6-Mercaptopurine-Induced Non-Cirrhotic Portal Hypertension With Rapid Progression to Liver Cirrhosis in the Absence of Pre-Existing Liver Disease

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

Endoscopy International Open ◽

10.1055/a-1233-1934 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1623-E1632

Author(s):

Carlos Robles-Medranda ◽

Roberto Oleas ◽

Miguel Puga-Tejada ◽

Manuel Valero ◽

Raquel Del Valle ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Chronic Liver Disease ◽

Predictive Value ◽

Strain Ratio ◽

Chronic Liver ◽

Spleen Stiffness ◽

Eus Elastography ◽

Sensitivity Specificity

Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

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Handgrip strength in prediction of sarcopenia in Chronic HCV patient

QJM ◽

10.1093/qjmed/hcab100.045 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Essam Mohammed Bayoumi ◽

Moataz Mohammed Sayed ◽

Samia Ahmed Abdul-Rahman ◽

Shereen Abo Baker Saleh ◽

Mohammed Magdy Mohammed ◽

...

Keyword(s):

Internal Medicine ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Handgrip Strength ◽

Accurate Method ◽

Outpatient Clinics ◽

Anthropometric Parameter ◽

The World ◽

Chronic Hcv

Abstract Background HCV is one of the major causes of morbidity and mortality in the world and especially in Egypt. However, there is numerous complications to HCV infection (e.g. liver cirrhosis, ascites, portal hypertension, encephalopathy …. etc.) but there is multiple unseen complication (e.g. sarcopenia, loss of electrolytes, loss of protein …etc.) Objective To evaluate value of handgrip strength in assessment of sarcopenia in HCV related chronic liver disease patients Patients and Methods This study was conducted on 64 adult persons older than 18 years. They were randomly collected from the outpatient clinics at department of internal Medicine in Ain Shams University during the period from June 2018 to August 2019. Results In our study there was a great significance relation between handgrip strength and child score in evaluating nutritional status more than anthropometric parameter. Therefore, even that several methods to evaluate nutritional and functional capacity status in patients with cirrhosis have been tested, they have reported diverse results. Conclusion Our study we can conclude that HGS is a simple, easy to be applied and more accurate method in evaluation of sarcopenia in chronic HCV patients.

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Enteroscopic Management of Ectopic Varices in a Patient with Liver Cirrhosis and Portal Hypertension

Case Reports in Hepatology ◽

10.1155/2016/2018642 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

G. A. Watson ◽

A. Abu-Shanab ◽

R. L. O’Donohoe ◽

M. Iqbal

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Early Detection ◽

Gastrointestinal Bleeding ◽

Alcoholic Liver Disease ◽

Significant Morbidity ◽

Push Enteroscopy ◽

Ectopic Varices ◽

Occult Gastrointestinal Bleeding

Portal hypertension and liver cirrhosis may predispose patients to varices, which have a propensity to bleed and cause significant morbidity and mortality. These varices are most commonly located in the gastroesophageal area; however, rarely ectopic varices may develop in unusual locations outside of this region. Haemorrhage from these sites can be massive and difficult to control; thus early detection and management may be lifesaving. We present a case of occult gastrointestinal bleeding in a patient with underlying alcoholic liver disease where an ectopic varix was ultimately detected with push enteroscopy.

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A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl2.2223 ◽

2020 ◽

Vol 11 (SPL2) ◽

pp. 228-234

Author(s):

Karthick M ◽

Prabakaran P T ◽

Rajendran K ◽

Gowrishankar A ◽

Halleys Kumar E ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Variceal Bleeding ◽

Chronic Liver ◽

First Episode ◽

Oesophageal Varices ◽

Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

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Liver cirrhosis and portal hypertension in cystic fibrosis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1312764f ◽

2013 ◽

Vol 141 (11-12) ◽

pp. 764-769 ◽

Cited By ~ 1

Author(s):

Stojka Fustik

Keyword(s):

Cystic Fibrosis ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Nutritional Status ◽

