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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Like hydrothorax, ascites and edema, pericardial effusion is present in decompensated hepatic cirrhosis. In order to evaluate the extent of effusion and to assess whether it is concomitant with left ventricular dysfunction, 21 patients who had been hospitalised for hepatic cirrhosis and ascites were studied following echocardiographic examinations and compared to 21 subjects without signs of cardiopathy. The following findings were statistically significant: the increased presence of pericardial effusion in patients with cirrhosis in comparison to controls, and likewise the higher ejection fraction in the former group. No differences were found between the two groups with regard to the size of the left ventricle. Within the group of patients affected by cirrhosis, the sole statistically significant difference between those patients with pericardial effusion and those without was observed with regard to the telediastolic diameter, which was greater in patients with pericardial effusion. In conclusion, pericardial effusion is common in patients with hepatic cirrhosis and ascites and is not accompanied by left ventricular dysfunction.
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PMID:[Incidence of pericardial effusion and study of left ventricular function in patients with hepatic cirrhosis with ascites]. 208 22

This paper describes two patients with liver cirrhosis presenting with right sided hydrothorax. The diagnosis of hepatic hydrothorax was confirmed by a radionuclide study using an intraperitoneal injection of radioactive 99mTc-tin-colloid, demonstrating the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities. Pleural taps, salt restriction and diuretics resulted in volume depletion and impaired renal function in the first patient. Medical therapy and a single thoracocentesis were successful in the other patient.
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PMID:Hepatic hydrothorax: report of two cases. 216 9

In a patient with decompensated liver cirrhosis, ascites and hydrothorax on the right side, a chylous transformation of the peritoneal and pleural effusions was seen. This case prompts deliberations on the spontaneous chylothorax in a rather rare disease pattern, in respect of its connection with the abdomen and especially with the cirrhosis of the liver.
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PMID:[Chylothorax in liver cirrhosis: a case report]. 232 47

We reviewed 79 patients with a picture of pleural effusion (EP) and ascites, who represented 8% of a total of 982 pleural effusions studied. Liver cirrhosis (CH), 37 cases (47%), disseminated carcinomatosis, 31 cases (39.5%), and congestive heart failure, 6 cases (7%), were the main causes. We made two groups of liver cirrhosis: A) liver cirrhosis with hydropic decompensation, 12 patients (15%), and B) liver cirrhosis with an additional complication added to the above, 25 patients (31.5%), this being infectious in 88% of the cases. In the B group there were cases of left hydrothorax, more features of effusion and a lower survival at 3 months of follow-up than in tha A group. Effusions of neoplastic origin were most frequently seen in tumors of the ovary, digestive system, lymphomas and undetermined origin. In malignant effusions, the cytology was positive in pleura in 60% and in ascites in 55%. Twenty percent of peritoneal fluids and 47% of pleural effusions were serohemorrhagic and 100% and 88%, respectively, were of exudative nature. In liver cirrhosis the ascites was serofibrinous and transudated (100% in group A and 85.5% in B) and the pleural effusion was a serofibrinous transudate except in the cases in which there was an added infection. We confirm the ominous prognosis of the coexistence of pleural effusion and ascites.
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PMID:[Ascites and pleural effusion. Study and follow-up of 79 patients]. 259 69

Hepatic hydrothorax is a complication in approximately 5% of patients with cirrhosis. Ascites is almost always present and helps to suggest the correct diagnosis. However, when ascites is absent, radionuclide imaging has proven to be helpful in establishing that the pleural effusion originated from ascitic fluid. When pleural fluid is rapidly removed, such as by thoracostomy tube drainage, the radioisotope may accumulate outside the thorax and produce a negative scan of the chest. When the radionuclide scan is nondiagnostic and the pleural space is being rapidly drained, the pleural fluid collecting system should always be imaged before rejecting a diagnosis of hepatic hydrothorax.
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PMID:External accumulation of radionuclide in hepatic hydrothorax. 265 40

