Gerbes Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment

1. Auflage 2010
ISBN: 978-3-8055-9592-6
Verlag: S. Karger
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 28, 220 Seiten

Reihe: Frontiers of Gastrointestinal Research

Ascites is the most frequent and hepatorenal syndrome the most lethal complication in liver cirrhosis. In recent years, major progress has been made regarding effective treatment of these complications, thus reducing mortality in patients.This publication highlights and critically appraises recent achievements and novel advances, and at the same time provides the background needed to grasp novel concepts. Topics treated include complications of paracentesis, the right choice of plasma expanders, and selection of patients who will experience survival benefit from transjugular intrahepatic portosystemic shunt. Hepatorenal syndrome, on the other hand, is responsible for a broad spectrum of manifestations caused by acute kidney injury, which until recently was considered a lethal condition. Drug treatments to improve renal function and prolong survival are therefore also discussed, including important issues for clinical outcome which are still under debate. Moreover, the role of combined kidney-liver transplantation versus conventional liver-only transplantation is addressed, as well as the use of vaptans in hyponatremia and their controversial role in the treatment of ascites.Renowned experts share their knowledge and expertise and provide an international perspective. Their contributions include up-to-date references and a bullet-point summary, making this publication most valuable for practitioners, clinicians and scientists in the field.

Autoren/Hrsg.

Gerbes

Gerbes, A.L.

Weitere Mitwirkende

Rogler

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Hepatologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Pharmakologie, Toxikologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gastroentereologie, Proktologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Nephrologie

