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1.
World J Gastroenterol ; 30(23): 2954-2958, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38946869

RESUMO

The Baveno VII criteria redefine the management of decompensated liver cirrhosis, introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline. Central to this concept is addressing the underlying cause of cirrhosis through tailored therapies, including antivirals and lifestyle modifications. Studies on alcohol, hepatitis C virus, and hepatitis B virus-related cirrhosis demonstrate the efficacy of these interventions in improving liver function and patient outcomes. Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a promising intervention, effectively resolving complications of portal hypertension and facilitating recompensation. However, optimal timing and patient selection for TIPS remain unresolved. Despite challenges, TIPS offers renewed hope for hepatic recompensation, marking a significant advancement in cirrhosis management. Further research is needed to refine its implementation and maximize its benefits. In conclusion, TIPS stands as a promising avenue for improving hepatic function and patient outcomes in decompensated liver cirrhosis within the framework of the Baveno VII criteria.


Assuntos
Hipertensão Portal , Cirrose Hepática , Seleção de Pacientes , Derivação Portossistêmica Transjugular Intra-Hepática , Humanos , Cirrose Hepática/virologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Hipertensão Portal/etiologia , Hipertensão Portal/diagnóstico , Hipertensão Portal/terapia , Resultado do Tratamento , Antivirais/uso terapêutico , Fígado/cirurgia
3.
Radiographics ; 44(8): e230140, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38990775

RESUMO

Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for antegrade transvenous obliteration. Given the absence of consensus and guidelines, a multidisciplinary team approach is essential for the individualized management of ectopic varices. Interventional radiologists must be knowledgeable about the anatomy and hemodynamic characteristics of ectopic varices based on CT images and be prepared to consider appropriate options for each specific situation. ©RSNA, 2024 Supplemental material is available for this article.


Assuntos
Hemorragia Gastrointestinal , Derivação Portossistêmica Transjugular Intra-Hepática , Humanos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiologia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/terapia , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/complicações , Varizes/diagnóstico por imagem , Varizes/terapia , Radiografia Intervencionista/métodos , Radiologia Intervencionista/métodos , Embolização Terapêutica/métodos , Tomografia Computadorizada por Raios X/métodos
4.
Nihon Shokakibyo Gakkai Zasshi ; 121(7): 580-588, 2024.
Artigo em Japonês | MEDLINE | ID: mdl-38987168

RESUMO

Improvement and worsening of portal hypertension after direct acting antiviral agent (DAA) treatment for hepatitis C virus-related cirrhosis have been reported, and a consensus remains elusive. In this study, we underscored on the intraperitoneal shunt formed via portal hypertension and examined how the shunt system confirmed by computed tomography (CT) changes before and after treatment in cases in which sustained virological response (SVR) was attained with DAAs. Of the cases in which we achieved an SVR of 24 with DAA treatment for hepatitis C virus-related cirrhosis at our hospital, 83 cases in which CT images were taken before and after treatment were investigated. If the intraperitoneal shunt diameter changed by 20% or more, it was analyzed as an increase or decrease. In 29 patients, intraperitoneal shunt enlargement was noted. When examining factors related to the increase, multivariate analysis detected the FIB4 index at the end of the DAA treatment. Conversely, only four cases were observed in which the size decreased. At the end of treatment, the FIB4 index was the most important factor in increasing the intraperitoneal shunt after DAA treatment for hepatitis C virus-related cirrhosis, and fibrosis was believed to be an influencing factor.


Assuntos
Antivirais , Hepatite C , Humanos , Antivirais/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hepatite C/tratamento farmacológico , Hepatite C/complicações , Tomografia Computadorizada por Raios X , Hipertensão Portal , Cirrose Hepática/cirurgia
5.
Rev Gastroenterol Peru ; 44(2): 145-149, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-39019808

RESUMO

Portal hypertension (PHT) is defined as an increase in pressure at the level of the portal vein above 5 mmHg, the most common cause being liver cirrhosis. Among the presinusoidal intrahepatic causes of PHT with portal venular involvement, what was traditionally known as idiopathic non-cirrhotic portal hypertension (NCIH) is described, with the requirements of excluding those patients who did not present PHT, as well as those with the presence of liver cirrhosis and thrombosis. portal venous vein (PVT). Currently, the diagnostic criteria for this entity have been reconsidered, and its name, being known as porto-sinusoidal vascular disease (PSVD), also does not exclude patients with PHT or the presence of underlying liver disease. Liver biopsy continues to be the gold standard for diagnosis. The clinical manifestations are derived from PHT and the management is similar to the complications that occur in patients with liver cirrhosis. The case of a male patient is presented who presents with symptoms of digestive bleeding, with findings of esophageal varices in upper endoscopy in addition to a study of viral, autoimmune liver disease and negative deposits, with a conclusive liver biopsy of porto-sinusoidal vascular disease.