Pancreatic Insufficiency ◽

Standard Deviation Score ◽

Liver Parenchyma ◽

Venous Flow ◽

Genetic Characteristics

Introduction. As the expected survival improves in individuals with the cystic fibrosis (CF), so they may be faced with a number of medical complications. Objective. The aim of this study was to analyze the prevalence of liver cirrhosis in our CF population as well as the clinical and genetic characteristics of these patients. Methods. All patients older than 2 years (n=96) were screened for liver disease. Liver cirrhosis was defined by ultrasonographic findings of distinct heterogeneity of liver parenchyma and nodular liver surface and/or by liver biopsy findings. Enlarged spleen, distended portal vein and abnormal portal venous flow indicated portal hypertension. Clinical and genotype data were analyzed. Results. Sixteen patients were found to have liver cirrhosis, three of them with portal hypertension. All patients had pancreatic insufficiency. Nutritional status expressed as standard deviation score (Z score) for weight, height, and body mass index was as follows: zW=-0.40?1.24, zH=-0.83?1.02, and BMI=20.1?2.3. CF patients with liver cirrhosis generally had mild-to-moderate lung disease, with average FVC and FEV1 values of 97.1?16.5% of predicted and 87.9?23.5% of predicted, respectively. Genetic analysis showed high frequency of F508del mutation in the group with cirrhosis (90.6%). Conclusion. The prevalence of liver cirrhosis in our CF population older than 2 years was 16.6%. Patients with pancreatic insufficiency and severe CFTR mutations, especially F508del, were exposed to higher risk of developing liver cirrhosis. Liver cirrhosis has no significant impact on the pulmonary function and the nutritional status, until the end-stage liver disease.

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Plasma amino acid abnormalities in liver disease. Comparative analysis of idiopathic portal hypertension, extrahepatic portal occlusion and liver cirrhosis.

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.158.171 ◽

1989 ◽

Vol 158 (2) ◽

pp. 171-178 ◽

Cited By ~ 7

Author(s):

KIYOAKI OUCHI ◽

SHUJI MATSUBARA ◽

KENJI FUKUHARA ◽

SEIKI MATSUNO

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Comparative Analysis ◽

Amino Acid ◽

Idiopathic Portal Hypertension ◽

Plasma Amino Acid

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Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH

Digestive Diseases ◽

10.1159/000375353 ◽

2015 ◽

Vol 33 (4) ◽

pp. 598-607 ◽

Cited By ~ 18

Author(s):

Stefan Traussnigg ◽

Christian Kienbacher ◽

Emina Halilbasic ◽

Christian Rechling ◽

Lili Kazemi-Shirazi ◽

...

Keyword(s):

Bariatric Surgery ◽

Liver Transplantation ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Lifestyle Modification ◽

Morbidly Obese ◽

Nonalcoholic Fatty Liver ◽

The Metabolic Syndrome ◽

Metabolic Conditions

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and comprises a liver disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) with risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Associated metabolic conditions and comorbidities such as obesity, diabetes and cardiovascular diseases are common and require concerted management. Adiponutrin (PNPLA3) variants may help to identify NAFLD patients at higher risk for liver disease progression towards advanced fibrosis and HCC. The therapeutic options in NAFLD/NASH include lifestyle modification, pharmacological treatment, bariatric surgery for patients with morbid obesity and treatment of complications of liver cirrhosis and HCC, including liver transplantation. Insulin sensitizers and antioxidative treatment strategies with vitamin E are among the best-established pharmacological approaches, but both drugs have long-term safety issues and there is limited evidence in cirrhotic patients. Treatment of concomitant/underlying metabolic conditions with statins or metformin may also have beneficial effects on portal hypertension, complications of liver cirrhosis and HCC prevention. The bile acid receptor FXR may be a promising novel therapeutic target for the treatment of NAFLD/NASH, fibrosis and portal hypertension, but the prognostic implications of associated changes in low- and high-density lipoprotein cholesterol require further studies. Morbidly obese NASH patients can benefit from bariatric surgery which may reduce liver fibrosis but carries a risk of decompensation in patients with advanced liver cirrhosis. When carefully selected, patients with NASH cirrhosis undergoing liver transplantation have a good outcome. This review summarizes recent progress in the management of patients with liver cirrhosis due to NASH.

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An Unusual Cause of Abdominal Ascites

Case Reports in Gastroenterology ◽

10.1159/000490660 ◽

2018 ◽

Vol 12 (2) ◽

pp. 420-424

Author(s):

Kimberly A. Wong ◽

Kristin A. Olson ◽

Eric W. Chak

Keyword(s):

Liver Cirrhosis ◽

Nephrotic Syndrome ◽

Portal Hypertension ◽

Liver Disease ◽

Diagnostic Laparoscopy ◽

Elevated Serum ◽

Peritoneal Mesothelioma

Abdominal ascites is most commonly caused by portal hypertension from liver cirrhosis. When present, portal hypertension is associated with an elevated serum-ascites albumin gradient (SAAG) ≥1.1 g/dL. In contrast, a SAAG < 1.1 g/dL suggests malignancy, tuberculosis, pancreatitis, or nephrotic syndrome. Here, we present a case of low SAAG ascites caused by epithelioid peritoneal mesothelioma in a woman with no known liver disease. The diagnosis proved elusive until diagnostic laparoscopy with biopsy was performed.

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