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

BACKGROUND: Although jejunoileal bypass (JIB) causes long-standing weight loss, it is no longer recommended as a surgical treatment of morbid obesity due to adverse effects. METHODS: JIB was performed on 87 morbidly obese subjects with a mean age of 35 years. Complete follow-up on 95% of the patients included monitoring weight, metabolic parameters and liver biopsies up to 25 years postoperatively. RESULTS: The mean (+/- SD) Body Mass Index (BMI) was reduced from 41.5 +/- 5.8 kg m(2) preoperative, to 26.7 +/- 3.8 kg m(2) at 2 years and 29.7 +/- 3.9 kg m(2) at 16 years follow-up. More than 60% loss of initial excess weight was achieved by 88% of the patients at four years and by 75% at 16 years follow-up. Reversal of the bypass was performed in 3% of the patients and revisions in 8% of the patients. There was no 30-day hospital mortality but there was one (1 %) late bypass-related death. Complications included urinary calculi in 39% of the patients, electrolyte disturbances in 25% and transient liver failure in 5.5%. Liver biopsies taken more than 13 years postoperatively in 44 patients revealed no cirrhosis. All patients were normoglycemic and normolipemic at follow-up. CONCLUSIONS: The majority of the patients have an acceptable weight reduction, few serious adverse effects but several beneficial effects after more than 16 years. The JIB deserves a reconsideration as an alternative in obesity surgery.
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PMID:Favorable Long-term Results with the End-to-Side Jejunoileal Bypass. 1073 26

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. One concern in patients undergoing any form of intestinal bypass surgery is that of possible liver damage. To assess for possible liver damage in morbidly obese patients undergoing ileogastrostomy, we undertook a prospective study of liver biopsies in 12 consecutive patients. Preoperative and 2-year postoperative biopsies of the liver were planned. There were six liver biopsies available for comparison both pre- and post-operatively. The biopsies showed changes of fatty infiltration both pro- and post-operatively. There were no differences in the degree of fatty infiltration, or of other histological parameters which we measured. There were no cases of cirrhosis of the liver recorded.
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PMID:Liver Biopsies Following Ileogastrostomy. 1075 28

Life-threatening intractable uterine bleeding is difficult to treat when concurrent medical complications contraindicate invasive surgery. We present a case of heavy uterine bleeding in a postmenopausal woman that was complicated by liver cirrhosis and morbid obesity. The bleeding was successfully halted through emergency endometrial ablation after failure of uterine artery embolization.
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PMID:Successful emergency endometrial ablation for intractable uterine bleeding in a postmenopausal woman complicated with liver cirrhosis and morbid obesity. 1144 33

Studies assessing morbidity and mortality in obese patients undergoing orthotopic liver transplantation (OLT) have produced conflicting results, mainly because of the small sample size. The objective of our study was to determine graft and patient survival in obese adults receiving OLT in the U.S. between 1988 through 1996 using the United Network for Organ Sharing (UNOS) database. Among the 23,675 transplantations performed during the 9-year study period, 18,172 (75%) patients fulfilled the inclusion criteria. Of these, 8,382 (46%) were nonobese (body mass index [BMI] < 25 kg/m(2)), 5,913 (33%) were overweight (BMI, 25.1-30 kg/m(2)), 2,611 (14%) were obese (BMI, 30.1-35 kg/m(2)), 911 (5%) were severely obese (BMI, 35.1-40 kg/m(2)), and 355 (2%) were morbidly obese (BMI, 40.1-50 kg/m(2)). The outcome measures assessed were immediate (30-day), 1-, 2-, and 5-year patient survival. Obese groups had a higher proportion of women, a greater prevalence of cryptogenic cirrhosis (P <.05) and diabetes (P <.05), and a higher serum creatinine. Primary graft nonfunction, and immediate, 1-year, and 2-year mortality were significantly higher in the morbidly obese group (P <.05). Five-year mortality was significantly higher both in the severely and morbidly obese subjects (P <.05), mostly as a result of adverse cardiovascular events. Kaplan-Meier survival was significantly lower in morbidly obese patients, and morbid obesity was an independent predictor of mortality. Obesity is associated with a significant increase in long-term mortality, mostly as a result of cardiovascular events. Weight loss should be recommended for all patients awaiting a liver transplantation, especially if their BMI is more than 35 kg/m(2).
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PMID:Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. 1248 Nov 72

The Department of Digestive Surgery was born in 1977. It is a part of the medical surgical unit of gastroenterology and hepatopancreatology. The various developed sectors concern hepatic surgery and liver transplantation (treatment of hepatic tumors and cirrhosis), pancreatic surgery and surgery of the biliary tract (treatment of benign and malignant pancreatic tumors, tumor of the biliary tract, chronic pancreatitis and biliary stones), surgery of morbid obesity (gastroplasty or gastric by-pass), surgery of the upper digestive tract (benign and malignant tumors of the oesophagus or the stomach, treatment of gastroesophageal reflux), surgery of the abdominal wall, colorectal surgery and surgery of the inflammatory bowel diseases (colorectal cancer, familial polyposis, Crohn's disease, ulcerative colitis), proctologic surgery and surgery of anorectal functional disorders, neonatal and paediatric surgery.
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PMID:[The surgical gastroenterology department]. 1258 13

