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

Large volume paracentesis (LVP) is a safe, rapid, and effective treatment of ascites in cirrhotic patients. We investigated the effects of a 5-L aspiration of ascites on pulmonary function parameters in eight hemodynamically stable patients with cirrhosis and tense ascites. None had known lung disease or abnormal chest roentgenograms. At baseline, mean lung volumes, diffusing capacity, and arterial pO2 were all reduced from normal predicted values. Airflow, however, when related to lung volume, was normal. Post-LVP, lung volumes increased significantly; the mean expiratory reserve volume showed the greatest percent increase (105%) and correlated with the increases in the vital capacity, functional residual capacity, and total lung capacity. Airflow, the mean diffusing capacity, and arterial oxygenation were not significantly changed after LVP. We conclude that LVP significantly increases indices of lung volume but does not significantly alter parameters of airflow or gas exchange.
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PMID:Pulmonary function changes after large volume paracentesis. 850 87

Seventeen patients with biopsy-confirmed hepatic cirrhosis and tense ascites performed reproducible pulmonary functions and had arterial blood gas analysis before and after having a therapeutic large volume paracentesis. Each patient showed significant improvement in the static lung volumes as determined by helium dilution techniques. Dynamic airflow also improved as expressed by the FVC and the FEV1. The FEV1/FVC ratio remained unchanged. Each patient showed a significant improvement in oxygenation 120 minutes after LVP. Alveolar ventilation as expressed by PaCO2 did not change. The pathophysiology that explains the improvement in oxygenation remains speculative. Large volume paracentesis appears to have a salutary effect on oxygenation, as well as on pulmonary function.
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PMID:Improvement in oxygenation after large volume paracentesis. 868 55

Ascites is a common complication of cirrhosis and has a major clinical impact on the patient's general well-being. Approximately 10% of patients with cirrhosis can develop diuretic-resistant, tense ascites that requires other therapeutic interventions. In recent years, there has been a renewed interest in large-volume paracentesis (LVP) as a safe, simple, and inexpensive method to substitute for other more complicated and costly therapeutic interventions for refractory ascites. In this article, we review the latest literature supporting the use of LVP for the treatment of refractory, tense ascites. We also address the role of intravascular volume expansion after LVP, note that usually no postparacentesis volume expansion is necessary, and compare, when used, the different plasma volume expanders in terms of efficacy, safety, and cost.
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PMID:Large-volume paracentesis in the treatment of cirrhotic patients with refractory ascites. The role of postparacentesis plasma volume expansion. 872 59

Ascites, a late manifestation of cirrhosis of the liver, causes increased morbidity and mortality. The renin-angiotensin-aldosterone system, the sympathetic nervous system, and arginine vasopressin are responsible for sodium and water retention in patients with cirrhosis. Fluid localizes to the peritoneal cavity mainly as a result of portal hypertension. Recent developments in the understanding of the pathophysiologic mechanisms of ascites include the role of inadequate renal prostaglandin production in the development of the hepatorenal syndrome and the possible role of nitric oxide in the pathogenesis of the renal complications of cirrhosis. The aim of medical therapy is to achieve a negative sodium balance and, consequently, fluid loss. Large-volume paracentesis is safe and effective in the management of tense ascites, but use of diuretic agents should be continued to prevent reaccumulation of ascites. Liver transplantation, transjugular intrahepatic portosystemic shunts, or LeVeen shunts should be considered in selected patients with persistent ascites. In patients with diuretic-resistant or diuretic-refractory ascites, a thorough assessment must be performed to exclude potentially reversible causes. The hepatorenal syndrome has an associated grave prognosis, especially in patients who are not candidates for liver transplantation.
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PMID:Ascites and hepatorenal syndrome: pathophysiology and management. 914 95