The most common complication of chronic pancreatitis is pain, which in many cases seems related to pancreatic ductal obstruction with ductal hypertension. Longitudinal pancreaticojejunostomy is indicated in patients with a dilated (larger than 7 mm) duct and pain that requires narcotic analgesics for relief. Chronic pseudocysts may be corrected surgically without the usual 6-week wait, and asymptomatic pseudocysts less than 4 cm in diameter may not require surgery at all. The relative efficacy and risks of percutaneous drainage of pseudocysts versus the standard surgical approaches need to be studied. Pancreatic fistulas may be external or internal, where pancreatic ascites or hydrothorax can be the clinical manifestation. The pharmacologic suppression of pancreatic secretion (e.g., with somatostatin) may be useful in their management, but surgery may be required. Pancreatic resection or internal drainage is usually effective. Persistent jaundice should be relieved surgically by choledochoduodenostomy to avoid the development of secondary biliary cirrhosis. Obstruction at various levels of the gastrointestinal tract (duodenum, small bowel, colon) may require bypass (gastrojejunostomy) or resection. Hemorrhage from major arteries is an infrequent but often lethal complication of chronic pancreatitis, especially associated with pseudocysts. Angiography is invaluable for diagnosis and occasionally for treatment (embolization). Surgery is preferred in good-risk patients, with suture ligation (resection) of the bleeding source. Chronic pancreatitis is the most common cause of splenic vein thrombosis. The resultant hemorrhage from gastric varices is managed effectively by splenectomy.
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PMID:Complications of chronic pancreatitis. 265 60

A 56-year-old woman with a 2-year history of cirrhosis of the liver and frequent right pleural effusion was admitted with intractable shortness of breath. Chest x-ray examination showed marked pleural effusion of the right lung field with a shift of the mediastinum to the left. Ascites was not conspicuous. Except for the liver cirrhosis, there was no clinical evidence of other underlying diseases. The patient died with a relatively short course after hospitalization. At autopsy, an apparent bleb with 1-mm hole in the tendinous portion of the right diaphragm was noted. We suggest that the ascitic fluid directly crossed the diaphragmatic defect to the pleural cavity, which contributed to the hydrothorax. In this article we review the pertinent literature.
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PMID:Diaphragmatic defect as a cause of massive hydrothorax in cirrhosis of liver. 306 4

Fluid retention in decompensated hepatic cirrhosis is frequently accompanied by edema, ascites, and hydrothorax. Whether pericardial effusion occurs in such patients has not been studied. Twenty-seven consecutively hospitalized patients with ascites secondary to alcoholic cirrhosis of the liver were studied, and 28 control subjects were studied with the use of an echocardiographic method to detect pericardial effusion and to evaluate their left ventricular (LV) function. Seventeen patients (63%) and three control subjects (11%) showed pericardial effusion. The prevalence of pericardial effusion in the patients was significantly greater than in the control subjects (chi 2 = 10.6). Although the mean values of the echocardiographic measurements of LV function of the patients and the control subjects did not differ significantly, the individual values of the patients varied considerably. Among the patients, six patients (27%) had LV dysfunction, 14 patients (64%) had normal values, and two patients (9%) had values suggestive of hypercontractility of the left ventricle. Furthermore, abnormal systolic motions of the mitral valve and/or septum were noted in eight patients (30%) but in none of the control subjects. Six patients with pericardial effusion on initial examination were evaluated after the resolution of their ascites; pericardial effusion disappeared in two patients, diminished in two others, and remained unchanged in two patients. Resolution of ascites was also associated with normalization of the systolic motion of the mitral valve and septum. It was concluded that pericardial effusion is common in patients with ascites secondary to alcoholic hepatic cirrhosis and that its presence is probably related to fluid retention.
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PMID:Pericardial effusion and left ventricular dysfunction associated with ascites secondary to hepatic cirrhosis. 177 78

Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.
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PMID:Hepatic hydrothorax is a relative contraindication to chest tube insertion. 371 19

Ascites is the end result when the rate of conversion of plasma to peritoneal fluid exceeds the rate of reabsorption from the peritoneal cavity. Physiologic therapy demands the return of this fluid to the plasma volume from whence it arose. The peritoneovenous shunt was devised to accomplish this. If precautionary measures are followed, complications are avoided. The shunt can be accomplished with a mortality under 1% in uncomplicated cirrhosis without jaundice or hydrothorax. Postoperative coagulopathy and infection are avoidable complications. Shunt failure is partly preventable and can almost always be remedied. Patients must be carefully followed to prevent late sepsis: care must be even more rigorous than that given to implanted artificial heart valves, because of the lower resistance of cirrhotics to infection. The cause of death in ascites untreated by shunts is early renal failure that is averted by the shunt. The shunt does not prevent rupture of esophageal varices, a frequent mode of late mortality. Varices require separate therapy. Because the shunt is effective with minimal morbidity and mortality, the indications for a peritoneovenous shunt should be liberalized.
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PMID:The LeVeen shunt. 388 61


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