Assuntos
Hemorragia Gastrointestinal , Hipertensão Portal , Humanos , Masculino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hipertensão Portal/complicações , Hipertensão Portal/etiologia , Hipertensão Portal/diagnóstico , Veia Porta , Pessoa de Meia-Idade , Hepatopatia Veno-Oclusiva/diagnóstico , Hepatopatia Veno-Oclusiva/complicações
6.
Pediatr Surg Int ; 40(1): 196, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39017953

RESUMO

PURPOSE: This study evaluated portal hypertension (PHT) and its predictors among native liver survivors (NLS) of biliary atresia (BA) after Kasai portoenterostomy (KPE). METHODS: This was a multicenter study using prospectively collected data. The subjects were patients who remained transplant-free for 5 years after KPE. Their status of PHT was evaluated and variables that predicted PHT were determined by regression analysis and receiver operating characteristic (ROC) curve. RESULTS: Six centers from East Asia participated in this study and 320 subjects with KPE between 1980 to 2018 were analyzed. The mean follow-up period was 10.6 ± 6.2 years. At the 5th year after KPE, PHT was found in 37.8% of the subjects (n = 121). Patients with KPE done before day 41 of life had the lowest percentage of PHT compared to operation at older age. At 12 months after KPE, PHT + ve subjects had a higher bilirubin level (27.1 ± 11.7 vs 12.3 ± 7.9 µmol/L, p = 0.000) and persistent jaundice conferred a higher risk for PHT (OR = 12.9 [9.2-15.4], p = 0.000). ROC analysis demonstrated that a bilirubin level above 38 µmol/L at 12 months after KPE predicted PHT development (sensitivity: 78%, specificity: 60%, AUROC: 0.75). CONCLUSIONS: In BA, early KPE protects against the development of PHT among NLSs. Patients with persistent cholestasis at one year after KPE are at a higher risk of this complication. They should receive a more vigilant follow-up. LEVEL OF EVIDENCE: Level III.


Assuntos
Atresia Biliar , Colestase , Hipertensão Portal , Portoenterostomia Hepática , Humanos , Atresia Biliar/cirurgia , Atresia Biliar/complicações , Portoenterostomia Hepática/métodos , Masculino , Feminino , Hipertensão Portal/etiologia , Lactente , Colestase/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Seguimentos , Sobreviventes/estatística & dados numéricos , Recém-Nascido , Pré-Escolar
7.
BMJ Open ; 14(7): e081623, 2024 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-38991669

RESUMO

INTRODUCTION: Patients with clinically significant portal hypertension (CSPH) are recommended to be treated with non-selective beta-blockers (ie, carvedilol) to prevent the first hepatic decompensation event by the renewing Baveno VII consensus. CSPH is defined by hepatic venous pressure gradient (HVPG)≥10 mm Hg; however, the HVPG measurement is not widely adopted due to its invasiveness. Liver stiffness (LS)≥25 kPa can be used as a surrogate of HVPG≥10 mm Hg to rule in CSPH with 90% of the positive predicting value in majority aetiologies of patients. A compelling argument is existing for using LS≥25 kPa to diagnose CSPH and then to initiate carvedilol in patients with compensated cirrhosis, and about 5%-6% of patients under this diagnosis criteria may not be benefited from carvedilol and are at risk of lower heart rate and mean arterial pressure. Randomised controlled trial on the use of carvedilol to prevent liver decompensation in CSPH diagnosed by LS remains to elucidate. Therefore, we aimed to investigate if compensated cirrhosis patients with LS≥25 kPa may benefit from carvedilol therapy. METHODS AND ANALYSIS: This study is a randomised, double-blind, placebo-controlled, multicentre trial. We will randomly assign 446 adult compensated cirrhosis patients with LS≥25 kPa and without any previous decompensated event and without high-risk gastro-oesophageal varices. Patients are randomly divided into two groups, with 223 subjects in group A and 223 subjects in group B. Group A is a carvedilol intervention group, while group B is a placebo group. All patients in both groups will receive aetiology therapies and are followed up at an interval of 6 months. The 3-year incidences of decompensated events of cirrhosis-related and liver-related death are the primary outcome. The secondary outcomes include development of each complication of portal hypertension individually (ascites, variceal bleeding or overt hepatic encephalopathy), development of spontaneous bacterial peritonitis and other bacterial infections, development of new varices, growth of small varices to large varices, delta changes in LS and spleen stiffness, change in hepatic dysfunction assessed by Child-Pugh and model for end-stage liver disease score, change in platelet count, development of hepatocellular carcinoma, development of portal vein thrombosis and adverse events with a 3-year follow-up. A predefined interim analysis will be performed to ensure that the calculation is reasonable. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethics committees of the Sixth People's Hospital of Shenyang (2023-05-003-01) and independent ethics committee for clinical research of Zhongda Hospital, affiliated to Southeast University (2023ZDSYLL433-P01). The results from this trial will be submitted for publication in peer-reviewed journals and will be presented at international conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300073864.


