of peritonitis [5]. In patients with liver cirrhosis, spontaneous bacterial peritonitis resulting from abnormal intestinal permeability and bacterial overgrowth have also been well documented as risk factors [6,7]. In addition for patients with renal failure, impaired gastrointestinal barrier function and increased gut permeability promote the translocation of bacteria [8–14].