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

Pulmonary hypertension (PH) may develop because of a spectrum of insults to the lungs; in some patients, there seems to be no cause. Noninvasive tests, such as standard chest radiography, electrocardiography, and transthoracic Doppler echocardiography, provide effective screening if PH is suspected. This synopsis focuses on these screening studies and the more common clinical problems, including primary cardiac abnormalities, obstructive sleep apnea, chronic pulmonary embolism, pulmonary parenchymal problems, connective tissue disorders, cirrhosis with portal hypertension, and use of appetite suppressants, that should be considered when PH exists. Treatment options for PH, including intravenous prostacyclin (epoprostenol), and investigational agents such as subcutaneous or oral prostacyclin analogues and oral endothelin receptor antagonists are described.
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PMID:Pulmonary hypertension: diagnostics and therapeutics. 1085 24

Platypnea-orthodeoxia is an uncommon syndrome that may occur due to the postpneumonectomy state, cirrhosis of the liver, recurrent pulmonary embolism, and intracardiac shunting. We describe a patient who was found to have a positional change in desaturation after being admitted for dehydration. Workup revealed an atrial septal defect with aneurysm. Following surgical repair, the orthodeoxia resolved. Different mechanisms explain positional desaturation, such as atriovenous malformations at the lung base of cirrhotic patients. In an atrial septal defect, the increased shunting of blood across a malformed septum in an upright position may cause orthodeoxia. This case highlights the necessity of heightened awareness of this syndrome and the need for documenting orthostatic changes in cases of severe hypoxemia.
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PMID:A case of orthodeoxia caused by an atrial septal aneurysm. 1098 20

A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. Heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. Autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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PMID:Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism. 1102 Aug 95

Cardiac troponin I levels are frequently above normal values in several disease states in which myocardial necrosis is not a prominent aspect, particularly in pulmonary embolism, heart failure, liver cirrhosis, septic shock, renal failure and arterial hypertension. Sub-clinical myocardial necrosis has been postulated to be the cause of the phenomenon. Studies performed so far have not included pathological data to confirm this hypothesis. Increased troponin I plasma levels may be the result of myocardial strain, especially the type of strain that accompanies some forms of cardiac dilatation or hypertrophy. Troponin I may act as a marker of myocardial strain, either acute (in pulmonary embolism, septic shock and acute heart failure) or chronic (in chronic cardiac, renal and hepatic failure, as well as in arterial hypertension). The apparent paradox of elevated levels of troponin I without elevated levels of creatine kinase in several disease states might be solved if troponin I could be released from myocardial cells without the disruption of myocardial cell plasma membranes. Precise pathological studies are needed to elucidate whether increased troponin I with normal CK is associated with myocyte death, and, if so, with necrosis or with apoptosis.
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PMID:Cardiac troponin I in systemic diseases. A possible role for myocardial strain. 1158 28

The development of hepatic surgery involved also definition of indications for resection in primary liver tumours. Based on an analysis of a group of 76 patients with primary liver tumours operated in 1978-2001 (up to the end of October) the authors evaluated the indication criteria for resection of primary hepatic tumours. As to benign tumours most frequently haemangiomas were resected (in 35 patients) and follicular nodular hyperplasia in 10 patients. Indication for resection was the symptomatology of the tumour (40x), signs of progression during a check-up examination (13x) or doubts as regards preoperative ruling out of malignity (16x). Hepatocellular adenoma was resected in 8 patients, incl. 7 where the preoperative diagnosis was assessed by bioptic examination. The extent of resection depended on the size and site of the tumour, in haemangiomas and follicular nodular hyperplasia non-anatomical resections predominated (in 27 patients). On account of hepatocellular carcinoma resections were made in 18 patients, incl. 8 who suffered also from cirrhosis which limited the extent of resection. In patients without cirrhosis with carcinoma in one of the lobes an anatomical resection was implemented. Postoperative complications developed in 14 patients (18%), two died (3%) from hepatic failure and pulmonary embolism.
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PMID:[When is resection indicated in primary liver tumors?]. 1203 52

Duodenal varices are rarely occurring sites of hemorrhage in patients with portal hypertension, and such hemorrhaging can be a life-threatening event. We report the case of a 58-year-old woman with cirrhosis who presented with melena after successful ligation of gastroesophageal varices 1 week earlier. Upper gastrointestinal endoscopy revealed bleeding duodenal varices in the second portion of the duodenum, which was considered to be the source of the bleeding. Endoscopic injection sclerotherapy with histoacryl and lipiodol achieved successful hemostasis. Nonetheless, the sclerosant spread to the lungs via a portosystemic shunt, causing a pulmonary embolism. This is a rare complication seldom reported in the world literature.
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PMID:Bleeding duodenal varices after gastroesophageal varices ligation: a case report. 1251 21

