ABSTRACT
Portal hypertension(PH) is one of the main complications of cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH (i.e., variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines (CPGs) presents profession associational recommendations of the Chinese College of Interventionalists(CCI) on TIPS for PH. The CPGs was written by more than 30 experts in the field of TIPS in China (including interventional radiologists, liver surgeons, hepatologists and gastroenterologist, et al.). The panel of experts, produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.
ABSTRACT
Portal hypertension(PH) is one of the main complications of cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH (i.e., variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines (CPGs) presents profession associational recommendations of the Chinese College of Interventionalists(CCI) on TIPS for PH. The CPGs was written by more than 30 experts in the field of TIPS in China (including interventional radiologists, liver surgeons, hepatologists and gastroenterologist, et al.). The panel of experts, produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.
Subject(s)
Humans , China , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Hypertension, Portal/therapy , Liver Cirrhosis/therapy , Portasystemic Shunt, Transjugular Intrahepatic , Treatment OutcomeABSTRACT
Portal hypertension(PH) is one of the main complications of cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH (i.e., variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines (CPGs) presents profession associational recommendations of the Chinese College of Interventionalists(CCI) on TIPS for PH. The CPGs was written by more than 30 experts in the field of TIPS in China (including interventional radiologists, liver surgeons, hepatologists and gastroenterologist, et al.). The panel of experts, produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.
Subject(s)
Humans , China , Esophageal and Gastric Varices , Therapeutics , Gastrointestinal Hemorrhage , Therapeutics , Hypertension, Portal , Therapeutics , Liver Cirrhosis , Therapeutics , Portasystemic Shunt, Transjugular Intrahepatic , Treatment OutcomeABSTRACT
The activation of renin-angiotensin-aldosterone-vasopressin system is a key factor in the formation of ascites due to splanchnic vasodilation in cirrhosis. In theory, aldosterone antagonists, contraction of blood vessels, vasopressin V2 receptor, and angiotensin receptor antagonists are important targets for the prevention and treatment of cirrhotic ascites. The 15%-20% of patients with cirrhotic ascites that show no response to at least one week’s treatment with potent diuretics (spironolactone 160 mg/d combined with furosemide 80 mg/d) are considered to have refractory ascites. At present, effective treatments for refractory ascites include tolvaptan, large-volume paracentesis (4000-6000 ml/time/day) combined with albumin (4 g/L ascites), ascites ultrafiltration and reinfusion, transjugular intrahepatic portosystemic shunt, and liver transplantation. In the future, with the development of vasoactive drugs, rifaximin, ascites drainage pump, and other new therapies, the treatment of refractory ascites may be more effective to reduce the need for liver transplantation.
ABSTRACT
This study was aimed to observe the clinical curative effect of Wen-Yang Jian-Pi (WYJP) decoction for treating hepatitis B cirrhosis patients with refractory ascites.A total of 81 hepatitis B cirrhosis patients with refractory ascites after admission to our hospital were randomly divided into two groups,41 patients were in the treatment group and 40 were in the control group.Patients in both groups received basic treatment,including antivirus,liver-protective,antiinfective and diuretic therapy,as well as albumin supplementation;while the treatment group were additionally given oral traditional Chinese medicine (TCM) of WYJP decoction at the same time.Changes of subjective symptoms,abdominal circumference,urine volume,main hepatic function indexes,and main indexes of B-ultrasound before and after treatment were measured and compared between two groups.Patients in both groups were treated for 3 one-month therapeutic courses,with 3 to 5 day-intervals,after which the curative effect was evaluated.The results showed that the total effective rate in the treatment group was 87.8％,which was significant higher than that of 70.0％ in the control group (P ＜ 0.05).And the treatment group in ascites,urine volume,symptoms,body signs and B ultrasonic improvement were better than those of the control group,with statistical significance (P ＜ 0.05).It was concluded that WYJP decoction has definite therapeutic effect on hepatitis B cirrhosis patients with refractory ascites.
ABSTRACT
Objective: To apply the development of ascites ultrafiltration treatment instrument and ascites ultrafiltration technology for clinical observation research. Methods:By intraperitoneal on peritoneal ascites reinfusion of various causes of refractory ascites were treated. Results: A total of 647 cases of patients with refractory ascites, with the average for 2.8±1.5 times, treatment time 2.4±1.2 hours/times; filtering out ascites in 8543±2427 ml/times, lost an average of 8.4±2.4 kg; abdominal circumference decreased from 108.7 before treatment to 87.4±15.3 cm; 24 hour urine volume increased significantly, from 257.8±235.6 ml to 725.8±436.9 ml (P<0.01). The incidence of adverse reaction was 3.3%(63/1892 cases). Conclusion:Abdominal peritoneal ascites reinfusion method is simple, wide indications, adverse reactions, is a kind of method for the treatment of intractable ascites effectively.