Assuntos
Carvedilol , Hipertensão Portal , Cirrose Hepática , Carvedilol/uso terapêutico , Carvedilol/farmacologia , Humanos , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Método Duplo-Cego , China/epidemiologia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Antagonistas Adrenérgicos beta/uso terapêutico , Feminino , Fígado/efeitos dos fármacos , Fígado/fisiopatologia , Pressão na Veia Porta/efeitos dos fármacos , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/prevenção & controle , Técnicas de Imagem por Elasticidade , Adulto , Masculino
8.
Expert Rev Respir Med ; 18(5): 269-281, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38962827

RESUMO

INTRODUCTION: Cystic fibrosis (CF)-associated liver disease can significantly affect the quality of life and survival of people with CF. The hepatobiliary manifestations in CF are various, with focal/multilobular biliary cirrhosis more common in children and porto-sinusoidal vascular disease (PSVD) in young adults. Portal hypertensive complications, particularly bleeding from esophagogastric varices and hypersplenism are common, while liver failure is rarer and mainly linked to biliary disease. AREAS COVERED: This review explores current therapeutic options for CF-associated liver disease, presenting ongoing studies and new insights into parthenogenesis for potential future therapies. EXPERT OPINION: Monitoring for signs of portal hypertension is essential. Limited evidence supports ursodeoxycholic acid (UDCA) efficacy in halting CF liver disease progression. The effect of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on liver outcomes lacks definitive data, since patients with CF-related liver disease were excluded from trials due to potential hepatotoxicity. A proposed approach involves using UDCA and modulators in early stages, along with anti-inflammatory agents, with further therapeutic strategies awaiting randomized trials. Prevention of portal hypertensive bleeding includes endoscopic sclerotherapy or ligation of esophageal varices. Nonselective beta-blockers may also prevent bleeding and could be cautiously implemented. Other non-etiological treatments require investigation.


Assuntos
Fibrose Cística , Hipertensão Portal , Humanos , Hipertensão Portal/fisiopatologia , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/etiologia , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Fibrose Cística/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêutico , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Hepatopatias/tratamento farmacológico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Varizes Esofágicas e Gástricas/fisiopatologia , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/metabolismo , Qualidade de Vida , Progressão da Doença
9.
Wiad Lek ; 77(5): 932-936, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39008579

RESUMO

OBJECTIVE: Aim: To evaluate the effectiveness of PSAE for secondary prevention of VB episodes in patients with chronic liver disease (CLD) and CSPH. PATIENTS AND METHODS: Materials and Methods: One hundred twenty patients (from 2008 to 2020) were submitted of PSAE as secondary prevention treatment. The results of the treatment of 27 patients between 2008 and 2012 (first period) were compared with those of 93 patients treated with PSAE since 2013 (second period), as procedure and management protocol were modificated. VB recurrence rate and mortality (related and non-related to bleeding episodes) were defined as study end-points in both groups at 12-months follow-up. RESULTS: Results: At 12-months follow-up, 11 (40,7 %) and 54 (58,1 %) patients in groups 1 and 2, respectively, were free from VBs (p=0,129). Overall mortality rate was significantly higher in group 1, as compared to group 2: 10 (37,0 %) versus 6 (6,4 %) patients, respectively (p<0,001), - due to higher frequency of fatal VB events (7 (26,0 %) vs. 3 (3,2 %) patients, respectively; p=0,001). CONCLUSION: Conclusions: PSAE is an effective treatment for secondary prevention of VB in patients with CLD and CSPS. The management protocol modification resulted in the decrease in overall mortality rate and mortality related to recurrent VB episodes.


