Cirrhosis in Surgery
Stephen M. Cohn, Peter Rhee in 50 Landmark Papers, 2019
Unlike the liver injury with Prometheus, cirrhosis is chronic liver damage from a number of sources that causes irreversible fibrosis and leads to portal hypertension, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, coagulopathy, hepatorenal syndrome, and hepatocellular carcinoma. The major causes of cirrhosis include chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, alcoholism, and nonalcoholic steatohepatitis. Cirrhosis is the eighth leading cause of death in the United States and the thirteenth leading cause of death globally. A diagnosis of compensated cirrhosis is associated with a risk of death that is 4.7 times the general population, and decompensated cirrhosis is associated with a risk that is 9.7 times as high. The average life expectancy of a patient with compensated cirrhosis is 10–13 years, and the average life expectancy may be as low as 2 years for decompensated cirrhosis (Ge et al., 2016).
Mixed Cavernous Hemangioma-Lymphangioma of the Gastroesophageal Junction
Wickii T. Vigneswaran in Thoracic Surgery, 2019
One of the few published series examining such tumors is a histopathological review of 27 gastrointestinal tract vascular malformations, in which 12 were hemangiomas, lymphangiomas, or mixed hemangiolymphomas [2]. None were located in the esophagus. The most common location was the small bowel and 27% of patients presented with gastrointestinal bleeding. Associations with esophageal carcinoma [3] and malignant degeneration have been rarely reported in esophageal hemangiomas, generally in tumors greater than 3 cm [4]. Due to their similar appearance and symptomatology, these lesions must be distinguished from esophageal varices. A proximal lesion may suggest vascular malformation since isolated cervical varices are extremely rare in cirrhotic patients [5]. CT, MRI, physical exam, and blood work can be utilized to assess for signs of cirrhosis. Biopsy of hypervascular esophageal tumors is not typically recommended due to the potential for bleeding [6].
Using evidence and logic in everyday clinical reasoning, communication and legal and scientific argumentation
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
The classical argument (syllogism) is replaced by a fuzzy argument, which may be based then, on one or more fuzzy premises and its conclusion will necessarily be fuzzy. It may lead to a deductively invalid argument such as:In dispositional reasoning, propositions are not necessarily always true; Heavy alcohol drinking is a leading cause of liver cirrhosis. To avoid liver cirrhosis, avoid heavy drinking of alcohol.In qualitative reasoning, the input-output is expressed as a collection of fuzzy if-then rules in which the antecedents (premises) and consequents (conclusions) involve linguistic variables. This kind of reasoning bears some similarity to the if-then reasoning in the artificial intelligence domain.49
Growth differentiation factor 15: A novel biomarker with high clinical potential
Published in Critical Reviews in Clinical Laboratory Sciences, 2019
Stéphanie Desmedt, Valérie Desmedt, Leen De Vos, Joris R. Delanghe, Reinhart Speeckaert, Marijn M. Speeckaert
Liver cirrhosis is a condition in which liver tissue is replaced by scar tissue, leading to impairment of function. GDF-15 has been put forward as a predictive biomarker of liver fibrosis and severity in patients with chronic liver disease. As a result of chronic damage to hepatocytes, prolonged stimulation of hepatic stellate cells results in the release of profibrogenic abundant factors such as GDF-15, leading to the development of liver cirrhosis. In a cohort study of 834 European individuals (age: 17–84 years, males 61%) with viral (n = 559) and non-viral (n = 275) chronic liver diseases, a three-marker algorithm (placental growth factor = 20.2 ng/L, GDF-15 = 1582 ng/L, and hepatic growth factor = 2598 ng/L) identified an additional 50% of patients with chronic liver diseases at risk for progressed fibrosis who presented with low elastography values [126]. A multicenter retrospective study found significantly elevated serum GDF-15 concentrations in Asian subjects with liver cirrhosis (60 cases, mean age: 50 years, 42% males) in comparison with healthy subjects (183 cases, mean age: 50 years, 50.3% males). At the optimal cutoff point of 2463 ng/L, GDF-15 had a moderate sensitivity (63.1%) and a high specificity (86.6%) for patients with liver cirrhosis in comparison with hepatitis B virus or hepatitis C virus (HCV) carriers [127].
Emerging synthetic drugs for the treatment of liver cirrhosis
Published in Expert Opinion on Emerging Drugs, 2021
Jonathan Andrew Fallowfield, Maria Jimenez-Ramos, Andrew Robertson
Cirrhosis is characterized by extreme liver scarring (fibrosis), loss of organ function and serious complications related to portal hypertension (high blood pressure in the hepatic portal vein and its branches). It represents a generic end-stage for a variety of chronic liver diseases (CLD) including nonalcoholic fatty liver disease (NAFLD), alcohol-related liver disease and chronic viral hepatitis. NAFLD is now the commonest etiology worldwide, affecting 1 in 4 adults [1], and the progressive form that leads to patient harm (nonalcoholic steatohepatitis (NASH)) is predicted to increase by 63% between 2015 and 2030 [2], representing a global cohort of at least 100 million individuals. Cirrhosis is typically classified as either compensated or decompensated. In compensated cirrhosis, the liver can maintain its important functions and patients are generally asymptomatic. In decompensated cirrhosis the liver no longer functions adequately, and patients develop life-threatening problems including bleeding varices (varicose veins in the esophagus), ascites (abnormal buildup of fluid in the abdomen) and hepatic encephalopathy (altered brain function).
Diagnostic accuracy and prognostic significance of osteopontin in liver cirrhosis and hepatocellular carcinoma: a Meta-analysis
Published in Biomarkers, 2022
Yingshi Zhang, Jiayue Gao, Yu Bao, Yang Liu, Yimeng Tong, Shuqing Jin, Qingchun Zhao
Hepatocellular carcinoma (HCC) is currently the sixth most common malignant tumour worldwide and the fifth most common cause of cancer-related death after lung, pancreas, breast and colon cancers (Siegel et al.2020). Liver cirrhosis (LC) is the most common predisposing factor for HCC, and approximately 80–88% of HCC cases develop in patients with cirrhotic livers, which represents the final stage of injury and is characterised by inflammation and pronounced distortion of the hepatic vascular architecture (Kornberg 2014, Tsochatzis et al.2014, Llovet et al.2016, Lleo et al.2019). Generally, a regenerative liver fibrosis nodule first progresses to a dysplastic nodule, then to well-differentiated HCC, and finally to moderately/poorly differentiated HCC (Choi et al.2014). The major causes of cirrhosis are viral hepatitis (hepatitis B virus, hepatitis C virus), alcoholic liver disease, and non-alcoholic steatohepatitis, and only one in three people with LC knows that they have it (Smith et al.2019). Therefore, a simple diagnostic method is urgently needed.
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