ABSTRACT
Objective To observe the curative effect of refractory ascites with ascitic ultrafiltration and reinfusion into abdominal cavity.Methods Thirty-seven patients diganosed as refractory ascites were given ultrafiltration and reinfusion into abdominal cavity.The following parameters were detected respectively:24h urine volume,abdomen circumference,heart rate,blood pressure,serum electrolytes,serum albumin,total serum bilirubin.Results After treatment,the 24h urine volume increased and abdomen circumference decreasd significantly (P ＜ 0.01 ).There was no significant difference in heart rate,blood pressure,serum electrolytes,serum albumin and total serum bilirubin before and after treatment (P ＞0.05).Conclusion Ascitic ultrafiltration and reinfusion into abdominal cavity has some effects on refractory ascites.
ABSTRACT
La ascitis es el acúmulo anormal de líquido en la cavidad abdominal, que en el caso del paciente cirrótico obedece a una conjugación de factores determinantes. Diversas teorías se han elaborado al respecto a lo largo de las décadas anteriores, sin embargo el concepto actual es que el principal mecanismo patofisiológico de formación de ascitis es un estado de vasodilatación periférica permanente en el cirrótico, asociado a una relativa hipoperfusión renal que a su vez determina la activación de una serie de mecanismos retenedores de sodio y agua. Es un fenómeno progresivo cuya historia natural se puede ver como un espectro de enfermedad, teniendo como evento extremo al síndrome hepato-renal, con ascitis refractaria al tratamiento diurético y la mayor frecuencia de colonización bacteriana del líquido ascítico, fenómeno conocido como peritonitis bacteriana espontánea. El siguiente artículo revisa la patofisiología, diagnóstico, complicaciones y aspectos terapéuticos de la ascitis en el paciente cirrótico.
Ascites is the abnormal accumulation of fluid into the peritoneal cavity, which in the cirrhotic patient is due to a number of determinant factors. Many theories have been elaborated in that regard during the previous decades, however the current concept states that the chief pathophysiologic mechamism of ascites formation is a permanent state of peripheral vasodilation in the cirrhotic patient, associated with a relative renal hypoperfusion, which in turn activates a host of sodium and water retaining mechanisms. It is a progressive phenomenon and its natural history can be viewed as a spectrum of disease, having at one end of the spectrum the so called hepatorenal syndrome, with ascites refractory to diuretic treatment and a higher frequency of bacterial colonization of the ascitic fluid, so called spontaneous bacterial peritonitis. This article reviews the pathophysiology, diagnosis, complications and therapeutic aspects of ascites in the cirrhotic patient.
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Objective To observe the clinical effect of treating refractory ascites by intermittent cycle ascites reinfusion.Methods Having 30 refractory ascites patients of both chronic renal failure and maintenance hemodialysis(MHD),treating them 102 times by intermittent close ascites reinfusion and synchronous hemodialysis,having reinfusion ascites 3000～5000ml each time,checking the change of serum creatinine(Scr),blood urea nitrogen(Bun),and serum albumin before and after hemodialysis(HD) by blood-test,and observing their temperature,weight,belly size,blood pressure,and pulse before and after treatment.Results After treatment,all the patients feel well,have good appetite,and have less swollen belly.The average treatment is 3.2 times.The table shows the patients' weight,belly size,serum albumin,serum creatinie and blood urea nitrogen(Bun) before and after treatment.The difference is obviously distinctive(P
ABSTRACT
patients with refractory ascites were treated 921 times using B type ascites concentrating device made in our institute.The mean time of reinfusion was(2 3?0 9)h and the average volume of ascites withdrawn from abdominal cacity was(6 820?2 315)ml.The weight was reduced(6 7?2 4)kg.The urine volume in 24 hours increased from (257 8?235 6)ml to (725 8?436 9)ml( P
ABSTRACT
BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Subject(s)
Humans , Abdomen , Aldosterone , Anti-Bacterial Agents , Ascites , Ascitic Fluid , Blood Pressure , Blood Urea Nitrogen , Carcinoma, Hepatocellular , Chemistry , Creatinine , Drainage , Electrolytes , Filtration , Fluid Therapy , Heart Rate , Hypotension , Korea , Liver Cirrhosis , Liver , Paracentesis , Patient Rights , Peritonitis , Plasma , Punctures , Renin , UltrafiltrationABSTRACT
Objective To observe the effect and machanism of Xiaogu Granule (Granules for treating tympanites) plus ultrafiltration and reinfusion of ascites on refractory ascites resulted from hepatocirrhosis. Methods The 100 cases of refractory ascites due to hepatocirrhosis were randomized into two groups,with 50 cases in each. Both groups were administered basic treatment + ultrafiltration and reinfusion of ascites. The experimented group was added Xiaogu Granule and the control groups was added placebo. Before treatment, 3 and 6 months after treatment, the portal vein diameter (PVD), splenic vein diameter (SVD), blood flow quantity of portal vein (PVQ) and of splenic vein (SVQ), and the level of serum alanine aminotransferase, total bilirubin, endotoxin, nitrous oxide (NO) and endothelin (ET) of the two groups were measured respectively. Results After treatment,all the indices of two groups showed that the effect of experimented group was obviously better than that of control group, the difference was significant (P
ABSTRACT
As a disease difficult to treat,the refractory ascites due to post hepatitis often results in a bad prognosis because the general medical treatment is ineffective.This paper introduces the current interventional treatment of the refractory ascites.