Venous Thromboembolism in Liver Cirrhosis: An Emerging Issue
Venous thromboembolism (VTE) carries a high morbidity and mortality and leads to a substantial economic burden. From the traditional perspectives, liver cirrhosis tends to bleeding but not VTE. However, modern concepts suggest that liver cirrhosis is also at a risk of VTE. The pooled incidence and prevalence of VTE in liver cirrhosis are 1% (95% confidence interval: 0.7–1.3%) and 1% (95% confidence interval: 0.7–1.2%), respectively. Evidence indicates that a higher international normalized ratio and a lower albumin should be associated with a higher probability of VTE in liver cirrhosis. Additionally, the presence of VTE significantly worsens the outcomes of liver cirrhosis.
Part of the book: Embolic Diseases
Alternative Diagnostic Tests of Gastroesophageal Varices in Liver Cirrhosis: Recent Advance
Routine screening for gastroesophageal varices in liver cirrhosis is necessary. At present, upper gastrointestinal endoscopy is the golden diagnostic test of gastroesophageal varices. However, the use of upper gastrointestinal endoscopy is restricted because of its poor compliance and adverse events. In this chapter, we reviewed the recent evidence regarding the value of noninvasive or less invasive tests for the diagnosis of gastroesophageal varices in liver cirrhosis.
Part of the book: Liver Cirrhosis
Red Blood Cell Transfusion Strategy for Upper Gastrointestinal Bleeding
Acute upper gastrointestinal bleeding (UGIB) is a potentially lethal and frequent digestive disease. It is mainly divided into the nonvariceal UGIB and variceal bleeding according to the source of bleeding. Red blood cell transfusion is the core therapeutic option for the management of acute UGIB. In this chapter, we reviewed the primary evidence from meta‐analyses and large‐scale randomized controlled trials regarding red blood cell transfusion strategy for acute UGIB.
Part of the book: Transfusion Medicine and Scientific Developments
Serum Sodium Concentration in Patients with Portal Hypertension and Acute Gastrointestinal Bleeding Treated with Terlipressin: A Retrospective Observational Study
This retrospective observational study aimed to investigate the risk of serum sodium concentration in patients treated with terlipressin and attempted to explore the factors associated with serum sodium concentration. We included 17 patients with portal hypertension treated with terlipressin (Group 1), 7 with portal hypertension treated with somatostatin/octreotide (Group 2), 20 with acute non-variceal gastrointestinal bleeding treated with somatostatin/octreotide (Group 3), and 19 with acute pancreatitis treated with somatostatin/octreotide (Group 4). In all groups, serum sodium concentration at baseline was not significantly different from the lowest value during the infusion of terlipressin, somatostatin, or octreotide (Group 1: 136.95 ± 4.68 versus 135.52 ± 4.79, p = 0.426; Group 2: 139.64 ± 3.86 versus 138.41 ± 5.34, p = 0.813; Group 3: 138.02 ± 4.08 versus 137.69 ± 3.11, p = 0.630; Group 4: 135.96 ± 6.87 versus 134.60 ± 3.40, p = 0.098). The rate of serum sodium concentration reduction in Group 1 (8/17) was not significantly different from Group 2 (3/7, p = 1.000), Group 3 (11/20, p = 0.746), or Group 4 (14/19, p = 0.171). Age, sex, baseline MELD and Child-Pugh scores, cDDD value and duration of terlipressin, blood transfusion, and diuretics and paracentesis during terlipressin were not significantly associated with serum sodium concentration reduction in Group 1. In conclusion, serum sodium concentration is often reduced in patients treated with terlipressin. However, the association of sodium concentration reduction with terlipressin should be clarified.
Part of the book: Digestive System
Stroke and Liver Cirrhosis: A Brief Review of Current Evidence
Stroke and liver cirrhosis are common in our everyday clinical practice, both of which can lead to serious complications. Their association is unclear. In this chapter, we briefly summarized the epidemiology of liver cirrhosis in stroke, reviewed the current evidence regarding the association between liver cirrhosis and stroke, and discussed the potential mechanisms for explaining such an association, such as coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia.
Part of the book: Liver Pathology
Non-Invasive Prediction of Gastroesophageal Varices in Patients with Portal HypertensionView all chapters
Gastroesophageal varices are the most common complication of portal hypertension and associated with a worse prognosis. Endoscopy is the gold standard method to diagnose gastroesophageal varices. However, endoscopy is an invasive method with potential complications and is not well adhered by patients. Non-invasive methods, including serum markers or scores, computed tomography, ultrasonographic, and elastography-based methods, have been explored for the diagnosis of gastroesophageal varices. In the current chapter, we will briefly review non-invasive methods for the prediction of gastroesophageal varices.
Part of the book: Portal Hypertension