Lege Artis Medicinae

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

NOVEMBER 20, 2009

Lege Artis Medicinae - 2009;19(11)

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

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[INTRODUCTION – Variceal haemorrhage from the oesophageal or gastric wall is a major cause of death in patients with chronic liver disease. Over the past two decades many new treatment modalities have been introduced in the management of variceal bleeding, such as emergency endoscopy, band ligation and postintervention observation of the bleeding patients in subintensive care units. This study presents the results of state-of-the-art therapy applied in our department, comparing them to published data. PATIENTS AND METHODS – Clinical records of patients with variceal haemorrhage admitted to our department between January 1st 2001 and December 31st 2004 were reviewed. Six-week mortality, incidence of recurrent bleeding, transfusion requirement and length of hospital stay were the main parameters analysed. RESULTS – A total of 228 admissions (191 patients) due to variceal bleeding were recorded in the study period. Cirrhosis was of alcoholic origin in 92% of patients. Upper endoscopy was performed in 94% of patients within 4 hours and endoscopic therapy was also applied in all but 7 patients. Octreotide was administered in 4 patients, and portosystemic shunt was performed in 1 patient. Primary endoscopic haemostasis was achieved in 85% of cases, while rebleeding rate was 31%. The mean length of total hospital stay was 10.6 days, including an average of 2.6 days in subintensive care units. The mean transfusion requirement was 3.75 units of packed red cells. Six-week mortality rate was 14.9%. CONCLUSION – In comparison to international data, the six-week mortality rate among our patients was substantially lower than that in earlier reports, and nearly equals with recent leading results.]

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[INTRODUCTION -The pathomechanism of hepatic osteopathy is not fully understood.We investigated how bone parameters change in growing rats with experimentally induced fatty liver, liver cirrhosis and hepatocellular carcinoma. METHODS - Liver disease was induced by administration of CCl4 and phenobarbital (PB) following a single injection of diethylnitrosamine (DEN) in 55 Fischer 344 rats.Animals were sacrificed and their femur removed at week 8 or 16. Bone mineral content (BMC), femoral length, cortical index (ratio of cortical thickness and total diameter at the diaphysis) and ultimate bending load (Fmax) of femora were determined. Results of animals treated with DEN+PB+CCl4 (group DPC, n=21) were compared to untreated animals (n=14) and to a second control group treated only with DEN+PB (group DP, n=20). RESULTS - Fatty liver and cirrhosis developed in each animal in the DPC group (n=21) at week 8 and in a subgroup of these animals (n=11) hepatocellular carcinoma also appeared by week 16. No changes in bone parameters were observed in this group at week 8, but lower BMD, femoral length, cortical index and Fmax values were found at week 16 compared to the untreated controls or to the DP group (p<0.05 for both). In the DP group no fatty liver or cirrhosis was observed at any time. Femoral length and Fmax values were higher in the DP group at week 8 compared to the untreated controls (p<0.05 for both).At week 16, however, no difference could be detected. CONCLUSION - Experimentally induced liver cirrhosis and hepatocellular carcinoma are associated with growth inhibition and reduced bone mineral content, cortical index and mechanical resistance in growing rats.]