Patients with end-stage renal disease combined with tense ascites caused by decompensated liver cirrhosis are sometimes encountered in a hemodialysis center. A big problem for the management of these patients is the tendency of hypotension during ultrafiltration. Subsequent fluid accumulation, especially in the abdominal cavity, causes breathing difficulty and abdominal discomfort. We present a new technique, ascites ultrafiltration, to solve this problem. Using the same equipment as for ordinary hemodialysis, and incurring the same cost, we removed directly approximately 8 L of ascites fluid during each nearly 4-hour session. No hemodynamic instability was noted. We proved this technique to be an effective and safe alternative method for this group of patients.
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PMID:Hemodialysis alternative with ascites ultrafiltration for an end-stage renal failure patient associated with tense ascites secondary to decompensated liver cirrhosis. 895 43

1. The hepatorenal syndrome is the development of renal failure in patients with severe liver disease in the absence of any identifiable renal pathology. 2. Decreased glomerular filtration is caused by a reduction in both renal blood flow and the renal filtration fraction. These changes arise as a consequence of a fall in mean arterial pressure due to systemic vasodilatation, activation of the sympathetic nervous system causing renal vasoconstriction, and increased synthesis of several vasoactive mediators, which together modulate both renal blood flow and the glomerular capillary ultrafiltration coefficient, and thence filtration fraction. 3. Patients with liver disease developing renal failure should have hypovolaemia excluded by volume challenge, and all nephrotoxic drugs including diuretics should be stopped. Broad-spectrum antibiotics should be given for subclinical infection, which may be a treatable precipitant of renal failure in cirrhosis. Renal perfusion should be optimized by ensuring that the blood pressure and systemic haemodynamics are adequate, and that if renal venous pressure is elevated, due to tense ascites, it is alleviated. 4. The prognosis of hepatorenal syndrome is poor with a > 90% mortality. However, patients can and do recover from the hepatorenal syndrome, but only if there is a significant improvement of their liver function, or if they undergo liver transplantation.
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PMID:The hepatorenal syndrome. 917 15

Cirrhosis is associated with cardiovascular abnormalities. Scanty information is available as to whether these include left ventricle diastolic dysfunction and wall thickness increase. To this aim in 27 cirrhotic patients with tense ascites, 17 cirrhotic patients with previous episodes of ascites (not actual), and 11 controls we investigated by echocardiography and echocolor Doppler left ventricle diastolic function (E wave, A wave, E/A ratio, deceleration time of E wave), systolic function (ejection fraction), and wall thickness (left ventricle posterior wall thickness + interventricular septum thickness) along with neurohumoral variables. All measurements (supine position) were repeated after total paracentesis (10.7 +/- 0.6 L of ascites) in ascitic patients. Both in patients with and without ascites E/A ratio was reduced as compared with controls (0.93 +/- 0.07 and 0.97 +/- 0.06 vs. 1.18 +/- 0.08, P < .05) while left ventricle wall thickness was increased (18.6 +/- 0.6 and 20.1 +/- 0.8 vs. 17.2 +/- 0.7, P < .05 and P < .01, respectively), irrespective of the postviral or alcoholic cause of liver disease. In all cirrhotics both right and left atrial and right ventricle diameters were significantly greater. Ejection fraction was slightly but significantly (P < .01) reduced in ascitic patients. Paracentesis induced a reduction of the highly increased basal plasma renin activity, aldosterone, norepinephrine (P < .01), and epinephrine (P < .05) and improved diastolic function (E/A, P < .05). Systolic function was unaffected. Thus, irrespective of ascites and cause, advanced cirrhosis is associated with left ventricle diastolic dysfunction and wall thickness increase. We can speculate that neurohumoral overactivity, known to stimulate cardiac tissue growth, may challenge the heart, promoting fibrosis and exerting a further hindrance to ventricular relaxation in patients with cirrhosis experiencing episodes of ascites.
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PMID:Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. 936 52

