Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012

Runyon, Bruce A.

doi:10.1002/hep.26359

Cited by 667 publications

(729 citation statements)

References 24 publications

Supporting

Mentioning

698

Contrasting

Unclassified

Order By: Relevance

“…Numerous studies have found that bleeding after procedures is not predicted by routinely measured coagulation parameters [1–3]. Guidelines from the American Association for the Study of Liver Disease (AASLD) do not recommend routine correction of coagulopathy prior to elective paracenteses [4]. Additional data suggests such cirrhotic patients can safely undergo thoracentesis in the setting of coagulopathy, including a recent retrospective series of 66 cirrhotic patients undergoing thoracentesis that found no major bleeding events irrespective of coagulation parameters or whether coagulation products were administered [5].…”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

“…The preferred management of hepatic hydrothorax is through dietary sodium restriction, and medical therapy with diuretics [3] . However, in approximately 25% of cases, these measures will be insufficient [4] .…”

Section: Discussionmentioning

confidence: 99%

“…TIPS has been demonstrated to be effective in controlling hepatic hydrothorax refractory to medical management [5] . Placement of percutaneous drainage catheters is associated with a high risk of various complications, including secondary bacterial pleuritic/ empyema [6,7] and current practice guidelines published by the American Association for the Study of Liver Diseases (AASLD) consider chest tube placement contra-indicated for the purpose of managing hepatic hydrothorax [3] .…”

Section: Discussionmentioning

confidence: 99%

Successful surgical decortication for trapped lung in a patient with decompensated cirrhosis

Chopade

Wong

Sass

et al. 2015

CRIM

View full text Add to dashboard Cite

Hepatic hydrothorax affects 5% to 10% of patients with cirrhosis. Infection of the pleural fluid may result in "trapped lung" physiology, which may jeopardize a patient's candidacy for liver transplant, and thus compromise long-term survival. We report a case of a patient with decompensated cirrhosis whose transplant candidacy hinged on management of his trapped lung, and who underwent successful decortication. In this particular case, surgical intervention was necessary not only as a "bridge" to transplant, but also because the patient's short-term survival was limited by ongoing infection, which was refractory to medical therapy alone. In conclusion, our case illustrates that this high-risk surgery can be successfully carried out in the decompensated cirrhotic, but that further research is needed to ascertain the role for surgical decortication specifically for the purpose of "bridging" a patient to transplant.

show abstract

“…SBP kezelése során az antibiotikum akkor hagyható el, ha az ascites PMN-száma (<250/mm 3 ) és a CRP normalizálódott [48].…”

Section: Táblázatunclassified

Spontán bakteriális peritonitis

Velkey

Vitális

2017

Orvosi Hetilap

View full text Add to dashboard Cite

A spontán bakteriális peritonitis megjelenésére ascitessel járó májzsugorban szenvedőknél számíthatunk. A kóroko-zók intestinalis bakteriális transzlokáció útján a véráramba jutnak, majd az ascitesbe kerülve elszaporodnak. A betegség diagnózisa az ascites megemelkedett neutrofilszámának igazolásán alapszik (>0,25 G/L). A tenyésztés gyakran álnegatív, az antibiotikum-érzékenység meghatározása miatt mégis fontos. Kezelésére stabil betegekben iv., majd orálisan alkalmazott ciprofloxacint vagy amoxicillin/klavulánsavat ajánlanak, súlyosabb állapotban III. generációs cefalosporint. Nosocomialis infekció esetén a gyakoribb Gram-pozitív és antibiotikum-rezisztens patogének okozta fertőzés miatt imipenemet vagy meropenemet célszerű választani. Profilaxisként norfloxacint javasolnak, bár a fokozódó rezisztenciával számolni kell. Gastrointestinalis vérzés esetén öt napon át alkalmazott norfloxacin, súlyos máj-elégtelenek vérzése esetén ceftriaxon adása indokolt. Tartós antibiotikum-profilaxist (napi 400 mg norfloxacin) -primer prevencióként -alacsony ascitesösszfehérje-szintű, előrehaladott májzsugorosok számára ajánlanak, míg szekunder prevenció gyanánt minden spontán bakteriális peritonitisből felépült beteg számára indokolt adni. Nem mindenki ért egyet a tartós antibiotikum-profilaxissal. A cikk megírásának ösztönzője volt az a mindennapi tapasztalat, hogy a kórképpel kapcsolatos ismeretek nem eléggé állnak a cirrhosis kezelésének középpontjában. Orv. Hetil., 2017, 158(2), 50-57. Kulcsszavak: májzsugor, intestinalis bakteriális transzlokáció, kezelés, profilaxis Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree.

show abstract

Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012

Cited by 667 publications

References 24 publications

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Successful surgical decortication for trapped lung in a patient with decompensated cirrhosis

Spontán bakteriális peritonitis

Contact Info

Product

Resources

About