Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study (June 1988-December 1989) of all patients admitted with ascites due to cirrhosis was undertaken: Biochemical and immunological factors which may have significance in the development of spontaneous bacterial peritonitis were determined. Among 56 patients (44 males and 12 females) SBP developed in 16% of the group. No age differences were found and the etiology of the cirrhosis was mainly alcoholic. Patients with SBP had lower alpha-2 globulin concentrations: 0.43 +/- 0.12 vs. 0.60 +/- 0.18 g/dl (p less than 0.05) and a lower prothrombin time: 41 +/- 13% vs. 69.5 +/- 13 vs. 69.5 +/- 21% (p less than 0.001). Patients with SBP had also lower ascitic fluid total protein 0.99 +/- 0.4 vs. 1.64 +/- 1.1 g/dl (p less than 0.01) as well as lower alfa-2 globulin: 0.065 +/- 0.012 vs. 0.096 +/- 0.067 g/dl (p less than 0.05); beta globulin, 0.11 +/- 0.047 vs. 0.2 +/- 0.17 g/dl (p less than 0.05); gamma globulin, 0.32 +/- 0.1 vs. 0.52 +/- 0.4 g/dl (p less than 0.05); IgG, 275 +/- 157 vs. 477 +/- 335 g/dl (p less than 0.05); C3, 9.2 +/- 3.2 vs. 17 +/- 13 mg/dl (p less than 0.01) and C4, 2.83 +/- 1.5 vs. 4.66 +/- 3.9 mg/dl (p less than 0.05) than patients without this complication.
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PMID:[Immunological and biochemical factors associated with spontaneous bacterial peritonitis]. 205 11

In view of high mortality, variable clinical presentation, and late results of bacterial culture, early diagnosis of SBP and treatment are based on indirect parameters of infection. Forty-two patients with ascites and liver cirrhosis were studied. Ascitic fluid (AF) was examined for total protein content, pH, lactate dehydrogenase, amylase, absolute polymorphonuclear cell count (PMN) and for presence of bacteria by examining a fresh smear of the deposit and culture of the fluid under aerobic and anaerobic conditions. AF/serum gradient of total proteins and LDH was calculated. One patient proved to have a malignant ascites and was excluded. The remaining 41 patients fell into two groups: Group I PMN less than 250 cell mm-3, culture negative, sterile ascites, 36 patients. Group II PMN greater than 250 cell mm-3. (a) Culture positive neutrophilic ascites (SBP), three patients. (b) Culture negative neutrophilic ascites (CNNA), two patients. In both CNNA and SBP:AF/serum total LDH gradient greater than 0.75 In the sterile group: AF/serum total LDH gradient less than 0.58 There was no correlation between presence of infection and ascitic fluid pH, protein content and AF/serum total protein gradient. Therefore AF PMN greater than 250 mm and AF/serum total LDH gradient greater than 0.6 should be considered reliable, indirect parameters of infection, and CNNA a variant of SBP with a small bacterial inoculum size.
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PMID:Re-evaluation of the value of ascitic fluid pH lactate dehydrogenase and total proteins in the diagnosis of spontaneous bacterial peritonitis (SBP). 291 80

Bacterial peritonitis in patients with cirrhosis has a wide variety of clinical presentations. We report a group of 21 cirrhotic patients with secondary peritonitis from intra-abdominal sources. Seven had infected ascites. All of them had unrecognized secondary peritonitis which was diagnosed and treated as spontaneous (primary) bacterial peritonitis (SBP). Ascitic fluid analysis yielded a mean white blood cell count of 23,750 +/- 10,935/cu mm with 91.5% polymorphonuclear leukocytes, significantly higher than patients surveyed with SBP, 1,757 +/- 2,154/cu mm (P less than .001). Ascitic fluid protein levels were also higher than those typically seen in SBP: 4.4 +/- 1.5 gm/dl vs 0.8 +/- 0.4 gm/dl (P less than .001). The ascites: serum protein ratio was consistent with an exudate in those patients with secondary peritonitis (0.7 +/- 0.2) in contrast to typically infected transudate in patients with SBP (0.15 +/- 0.05) (P less than .001). Bacteriologic determination was similar: single organisms with Escherichia coli the most common. Often the clinical features and ascitic fluid analysis will not differentiate spontaneous from secondary peritonitis. It is, therefore, clinically prudent to consider secondary bacterial peritonitis in cirrhotic patients, especially with ascitic fluid WBC counts in excess of 5,000/cu mm and protein levels of greater than or equal to 2.5 gm/dl. Noninvasive diagnostic procedures should be included to search for sources of intra-abdominal infection.
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PMID:Secondary bacterial peritonitis in cirrhotic patients with ascites. 637 7