The Scopinaro surgical technique for obesity consists of a partial distal gastrectomy with biliopancreatic diversion and cholecystectomy. It is an effective procedure in the control of the body weight but disrupts the physiological gut-liver axis. We report the case of a patient who developed liver cirrhosis with a multifactorial pathogenesis following antiobesity surgery according to Scopinaro and discuss the pathogenesis of the liver damage on the basis of our present understanding of alcoholic and nonalcoholic steatohepatitis. A 41-year-old male patient presented with ascites due to cryptogenic liver cirrhosis. Owing to morbid obesity, he had undergone antiobesity surgery according to Scopinaro when he was 25 years old. The procedure was effective and the patient lost about 40 kg of weight but manifested chronic diarrhea in the postoperative course. During the following 15 years, the patient continued to assume 100 g alcohol/day and did not turn up for clinical evaluation. Signs and symptoms of liver failure appeared in May 2000. After surgical correction of biliopancreatic diversion and abstinence from alcohol the hepatocellular function partially recovered and the patient regained his subjective complete well-being. The multifactorial pathogenesis of the liver disease observed in our patient included obesity, antrectomy, heavy alcohol consumption, bacterial overgrowth, and protein malnutrition.
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PMID:[Multifactorial hepatopathy in a patient with biliopancreatic diversion]. 1288 27

Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) that can lead to hepatic fibrosis and cirrhosis. Portal fibrosis in the absence of NASH, called isolated portal fibrosis (IPF), has received less attention and has not been classified as a spectrum of NAFLD. The aims of this study were to determine the prevalence of IPF in subjects undergoing gastric bypass surgery, to identify biochemical variables associated with IPF, and to assess the metabolic syndrome as defined by the AdultTreatment Panel III criteria. We analyzed liver biopsies from 195 morbidly obese subjects after excluding all other causes of liver disease. The prevalence of fatty liver (FL) only, IPF, and NASH was 30.3%, 33.3%, and 36.4%, respectively. Several biochemical parameters significantly trended across the 3 groups, with IPF falling between FL and NASH. Hyperglycemia was the only metabolic parameter associated with NASH (OR, 5.4; 95% CI, 2.4-12; P < .0001) and IPF (OR, 2.8; 95% CI, 1.2-6.5; P = .01). Subjects with diabetes had the greatest risk for NASH (OR, 8; 95% CI, 3.3-19.7; P < .0001) and IPF (OR, 4.3; 95% CI, 1.6-11.6; P = .003). The metabolic syndrome was identified in 78.5% of subjects, and a significant trend for the number of metabolic criteria was observed across the spectrum of FL, IPF, and NASH. In conclusion, a significant subset of morbidly obese individuals has portal fibrosis in the absence of NASH that is associated with glycemic dysregulation. Therefore, IPF should be considered a spectrum of NAFLD that may prelude NASH in morbid obesity.
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PMID:Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease. 1536 53

We report on four cases displaying the wide range of aetiological risk factors (presence or absence of family history of dyslipidaemia and cryptogenic cirrhosis, from subnormal body mass index through morbid obesity, from absent through hepatotoxic alcohol consumption), laboratory test results (from subnormal through elevated uric acid and ferritin values), ultrasonographic changes (from normal findings through 'bright liver' with or without attenuation of ultrasound beam and absence/presence of focal lesions), and histological severity of steatohepatitis (fibrosis appearing to be inversely related to the amount of liver fat but zone 3 accentuation of lesions and ballooning being observed in all cases). Cases illustrate the concepts of overlapping aetiologies of steatohepatitis (hepatitis C, diabetes and lipodystrophy); the relationships between cryptogenic cirrhosis, familial cirrhosis, non-alcoholic fatty liver disease and hepatocellular carcinoma; familial hypobetalipoproteinaemia as an aetiology of steatohepatitis; and alcoholic liver disease in the obese. These issues, which are worthy of future investigation, are reviewed.
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PMID:The wide spectrum of steatohepatitis: a report of four cases and a review of the literature. 1537 30

1. Diabetes mellitus is common in patients with cirrhosis; patients with DM undergoing liver transplantation often have many other co-morbid illnesses including obesity, coronary artery disease (CAD), autonomic neuropathy, gastroparesis, and nephropathy. 2. Long-term survival of patients with diabetes mellitus (DM) is significantly lower and morbidity higher when compared to non-diabetics mainly because of cardiovascular complications, infections, and renal failure. 3. Obesity, CAD, and renal failure are confounding factors that result in poor patient survival. 4. Patients with DM should undergo careful cardiovascular diagnostic work up, including routine coronary arteriogram, and necessary interventions before liver transplantation. This is especially important in those over 50 years old, and in those with retinopathy, nephropathy, and neuropathy. 5. Patients with coronary artery disease that is not amenable to surgery or stents, and those with impaired left ventricular function, should not be considered for liver transplantation. Other relative or absolute contraindications are those with proteinura and renal failure who are not candidates for combined liver/kidney transplantation, those with severe gastroparesis, especially when it is associated with diabetic autonomic neuropathy, and those with two or more risk factors such as CAD, morbid obesity, and renal failure. 6. Future studies should focus on risk stratification of patients with DM undergoing liver transplantation and better interventions to reduce the risk of diabetic complications before and after liver transplantation.
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PMID:When is diabetes mellitus a relative or absolute contraindication to liver transplantation? 1623 83

Liver cirrhosis is an escalating health problem attributed to numerous causes, including an increase in alcohol consumption, morbid obesity and chronic viral hepatitis. The circulatory disturbances seen in advanced cirrhosis lead to the development of ascites, which often lead to progressive renal impairment or the development of hepatorenal syndrome. Furthermore, cirrhotic patients commonly experience clinical situations that predispose them to the development of pre-renal failure, such as dehydration, hypovolaemia, septic shock, or exposure to nephrotoxic drugs. This article provides an overview of the main causes of acute renal failure in liver cirrhosis and describes the current medical and nursing management.
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PMID:Renal dysfunction in liver cirrhosis. 1641 41


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