Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many advances have been made in the understanding, diagnosis, and management of severe complications of liver disease. The pathogenesis of hepatic encephalopathy remains a challenge. Several toxins including ammonia, mercaptans, short-chain fatty acids, benzodiazepine-like substances, GABA-like substances, and impaired glutamatergic neurotransmission are at the top of the list of candidates. Use of the benzodiazepine antagonists is an experimental but promising new therapy in patients with hepatic encephalopathy. In patients with cirrhosis, spontaneous bacterial peritonitis (SBP) remains a common and highly lethal complication. The diagnosis of SBP is based on the polymorphonuclear cell count in the ascites and confirmed by culture of ascitic fluid. Early diagnosis and aggressive treatment has reduced mortality of SBP from greater than 90 per cent to 30 to 50 per cent. The appearance of cerebral edema in severe acute hepatocellular failure is associated with high mortality and conventional neurologic signs may be unreliable indicators of brain swelling. Current management of cerebral edema in fulminant hepatocellular failure may include early placement of an extradural sensor for continuous monitoring of intracranial pressure, so that short-term measures can be instituted making later liver transplantation safer. Coagulopathy remains a serious problem in patients with liver disease. Exchange plasmapheresis is a promising short-term adjuvant therapy. However, liver transplantation should be considered the definitive treatment for fulminant hepatocellular failure. The gastroenterologist often encounters multiorgan failure in patients with severe liver disease. Liver transplantation is now an important therapeutic consideration in almost every patient with severe, irreversible liver disease. Efforts should be targeted to early diagnosis of irreversible disease and coordination of patient care with a liver transplant center.
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PMID:Major complications of acute and chronic liver disease. 304 45

Bacterial infections are a serious complication of end-stage liver disease (ESLD) that occurs in 20% to 60% of patients. We retrospectively reviewed medical records of patients with ESLD who were identified by our microbiology laboratory as having Streptococcus salivarius bacteremia. Of 592 patients listed for transplantation between January 1998 and January 2006, 9 (1.5%) had 10 episodes of S salivarius bacteremia. Of 2 patients already receiving quinolone prophylaxis for spontaneous bacterial peritonitis (SBP), 1 later presented with a second episode. The male-to-female ratio was 1:1.2. Medians for age, Model for End-Stage Liver Disease score, and Child-Turcotte-Pugh score were 50 years, 17, and 10, respectively. Presenting symptoms and signs in 10 episodes of infection were ascites (in 8 episodes), elevated temperature (6), abdominal pain (5), and encephalopathy (4). Median laboratory values included: white blood cell count, 15.1 x 10(9)/L; creatinine, 0.9 mg/dL; albumin, 3.1 gm/dL; aspartate aminotransferase, 64 U/L; alanine aminotransferase, 52.5 U/L; ammonia, 67 mug/dL; and prothrombin time, 17.3 seconds. Ascitic fluid in patients with peritonitis showed a median white blood cell count of 466 cells/mm(3) (range, 250-12,822 cells/mm(3)), with 66% polymorphs, protein of 0.9 gm/dL, and albumin of 0.4 gm/dL. S salivarius may cause primary bacteremia and SBP in liver transplantation candidates despite quinolone prophylaxis.
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PMID:Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates. 1843 54

Cirrhosis is the 12th leading cause of death in the United States. It accounted for 29,165 deaths in 2007, with a mortality rate of 9.7 per 100,000 persons. Alcohol abuse and viral hepatitis are the most common causes of cirrhosis, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary care physicians share responsibility with specialists in managing the most common complications of the disease, screening for hepatocellular carcinoma, and preparing patients for referral to a transplant center. Patients with cirrhosis should be screened for hepatocellular carcinoma with imaging studies every six to 12 months. Causes of hepatic encephalopathy include constipation, infection, gastrointestinal bleeding, certain medications, electrolyte imbalances, and noncompliance with medical therapy. These should be sought and managed before instituting the use of lactulose or rifaximin, which is aimed at reducing serum ammonia levels. Ascites should be treated initially with salt restriction and diuresis. Patients with acute episodes of gastrointestinal bleeding should be monitored in an intensive care unit, and should have endoscopy performed within 24 hours. Physicians should also be vigilant for spontaneous bacterial peritonitis. Treating alcohol abuse, screening for viral hepatitis, and controlling risk factors for nonalcoholic fatty liver disease are mechanisms by which the primary care physician can reduce the incidence of cirrhosis.
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PMID:Cirrhosis: diagnosis, management, and prevention. 2223 Feb 70

Hepatic encephalopathy (HE) is characterized by altered sensorium and is the most common indication for hospitalization among patients with cirrhosis. Liver societal guidelines for inpatient HE revolve around identification of potential precipitants. In this retrospective study, we aimed to determine adherence to societal guidelines for evaluation of HE in 78 inpatients. The adherence rate to societal recommended guidelines for workup of HE was low, with only 17 (22%) patients having complete diagnostic workup within 24 hours of admission. Notably, 23 (30%) patients were not subjected to blood culture analysis, 16 (21%) were missing urinalysis, and 15 (20%) were missing chest radiograph. In patients with ascites (N = 34), 26 (77%) did not have a diagnostic paracentes is to exclude spontaneous bacterial peritonitis. In contrast, serum ammonia determination, a laboratory test not endorsed by societal guidelines for workup of HE, was ordered in 74 (95%) patients. These findings underscore the limited adherence to societal guidelines in hospitalized patients with HE.
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PMID:Adherence to Recommended Inpatient Hepatic Encephalopathy Workup. 3081 21