Assuntos
Embolização Terapêutica , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Hipertensão Portal , Humanos , Masculino , Feminino , Varizes Esofágicas e Gástricas/terapia , Embolização Terapêutica/métodos , Hipertensão Portal/complicações , Pessoa de Meia-Idade , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/mortalidade , Prevenção Secundária/métodos , Artéria Esplênica , Adulto , Recidiva , Resultado do Tratamento , Idoso
10.
Sci Rep ; 14(1): 13674, 2024 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-38871788

RESUMO

Managing complications of liver cirrhosis such as varices needing treatment (VNT) and clinically significant portal hypertension (CSPH) demands precise and non-invasive diagnostic methods. This study assesses the efficacy of spleen stiffness measurement (SSM) using a 100-Hz probe for predicting VNT and CSPH, aiming to refine diagnostic thresholds. A retrospective analysis was conducted on 257 cirrhotic patients, comparing the diagnostic performance of SSM against traditional criteria, including Baveno VII, for predicting VNT and CSPH. The DeLong test was used for statistical comparisons among predictive models. The success rate of SSM@100 Hz was 94.60%, and factors related to SSM failure were high body mass index and small spleen volume or length. In our cohort, the identified SSM cut-off of 38.9 kPa, which achieved a sensitivity of 92% and a negative predictive value (NPV) of 98% for detecting VNT, is clinically nearly identical to the established Baveno threshold of 40 kPa. The predictive capability of the SSM-based model for VNT was superior to the LSM ± PLT model (p = 0.017). For CSPH prediction, the SSM model notably outperformed existing non-invasive tests (NITs), with an AUC improvement and significant correlations with HVPG measurements (obtained from 49 patients), highlighting a correlation coefficient of 0.486 (p < 0.001) between SSM and HVPG. Therefore, incorporating SSM into clinical practice significantly enhances the prediction accuracy for both VNT and CSPH in cirrhosis patients, mainly due to the high correlation between SSM and HVPG. SSM@100 Hz can offer valuable clinical assistance in avoiding unnecessary endoscopy in these patients.


Assuntos
Técnicas de Imagem por Elasticidade , Hipertensão Portal , Cirrose Hepática , Baço , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Feminino , Baço/patologia , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Estudos Retrospectivos , Idoso , Técnicas de Imagem por Elasticidade/métodos , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Adulto
11.
Medicine (Baltimore) ; 103(23): e38424, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38847721

RESUMO

RATIONAL: Congenital hepatic fibrosis (CHF) is a rare autosomal recessive genetic disease, which is often diagnosed in children and young adults. The clinical manifestations of CHF were lack of specificity, mainly including portal hypertension related symptoms and signs, and normal or mildly abnormal liver function. When no obvious varices are indicated under endoscope, it can easily lead to misdiagnosis or missed diagnosis. We report this case in the hope of raising awareness of this disease. PATIENT CONCERNS: A 31 years old male patient with major clinical manifestations of unexplained thrombocytopenia for 5 years. DIAGNOSES: Results of ultrasound, magnetic resonance imaging (MRI) and computed tomography portal venography (CTV) showed that patient had liver cirrhosis with portal hypertension and liver biopsy revealed CHF. INTERVENTION: Patient received ursodeoxycholic acid tablets, fuzheng huayu capsule, ganshuang granule, etc for liver protection treatment. OUTCOMES: The condition of patient stabilized after symptomatic treatment. Spleen resection will be considered during follow-up. LESSONS: This case reminds us that in case of patients with negative endoscopic evaluation, ultrasonic, computed tomography (CT) and MRI examination should be performed at the same time to determine whether patients have portal hypertension. When patients with normal or mildly abnormal liver function had unexplained liver cirrhosis complicated with portal hypertension, the possibility of CHF should be considered.


Assuntos
Varizes Esofágicas e Gástricas , Cirrose Hepática , Humanos , Masculino , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/diagnóstico , Adulto , Cirrose Hepática/complicações , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos
12.
Clin Liver Dis ; 28(3): 369-381, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945632

RESUMO

This article reviews the pathophysiology of portal hypertension that includes multiple mechanisms internal and external to the liver. This article starts with a review of literature describing the cellular and molecular mechanisms of portal hypertension, microvascular thrombosis, sinusoidal venous congestion, portal angiogenesis, vascular hypocontractility, and hyperdynamic circulation. Mechanotransduction and the gut-liver axis, which are newer areas of research, are reviewed. Dysfunction of this axis contributes to chronic liver injury, inflammation, fibrosis, and portal hypertension. Sequelae of portal hypertension are discussed in subsequent studies.