The study included 200 patients with pleural effusion. Pleural effusions were transudative in 48 (24%) and exudative in 152 (76%) of cases. Congestive cardiac failure (14.5%), nephrotic syndrome (5.5%), and liver cirrhosis (2.5%) were the most common etiological diagnoses of transudate cases. Malignant effusion (16.5%), pneumonia (13%), pleural empyema (9%), tuberculosis (6%), and pulmonary embolism (5.5%) were the most common etiological diagnoses of exudative cases. Thirty-two (16%) cases of exudative pleural effusions were of undertermined etiology. Polymorphonuclear leucocytes predominated in 48 patients with exudative pleural effusions. The most common etiological diagnoses were pneumonia (41.67%), pleural empyema (39.59%) and pulmonary embolism (10.42%). Lymphocytes in pleural fluid were predominant in 63 patients, with malignant (6.34%), tuberculous pleurisy (19.02%), pulmonary embolism (6.34%), trauma (6.34%), and (46.11%) cases in patients with pleural exudate undertermined etiology. Eosinophyls were predominant in 16 (8%) patients with exudative pleural effusions. The most common etiology of eosinophilic pleural fluid were pneumonia (37.5%), malignant pleural effusion (25%), pulmonary embolism (12.5%), pyopneumothorax (6.25%) and trauma 6.25%. From 16 patients with eosinophilic pleural exudate, in 31% cases air, in 12.5% blood in pleural fluid were determined and in 12.5% cases previous pleural puncture was performed. Pleural fluid eosinophilia is most commonly associated with the presence of air or blood in the pleural fluid (correalation index 0.82). Malignant pleural effusions were determined in 33 patients. Malignant cells in pleural fluid were identified in 25 cases. The diagnostic sensitivity of pleural fluid cytology for malignant pleural effusions were 76%. Hemoragic pleuritis was determined in 18 and hemothorax in 4 patients. Etiology of hemothorax were trauma (75%) and coaguliopathia (25%). Most common etiological diagnoses of hemoragic pleuritis were neoplasia (33.3%), pulmonary embolism (16.65%), trauma (16.65%), pneumonia (11.11%), and congestive cardiac failure (11.11%). Diagnostic sensitivity and specifity of hemoragic pleuritis is low, 58% and 45% respectively.
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PMID:[Diagnostic value of pleural fluid cytologic examination]. 1255 57

Venous thromboembolism (VTE) results from multiple interactions between inherited and environmental risk factors. The lower limbs are the most common site of VTE, but more rarely other venous sites can be involved. The role of risk factors for VTE can be different in the various thrombotic manifestations, and there are specific risk factors for specific sites. Coagulation abnormalities causing inherited thrombophilia are frequently found in patients with cerebral vein thrombosis, but are more rare in those with "isolated" pulmonary embolism, upper limb or retinal vein thrombosis. Transient situations, such as surgery, trauma, prolonged immobilization, the use of oral contraceptives or hormone replacement therapy, and pregnancy or puerperium, are often recognized in patients with lower limb deep vein thrombosis, "isolated" pulmonary embolism, abdominal and cerebral vein thrombosis, but not in patients with upper limb deep vein thrombosis. Major risk factors for deep vein thrombosis of the upper limbs are strong efforts with the arms, whereas for abdominal vein thrombosis are myeloproliferative disorders and liver cirrhosis. In conclusion, there is increasing evidence that inherited and environmental risk factors may interact differently in determining VTE in different sites.
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PMID:Unusual forms of venous thrombosis and thrombophilia. 1367 71

A 48-year-old patient with known alcohol abuse and long-standing liver cirrhosis presented with spontaneous bacterial peritonitis and subsequent hepato-renal syndrome. Autopsy revealed a large hepatocellular carcinoma of the right liver lobe. Histologically, pulmonary arteries, arterioles, and capillaries were occluded by numerous tumor emboli. Small tumor emboli also covered the endocardium of the right ventricle. A review of the literature shows that macroscopic as well as microscopic pulmonary tumor embolism is often diagnosed in patients with a previously unknown malignancy. Moreover, pulmonary tumor embolism radiologically mimics pneumonia, tuberculosis, or interstitial lung disease. Therefore, an autopsy should be considered in cases of fulminant or massive pulmonary embolism to exclude tumor embolism even when the patients' history is insignificant as to this point, and in cases with known malignant tumors and respiratory symptoms to exclude tumor microembolism.
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PMID:Massive pulmonary tumor microembolism from a hepatocellular carcinoma. 1648 87

The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. An exudative effusion is diagnosed if the patient meets Light's criteria. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional transudate misidentified as an exudate by these criteria. If the patient has a transudative effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative effusion, attempts should be made to define the etiology. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative effusions. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy.
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PMID:Diagnostic approach to pleural effusion in adults. 1662 8


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