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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
Hepatorenal syndrome consists of functional renal failure in patients with advanced liver disease. The aetiology is not clear, but endotoxaemia and renal arterial vasoconstriction have been implicated. The urine sodium is very low.
Liver, biliary system and pancreas
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Satyajit Bhattacharya, Adrian O’Sullivan
Hepatorenal syndrome is characterised by the development of renal failure in patients with severe liver disease without underlying renal disease. Diagnosis is dependent on a low glomerular filtration rate; absence of shock; ongoing sepsis; fluid loss or haemorrhage; no improvement despite adequate plasma volume and diuretic withdrawal; proteinuria less than 500 mg/day; and no evidence of renal tract obstruction.
Kanamycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Karen Urbancic, M. Lindsay Grayson
No dose adjustment is required in patients with impaired liver function, although plasma concentrations can be affected owing to larger volume of distribution in cirrhotic patients with ascites. Prolonged use in patients with severe liver disease may progress rapidly to hepatorenal syndrome (WHO, 2014a). Careful monitoring of serum kanamycin levels is required.
The Impact of Chronic Liver Disease on Postoperative Outcomes and Resource Utilization
Published in Journal of Investigative Surgery, 2021
Joseph B. Oliver, Aziz M. Merchant, Baburao Koneru
Our findings combined with the data in the literature indicate the need for a more systematized care delivery by physicians and institutions with expertise in caring for chronic liver disease. Major areas to focus would be in preoperative optimization and intra and postoperative interventions to decrease clinical manifestations of liver failure and the associated comorbidities in the postoperative period. This is exemplified by the potential for the translation of the advances in prophylaxis and treatment of hepatorenal syndrome – use of vasoconstrictors and intravenous albumin – into the perioperative setting [36]. Another example would be use of preoperative transjugular intrahepatic portosystemic shunts (TIPS) in select patients undergoing major abdominal surgery. By decreasing portal hypertension, ascites and in some cases improving renal function, TIPS would help to decrease intraoperative bleeding, postoperative ascites, renal insufficiency, and variceal bleeding [37–39].
A study on clinical outcomes of combination of terlipressin and albumin in Hepatorenal Syndrome
Published in Scandinavian Journal of Gastroenterology, 2020
Rakhi Krishna, Jina Raj, Drishya Dev, Sruthy C. Prasad, Remya Reghu, Sudheer O. V.
Hepatorenal Syndrome is the most advanced stage of the various pathophysiologic derangements that take place in patients with cirrhosis. Through the study, we observed a reversal of HRS with an improvement in overall survival and restoration of both renal and liver function. The treatment enables to stabilise HRS patients and bridge them to liver transplantation. During the course of study, only mild ADRs due to terlipressin were observed which needed only minor medical management to resolve. We observed clinically and statistically significant improvement in both the physical and mental status of patients during the treatment with terlipressin and albumin. Hence the results of our present study suggested that terlipressin combined with intravenous albumin is quite beneficial in cirrhosis patients with HRS.
Colovesicular fistula from Candida dubliniensis in an immunocompetent resulting in poor outcome
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Christine Rizkalla, Jillian Ottombrino, Fahad Malik
He was managed in the intensive care unit for treatment of hepatorenal syndrome with hemodialysis, blood transfusion, intravenous fluids, midodrine, low dose norepinephrine (2–6 mcg), 100 mg hydrocortisone, pantoprazole, antibiotic (meropenem), octreotide and lactulose. He continued to be afebrile with no evidence of leukocytosis, but mental status continued to deteriorate. He had worsening of his synthetic liver functions with INR, up to 4.09. During the course of his admission, he also had a sudden drop in hemoglobin from 8.6 to 6.4 with inability to protect his airway requiring tracheal intubation with mechanical ventilation. A triple lumen catheter was also placed at the time and he underwent an urgent upper endoscopy for suspicion of variceal bleeding. The endoscopy revealed medium-sized varices and portal hypertensive gastropathy but no active bleeding at the time. A large amount of old blood was found in the gastric fundus.