Assuntos
Hipertensão Portal , Hipertensão Portal/fisiopatologia , Hipertensão Portal/etiologia , Humanos , Mecanotransdução Celular , Cirrose Hepática/fisiopatologia , Cirrose Hepática/complicações , Fígado/fisiopatologia , Fígado/irrigação sanguínea , Neovascularização Patológica/fisiopatologia , Circulação Hepática/fisiologia , Veia Porta/fisiopatologia
13.
Clin Liver Dis ; 28(3): 383-400, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945633

RESUMO

Measurement of hepatic venous pressure gradient (HVPG) effectively mirrors the severity of portal hypertension (PH) and offers valuable insights into prognosis of liver disease, including the risk of decompensation and mortality. Additionally, HVPG offers crucial information about treatment response to nonselective beta-blockers and other medications, with its utility demonstrated in clinical trials in patients with PH. Despite the widespread dissemination and validation of noninvasive tests, HVPG still holds a significant role in hepatology. Physicians treating patients with liver diseases should comprehend the HVPG measurement procedure, its applications, and how to interpret the results and potential pitfalls.


Assuntos
Hipertensão Portal , Pressão na Veia Porta , Humanos , Hipertensão Portal/fisiopatologia , Hipertensão Portal/diagnóstico , Veias Hepáticas/fisiopatologia , Prognóstico , Índice de Gravidade de Doença
14.
Clin Liver Dis ; 28(3): 437-453, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945636

RESUMO

Interventions for portal hypertension are continuously evolving and expanding beyond the realm of medical management. When complications such as varices and ascites persist despite conservative interventions, procedures including transjugular intrahepatic portosystemic shunt creation, transvenous obliteration, portal vein recanalization, splenic artery embolization, surgical shunt creation, and devascularization are all potential interventions detailed in this article. Selection of the optimal procedure to address the underlying cause, treat symptoms, and, in some cases, bridge to liver transplantation depends on the specific etiology of portal hypertension and the patient's comorbidities.


Assuntos
Embolização Terapêutica , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Humanos , Hipertensão Portal/cirurgia , Hipertensão Portal/terapia , Hipertensão Portal/etiologia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Embolização Terapêutica/métodos , Veia Porta/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Artéria Esplênica/cirurgia , Artéria Esplênica/diagnóstico por imagem , Derivação Portossistêmica Cirúrgica/métodos , Transplante de Fígado
15.
Clin Liver Dis ; 28(3): 455-466, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945637

RESUMO

Porto-sinusoidal vascular disease (PSVD) is the medical diagnosis for a patient who has portal hypertension in the absence of cirrhosis on liver biopsy. There are several specific histologic findings for PSVD, including obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Epidemiologic reports vary widely among regions; PSVD comprises less than 10% of causes of portal hypertension in Western countries but incidence has been found to be as high as 48% in India. There is an expansive list of etiologies that have been reported to cause PSVD.


Assuntos
Hipertensão Portal , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/diagnóstico , Hipertensão Portal/complicações , Hipertensão Portal/epidemiologia , Hepatopatia Veno-Oclusiva/etiologia , Hepatopatia Veno-Oclusiva/diagnóstico , Veia Porta/patologia
16.
Clin Liver Dis ; 28(3): 467-482, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945638

RESUMO

Portopulmonary hypertension (POPH), hepatopulmonary syndrome, and hepatic hydrothorax constitute significant complications of portal hypertension, with important implications for management and liver transplantation (LT) candidacy. POPH is characterized by obstruction and remodeling of the pulmonary resistance arterial bed. Hepatopulmonary syndrome is the most common pulmonary vascular disorder, characterized by intrapulmonary vascular dilatations causing impaired gas exchange. LT may improve prognosis in select patients with POPH. LT is the only effective treatment of hepatopulmonary syndrome. Hepatic hydrothorax is defined as transudative pleural fluid accumulation that is not explained by primary cardiopulmonary or pleural disease. LT is the definitive cure for hepatic hydrothorax.