Cirrhotic patients have disturbed systemic hemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulant device for monitoring blood pressure in 35 patients with cirrhosis and 35 healthy matched controls. During the daytime, SBP, DBP, and MAP were significantly lower in the patients than in the controls (median 118 vs. 127; 70 vs. 78; 86 vs. 94 mm Hg, P < .0001 to P < .05). The nighttime blood pressures were almost similar in the two groups (108 vs. 110; 65 vs. 67; 78 vs. 82 mm Hg, NS). Conversely, HR was significantly higher in the patients both in the daytime (86 vs. 72/min, P < .0001) and at night (80 vs. 64/min, P < .0001). Consequently, the reduction in blood pressure and HR from daytime to nighttime was significantly lower in the patients than in the controls (P < .0001 to P < .01). Multiple regression analysis showed HR, serum albumin, serum sodium, and clotting factors 2, 7, and 10 as significant independent predictors of SBP in cirrhosis. In conclusion, cirrhotic patients have elevated HR, but surprisingly normal arterial blood pressure during the nighttime, and the circadian variation in blood pressure and HR is diminished, probably because of an almost unaltered cardiac output during the 24 hours. These results may reflect a major defect in the ability of optimal regulation of blood pressure in cirrhotic patients.
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PMID:Noninvasive 24-hour ambulatory arterial blood pressure monitoring in cirrhosis. 760 38

Fifty eight cases of SBP for the latest 20 years in Japan were reviewed. General symptoms due to SBP were ascites (100%), abdominal pain (93%), jaundice (86%), fever (57%) and rebound tenderness (55%), including male/female ratio of 2.6:1. Eighty eight per cent of SBP patients had cirrhosis. Although there was no difference between bacterial spieces causing SBP in the first ten years and latter ten years, survival of short period within 2 weeks was improved from 26.7% to 71.4%. However, long survival of 6 months was very poor yet. In patients with decompensated liver function, prophylactic and early treatment of SBP were recommended for improvement of long survival in SBP patients.
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PMID:[Spontaneous bacterial peritonitis--a review of Japanese case reports]. 811 77

We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42% for 2 years and 18% for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.
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PMID:[Infections during the hospitalization of patients with liver cirrhosis]. 829 12

Cirrhotic patients have disturbed systemic haemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and man arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulatory device for monitoring blood pressure in 35 patients with cirrhosis and 35 healthy matched controls. During the day-time, SBP, DBP and MAP were significantly lower in the patients than in the controls (median 118 vs 127; 70 vs 78; 86 vs 94 mmHg, p < 0.0001 to p < 0.05). The night-time blood pressures were almost similar in the two groups (108 vs 110; 65 vs 67; 78 vs 82 mmHg, NS). Conversely, HR was significantly higher in the patients both in the day-time (86 vs 72 min-1, p < 0.0001) and night (80 vs 64 min-1, p < 0.0001). Consequently, the reduction in blood pressure and HR from day-time to night-time was significantly lower in the patients than in the controls (p < 0.0001 to p < 0.01). Multiple regression analysis revealed HR, serum albumin, serum sodium, and clotting factors 2, 7 and 10 as significant independent predictors of SBP in cirrhosis. In conclusion, cirrhotic patients have elevated HR, but surprisingly normal arterial blood pressure during the night-time, and the circadian variation in blood pressure and HR is diminished probably due to an almost unaltered cardiac output during the 24 hours. These results may reflect a major defect in the ability of optimal regulation of blood pressure in cirrhotic patients.
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PMID:[Determination of diurnal blood pressure variations in cirrhosis]. 865 Aug 16

Although only the expansion of the donor pool will have a major impact on the survival of patients with decompensated cirrhosis awaiting OLT, anticipation of complications such as SBP may improve the likelihood of a patient surviving until OLT, and may ameliorate some of the major causes of morbidity of cirrhosis, such as osteoporosis. Close communication between the treating physicians and the transplant center is crucial to ensure that the patients' UNOS status can be appropriately adjusted if additional complications of cirrhosis, such as intractable ascites, have occurred.
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PMID:Liver transplantation. Selection, listing criteria, and preoperative management. 1123 59

This complication described rather late and theoretically and practically under-evaluated occurs in long term evolution of ascitic hepatic cirrhosis. The positive diagnosis is indicated by the following elements: more than 250 polymorphonuclear count in ascitic fluid, under 1 g/dl protein concentration ascitic fluid, a positive culture for a unique bacterium. Treatment of SBP is made with third generation cephalosporins with immediate favorable evolution. Antibiotic prophylaxis appears to be effective in the prevention of the first SBP episode and long term norfloxacin administration appeared to be very effective in the prevention of the recurrence. The survivors of SBP episode should be recommended for a potential liver transplant.
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PMID:[Spontaneous bacterial peritonitis- undervalued complication in liver cirrhosis]. 1209 20

The use of intravenous albumin in cirrhosis has been reactivated during the last two decades. During this period several investigations have shown that albumin (1) prevents circulatory dysfunction in patients with massive ascites treated by paracentesis, (2) prevents circulatory dysfunction and type-1 HRS and increases survival in patients with SBP, and (3) in association with vasoconstrictors normalizes circulatory function and serum creatinine and increases survival in patients with type-1 HRS. Indications 2 and 3 are clear. There is discussion, however, regarding indication number 1. Although no significant differences in survival have been observed in trials comparing patients treated by paracentesis with and without albumin, in none of these studies was survival an end-point of the trial. In contrast, there is evidence that paracentesis-induced circulatory dysfunction is associated with a bad outcome. In consequence, although further studies on this indication are clearly required, with the current data it is advisable to use albumin as a plasma expander in patients with massive ascites treated by paracentesis.
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PMID:Use of albumin in the management of patients with decompensated cirrhosis. An independent verdict. 1456 91


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