Large volume paracentesis is a safe and widely diffused treatment of tense ascites in decompensated liver cirrhosis. Hemodynamic changes induced by this practice have been repeatedly indagated, but although some authors referred the lack of substantial modifications of plasma volumes after paracentesis, the administration of albumin or other plasma expanders is universally recommended to prevent complications as hyponatremia or renal insufficiency. On the other hand, hypoalbuminemia is one of the main features of nitrogen metabolism disturbances. Drawing ascites subtracts to the body an unknown amount of nitrogen because of its content in amino acids, which has never been documented. Because plasma amino acids imbalances have been involved in hepatic encephalopathy pathogenesis, which is a serious complications of cirrhosis potentially precipitated by paracentesis, our purpose was to document the amount of amino acids subtracted and to evaluate the possible modifications induced by paracentesis analyzing amino acidic patterns either in ascite or in plasma at the beginning and at the end of a large volume paracentesis (4 liters) in 20 ascitic patients. Paracentesis confirmed to be a safe practice, because it subtracts to body nitrogen no more than an amount of 3g of amino acids, and this is not followed by any modification of plasma patterns and ratios. In turn, these data allow a mathematical analysis of the relationship among osmolar and oncotic pressures in relationship to ascites and plasma volumes modifications.
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PMID:Nutritional and hemodynamic implications of large volumes paracentesis in cirrhotics. 944 97

During the XXII Congress of the Spanish Association for the Study of the Liver a questionnaire was distributed with the aim of describing the current therapeutic attitude of those attending the meeting, concerning two of the most frequent complications of cirrhosis: ascites and spontaneous bacterial peritonitis (SBP). One hundred twelve of the 135 physicians who answered the questionnaire (83%) use to treat tense ascites by therapeutic paracentesis, while 86 physicians (63.7%) managed moderate ascites with diuretics, with spironolactone being the drug most commonly used (n = 117; 87.3%). The most used diuretic schedule for the treatment of ascites was the isolated administration of spironolactone. Frusemide was associated with spironolactone only when moderate or high doses of the latter were found to be insufficient for increasing urinary sodium excretion and eliminating ascites. Following therapeutic paracentesis however, 79 of those surveyed (58.3%) administered a combination of both diuretics on initiation to avoid reaccumulation of ascitic fluid. Sixty-eight of the physicians (50.3%) used transhepatic intrajugular portosystemic shunt in the treatment of refractory ascites. Cefotaxime was the antibiotic most widely used in the treatment of SBP (n = 119; 88%). Most of the physicians surveyed performed prophylaxis of this infection (generally by the oral administration of norfloxacin) in patients with a previous history of SBP (n = 125; 92.6%) or an episode of gastrointestinal hemorrhage (n = 108; 80%) but not in those patients with no previous history of SBP and with low protein concentrations in the ascitic fluid (n = 40; 29.6%). On the appearance of SBP in patients undergoing prophylactic treatment, cefotaxime remained the antibiotic of choice (n = 104; 79%).
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PMID:[Current treatment of ascites and spontaneous bacterial peritonitis in Spain: analysis of a survey of gastroenterologists and hepatologists]. 944 35

Mesenteric vein thrombosis is a rare disorder which can develop rapidly with intestinal infarction or subacutely with abdominal pain due to intestinal ischemia. Despite the availability of modern diagnostic tools, which allow an early diagnosis in most cases, the mortality from this disease has not significantly diminished over the years. The problem is that the syndrome is rare and unusual and the clinical presentation is usually vague or confusing. Particularly in cirrhotic patients, this diagnosis requires the exclusion of several other complications of liver disease, like spontaneous bacterial peritonitis, tense ascites or portal thrombosis. Here, we report the occurrence of acute mesenteric vein thrombosis in two patients with liver cirrhosis. Severe subcontinuous abdominal pain out of proportion to the physical findings and abdominal distension were the major symptoms in both patients. Magnetic resonance imaging in one case and ultrasound scan with color Doppler followed by computed tomography in the other patient confirmed the diagnosis and enabled an appropriate early therapy to be undertaken.
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PMID:Mesenteric vein thrombosis: a rare cause of abdominal pain in cirrhotic patients--two case reports. 949 85


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