Assuntos
Síndrome Hepatopulmonar , Hidrotórax , Hipertensão Portal , Hipertensão Pulmonar , Transplante de Fígado , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/complicações , Hipertensão Portal/fisiopatologia , Síndrome Hepatopulmonar/etiologia , Síndrome Hepatopulmonar/fisiopatologia , Síndrome Hepatopulmonar/terapia , Hidrotórax/etiologia , Hidrotórax/terapia , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia
17.
Clin Liver Dis ; 28(3): 483-501, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945639

RESUMO

In portal hypertension, acute variceal bleed is the cause of 2/3rd of all upper gastrointestinal bleeding episodes. It is a life-threatening emergency in patients with cirrhosis. Nonselective beta-blockers by decreasing the hepatic venous pressure gradient are the mainstay of medical therapy for the prevention of variceal bleeding and rebleeding. Evaluation of the severity of bleed, hemodynamic resuscitation, prophylactic antibiotic, and intravenous splanchnic vasoconstrictors should precede the endoscopy procedure. Endoscopic band ligation is the recommended endotherapy. Rescue transjugular intrahepatic port-systemic shunt (TIPS) is recommended for variceal bleed refractory to endotherapy. In patients with a high risk of failure of combined pharmacologic and endoscopic therapy, pre-emptive TIPS may improve the outcome. For gastric varices, "Sarin classification" is universally applied as it is simple and has therapeutic implication. For IGV1 and GOV2, injection cyanoacrylate glue is considered the endotherapy of choice. Endoscopic ultrasound is a useful modality in the management of gastric varices.


Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Humanos , Hipertensão Portal/terapia , Hipertensão Portal/complicações , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Varizes Esofágicas e Gástricas/terapia , Varizes Esofágicas e Gástricas/etiologia , Ligadura , Antagonistas Adrenérgicos beta/uso terapêutico , Cirrose Hepática/complicações
18.
Clin Liver Dis ; 28(3): 401-415, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945634

RESUMO

The progressive use of noninvasive tests (NITs) has changed the way hepatologists diagnose and manage patients with chronic liver disease, mainly because of their easiness to use and the ability to be repeated during follow-up. Liver stiffness measurement is the NIT with more scientific evidence. NITs have demonstrated to be useful to detect not only liver fibrosis but also the presence of clinically significant portal hypertension. Moreover, current evidence supports they can also be useful to evaluate the prognosis of patients with chronic liver disease.


Assuntos
Técnicas de Imagem por Elasticidade , Hipertensão Portal , Cirrose Hepática , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/etiologia , Hipertensão Portal/fisiopatologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/fisiopatologia , Prognóstico , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia
19.
Clin Liver Dis ; 28(3): 417-435, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945635

RESUMO

Portal hypertension is the key mechanism driving the transition from compensated to decompensated cirrhosis. In this review, the authors described the pathophysiology of portal hypertension in cirrhosis and the rationale of pharmacologic treatment of portal hypertension. We discussed both etiologic and nonetiologic treatment of portal hypertension and the specific clinical scenarios how nonselective beta-blocker can be used in patients with cirrhosis. Finally, the authors summarized the evidence for emerging alternatives for portal hypertension in patients with cirrhosis.


Assuntos
Antagonistas Adrenérgicos beta , Hipertensão Portal , Cirrose Hepática , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/fisiopatologia , Hipertensão Portal/etiologia , Humanos , Antagonistas Adrenérgicos beta/uso terapêutico , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Anti-Hipertensivos/uso terapêutico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/tratamento farmacológico
20.
Clin Liver Dis ; 28(3): 525-539, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945641

RESUMO

Patients with cirrhosis and clinically significant portal hypertension are at high risk of developing bacterial infections (BIs) that are the most common trigger of acute decompensation and acute-on-chronic liver failure. Furthermore, after decompensation, the risk of developing BIs further increases in an ominous vicious circle. BIs may be subtle, and they should be ruled out in all patients at admission and in case of deterioration. Timely administration of adequate empirical antibiotics is the cornerstone of treatment. Herein, we reviewed current evidences about pathogenesis, clinical implications and management of BIs in patients with cirrhosis and portal hypertension.


Assuntos
Antibacterianos , Infecções Bacterianas , Hipertensão Portal , Cirrose Hepática , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Antibacterianos/uso terapêutico , Insuficiência Hepática Crônica Agudizada/etiologia , Insuficiência Hepática Crônica Agudizada/terapia
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