Inhaltsverzeichnis

1;cover;1
2;Contents;6
3;Preface;8
4;Differential Diagnosis of Ascites;10
4.1;Abstract;10
4.2;Clinical Work- Up and Problems;10
4.3;History and Physical Examination;12
4.4;Diagnostic Imaging Techniques;12
4.5;Diagnostic Paracentesis and Ascitic Fluid Analysis;12
4.6;Macroscopic Appearance of Ascites;13
4.7;Diagnostic Tests for Ascites;13
4.8;Some Common Causes of Ascites;16
4.9;Novel Aspects and Future Developments;17
4.10;References;18
5;Current Treatment Strategies: Diuretics;20
5.1;Abstract;20
5.2;Aldosterone Antagonists;21
5.3;Other ‘Potassium- Sparing’ Diuretics;24
5.4;Loop Diuretics;25
5.5;Diuretic Treatment Strategies in Decompensated Cirrhosis;26
5.6;References;30
6;Paracentesis;32
6.1;Abstract;32
6.2;Nomenclature Used in Assessment of Ascites;32
6.3;Confirmation and Ascitic Fluid Analysis;33
6.4;Indications of Abdominal Paracentesis;33
6.5;Contraindications;33
6.6;Paracentesis Techniques;34
6.7;Large- Volume Paracentesis;35
6.8;Ascitic Fluid Analysis;36
6.9;Coagulopathy in Liver Disease;37
6.10;Complications;38
6.11;References;39
7;Large- Volume Paracentesis: Which PlasmaExpander?;41
7.1;Abstract;41
7.2;Large- Volume Paracentesis in Clinical Practice;41
7.3;Rationale for Using Plasma Volume Expansion;42
7.4;Evidence Supporting the Use of Albumin for Plasma Expansion;43
7.5;References;47
8;Albumin: Not Just a Plasma Expander;49
8.1;Abstract;49
8.2;Albumin in Liver Disease;50
8.3;Albumin in Non- Liver Disease;55
8.4;Functional Characteristics in Liver Disease and Failure – Albumin Is Dysfunctional,Why?;57
8.5;References;58
9;Transjugular Intrahepatic PortosystemicShunt for Ascites: Which Patients WillBenefit?;61
9.1;Abstract;61
9.2;Treatment of Ascites;62
9.3;Prediction of Post- TIPS Survival;64
9.4;Predictors of Efficacy;69
9.5;Post- TIPS Quality of Life;69
9.6;Post- TIPS Hepatic Encephalopathy;70
9.7;References;71
10;Spontaneous Bacterial Peritonitis –Prophylaxis and Treatment;74
10.1;Abstract;74
10.2;Definition and Clinical Importance;74
10.3;Pathogenesis and Risk Factors;75
10.4;Prophylaxis;77
10.5;Therapy;83
10.6;References;87
11;Clinical Implications of Hyponatremia inCirrhosis;92
11.1;Abstract;92
11.2;Hyponatremia in Cirrhosis: Pathophysiology;92
11.3;Prognostic Significance of Sodium in Cirrhosis and Liver Transplantation;93
11.4;Hyponatremia in Cirrhosis: Treatment Options;95
11.5;Should We Treat Cirrhotic Hyponatremia?;96
11.6;References;98
12;Vaptans for Ascites – Chances and Risks;100
12.1;Abstract;100
12.2;The Clinical Problem;100
12.3;Therapeutic Limitations in the Management of Refractory Ascites;101
12.4;Recent Novel Therapeutic Agents for the Management of Ascites;101
12.5;The Vaptans;102
12.6;Vaptans in the Management of Hyponatremia in Cirrhosis;105
12.7;Vaptans in the Management of Ascites in Cirrhosis;106
12.8;Vaptans – the Chances;107
12.9;Vaptans – the Risks;107
12.10;The Future;108
12.11;References;109
13;Cardiorenal Syndrome – A New Entity?;111
13.1;Abstract;111
13.2;Hepatic Decompensation and Hemodynamic Derangements in Cirrhosis;112
13.3;Renal Failure in Cirrhosis – The Clinical Problem;114
13.4;Cardiac Dysfunction;114
13.5;Cardiorenal Axis in Cirrhosis;115
13.6;Conclusions and Future Developments;118
13.7;References;119
14;Renal Failure in Cirrhosis;121
14.1;Abstract;121
14.2;Acute Kidney Injury;122
14.3;Chronic Kidney Disease;124
14.4;Management of Acute Kidney Injury;125
14.5;Management of Chronic Kidney Disease;128
14.6;Selection of Candidates for Combined Liver and Kidney Transplantation;128
14.7;Conclusions;128
14.8;References;129
15;Novel Definition of Hepatorenal Syndrome:Clinical Consequences;131
15.1;Abstract;131
15.2;Hepatorenal Syndrome: Concept, Clinical Types and Diagnostic Caveats;131
15.3;New Definition of Hepatorenal Syndrome;135
15.4;Definition of Acute Kidney Injury in Cirrhosis;136
15.5;References;137
16;Role of Infections in Hepatorenal Syndrome;139
16.1;Abstract;139
16.2;Epidemiology and Prognosis of Bacterial Infections and Associated Renal Failure inCirrhosis;139
16.3;Key Events for Development of Renal Dysfunction in Advanced Cirrhosis withEmphasis on Bacterial Infections and Pathological Bacterial Translocation;141
16.4;General Assessment;145
16.5;Therapeutic Considerations for Bacterial Infections and Their Role for Developmentof Hepatorenal Syndrome;145
16.6;Clinical Problems and Future Developments;146
16.7;References;147
17;TIPS for HRS;151
17.1;Abstract;151
17.2;Rationale for TIPS in HRS;152
17.3;Results of TIPS in Patients with HRS;153
17.4;Conclusions;155
17.5;References;156
18;Vasoconstrictor Therapy for HepatorenalSyndrome;158
18.1;Abstract;158
18.2;Pathophysiological Bases of Pharmacological Therapy in Hepatorenal Syndrome;159
18.3;Clinical Use of Vasoconstrictors in Hepatorenal Syndrome Type 1;163
18.4;Clinical use of Vasoconstrictors in Hepatorenal Syndrome Type 2;167
18.5;Conclusions;168
18.6;References;169
19;Terlipressin for Hepatorenal Syndrome:The US Experience;172
19.1;Abstract;172
19.2;Rationale for the Use of Terlipressin for Type 1 HRS;172
19.3;Summary of the Study Design;173
19.4;Outcomes with Terlipressin Treatment;174
19.5;Primary Endpoint;175
19.6;Impact on Renal Function;175
19.7;Time Course of Changes in Renal Function;176
19.8;Factors Predictive of Response to Terlipressin;177
19.9;Impact on Survival;178
19.10;Impact on Liver Transplantation;178
19.11;Conclusion;178
19.12;References;179
20;Terlipressin for Hepatorenal Syndrome:Predictors of Response;181
20.1;Abstract;181
20.2;Terlipressin for Hepatorenal Syndrome;182
20.3;Predictors of Response;182
20.4;References;186
21;Safety of Terlipressin for HepatorenalSyndrome;187
21.1;Abstract;187
21.2;Pharmacokinetics and Receptor Affinity;188
21.3;Adverse Events Reported in Trials on the Hepatorenal Syndrome;188
21.4;Cardiac and Pulmonary Adverse Events;191
21.5;Skin Ischemia;192
21.6;Gastrointestinal Adverse Events;193
21.7;Hyponatremia and Hypokalemia;194
21.8;Contraindications to Terlipressin and Prevention of Side Effects;194
21.9;Dealing with Side Effects;195
21.10;Conclusions;196
21.11;References;196
22;Terlipressin for Hepatorenal Syndrome:Novel Strategies and Future Perspectives;198
22.1;Abstract;198
22.2;Novel Strategies;198
22.3;Future Perspectives;202
22.4;Septic Shock;203
22.5;Conclusions;203
22.6;References;204
23;Hepatorenal Syndrome and LiverTransplantation;207
23.1;Abstract;207
23.2;References;214
24;Author Index;217
25;Subject Index;218