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).
Hyperfibrinolysis in Liver Cirrhosis
Pia Glas-Greenwalt in Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
Cirrhosis is the most common chronic disease of the liver. It is defined as a diffuse process characterized by fibrosis and a conversion of normal architecture into structurally abnormal nodules. In most patients cirrhosis is caused by chronic active viral hepatitis or long-standing alcohol abuse. Other causes or diseases are, among others, primary biliary cirrhosis, pigment cirrhosis (hemochromatosis), cirrhosis associated with Wilson’s disease, autoimmune hepatitis, α1-antitrypsin deficiency, or sclerosing cholangitis. In many patients, no cause for the cirrhosis can be found (cryptogenic cirrhosis). Cirrhosis of the liver results in a reduced protein synthesis, caused by a decrease in the number as well as the function of the hepatocytes. A reduced dietary intake of amino acids may contribute to deficient protein synthesis. As a result of nodular regeneration and of the abnormal architecture of the liver, the vascular resistance in the sinusoidal bed of the liver increases. This causes a rise of the portal venous pressure (portal hypertension). Collateral vessels increase in size, which results in portal systemic shunting. Portal hypertension is usually associated with reduced hepatic clearance of substances that are normally rapidly cleared by a healthy liver.
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
Serum troponin is elevated in acute decompensation and acute-on-chronic liver failure and is associated with severity of liver disease and short-term mortality
Published in Scandinavian Journal of Gastroenterology, 2023
Iliana Mani, Theodoros Alexopoulos, Larisa Vasilieva, Alexandra Alexopoulou
A total of 296 consecutive patients with decompensated cirrhosis [69.3% male, median age 57 (IQR 51-68) years, MELD score 19 (13-25)] were included. Cause of cirrhosis was alcoholic liver disease in 54.4%, chronic viral hepatitis in 20.6% and miscellaneous in 25.0%. ACLF, AD and DC were diagnosed in 29.4%, 48.3% and 22.3%, respectively. Hs-cTnI ≥ 4 ng/L was detected on admission in 66.2% of total patients. Hs-cTnI ≥ 4 ng/L was more prevalent in ACLF vs AD or DC groups without the difference reaching statistical significance. Moreover, patients with hs-cTnI ≥ 4 ng/L were older and had more severe liver disease (higher MELD score, INR and more prevalent hepatic encephalopathy) and higher creatinine compared to those with < 4 ng/L (Table 1). In addition, higher CLIF-C AD grades were illustrated in those with hs-cTnI ≥ 4 ng/L within AD group. There was no difference in gender, etiology and inflammation markers (CRP and neutrophil-to-lymphocyte ratio) between patients with hs-cTnI ≥ 4 and those with hs-cTnI < 4 ng/L.
Deep learning for assessing liver fibrosis based on acoustic nonlinearity maps: an in vivo study of rabbits
Published in Computer Assisted Surgery, 2022
Jinzhen Song, Hao Yin, Jianbo Huang, Zhenru Wu, Chenchen Wei, Tingting Qiu, Yan Luo
Liver fibrosis, which may be caused by hepatic injury such as virus infection and alcohol abuse, is a stage progressing to cirrhosis [1]. Patients with cirrhosis might suffer from several complications, such as hepatocellular carcinomas, esophageal varices and/or hepatic failure [2]. Staging fibrosis stages is essential for prognosis, surveillance and management of patients with liver fibrosis [3,4]. The golden standard of assessing fibrosis stages is liver biopsy [5,6]. However, liver biopsy is invasive so that it may lead to various potential complications such as bleeding and rupture. Meanwhile, sampling errors also limit the diagnostic accuracy. Biomarkers show suboptimal diagnostic accuracy compared with imaging methods [7,8]. Conventional ultrasound, CT and MRI are not sensitive enough for predicting fibrosis. Ultrasound-based elastography is studied for staging liver fibrosis in recent years with good performance [9,10]. Shear wave speed is measured in ultrasound-based elastography such as Transient Elastography and Shear Wave Elastography. Diagnostic accuracy is high for the detection of significant and advanced fibrosis and cirrhosis (area under curve (AUC) > 0.90) [9]. Nevertheless, the cutoff values among various kinds of elastography machines require further investigation. Breath could also affect the reliability and accuracy [11].
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).
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